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Scientific Reports Mar 2019Interest is growing in the role of infectious agents in the pathogenesis of dementia, but current evidence is limited. We conducted a systematic review and meta-analysis... (Meta-Analysis)
Meta-Analysis
Interest is growing in the role of infectious agents in the pathogenesis of dementia, but current evidence is limited. We conducted a systematic review and meta-analysis to investigate the effect of any of eight human herpesviruses on development of dementia or mild cognitive impairment (MCI). We searched the Cochrane Library, Embase, Global Health, Medline, PsycINFO, Scopus, Web of Science, clinical trials registers and grey literature sources from inception to December 2017 for observational studies with cohort, case control or self-controlled designs, or randomised controlled trials of interventions against herpesviruses. Pooled effect estimates and 95% confidence intervals (CIs) were generated through random effects meta-analyses across studies with the same design, outcome, and virus type, method and site of measurement. We included 57 studies across various geographic settings. Past infection with herpesviruses, measured by IgG seropositivity, was generally not associated with dementia risk. A single cohort study rated moderate quality showed an association between varicella zoster virus reactivation (ophthalmic zoster) and incident dementia (HR 2.97; 95%CI, 1.89 to 4.66). Recent infection with, or reactivation of, herpes simplex virus type 1 or type 1/2 unspecified, cytomegalovirus and human herpes virus-6 measured by serum IgM, high titre IgG or clinical disease may be associated with dementia or MCI, though results were inconsistent across studies and overall evidence rated very low quality. Longitudinal population studies with robust repeated virus measurements taken sufficiently proximal to dementia onset are needed to establish whether, when and among whom herpesviruses affect dementia risk.
Topics: Cognitive Dysfunction; Cytomegalovirus; Dementia; Herpesviridae; Herpesviridae Infections; Herpesvirus 3, Human; Humans; Virus Activation
PubMed: 30894595
DOI: 10.1038/s41598-019-41218-w -
Human Vaccines & Immunotherapeutics Dec 2022This systematic review describes herpes zoster (HZ) economic burden in terms of healthcare resource use and cost outcomes in the Latin America and Caribbean (LAC)... (Meta-Analysis)
Meta-Analysis
This systematic review describes herpes zoster (HZ) economic burden in terms of healthcare resource use and cost outcomes in the Latin America and Caribbean (LAC) region. We searched online databases from 1 January 2000 to 20 February 2020 to identify eligible publications. We identified 23 publications that reported direct costs, indirect costs, and resources associated with HZ and its complications. The primary direct medical resources reported in the different studies were visits to doctors, transportation, days in the hospital, nursing, medication schedules, and physical therapy. Direct total costs per patient ranged from $99.99 to $4177.91. The highest cost was found in Brazil. Direct costs are, in average, 81.39% higher than indirect costs. The cost per patient that includes postherpetic neuralgia treatment is 115% higher on average for the directs and 73% for the indirect costs. Brazil reported a higher total cost per patient than Argentina and Mexico, while for indirect costs per patient, Brazil and Argentina had higher costs than Mexico, respectively. A meta-analysis on the number of days due to HZ hospitalization, performed on non-immunosuppressed patients over 65 years of age from three studies, resulted in a cumulative measure of 4.5 days of hospitalization. In the LAC region, the economic burden of HZ and associated complications is high, particularly among high-risk populations and older age groups. Preventative strategies such as vaccination could help avoid or reduce the HZ-associated disease economic burden in the LAC region.
Topics: Humans; Aged; Infant, Newborn; Latin America; Financial Stress; Herpes Zoster; Herpesvirus 3, Human; Neuralgia, Postherpetic
PubMed: 36519226
DOI: 10.1080/21645515.2022.2131167 -
Epidemiology and Infection Oct 2017Surveillance systems for varicella in Europe are highly heterogeneous or completely absent. We estimated the varicella incidence based on seroprevalence data, as these... (Review)
Review
Surveillance systems for varicella in Europe are highly heterogeneous or completely absent. We estimated the varicella incidence based on seroprevalence data, as these data are largely available and not biased by under-reporting or underascertainment. We conducted a systematic literature search for varicella serological data in Europe prior to introduction of universal varicella immunization. Age-specific serological data were pooled by country and serological profiles estimated using the catalytic model with piecewise constant force of infection. From the estimated profiles, we derived the annual incidence of varicella infection (/100·000) for six age groups (<5, 5-9, 10-14, 15-19, 20-39 and 40-65 years). In total, 43 studies from 16 countries were identified. By the age of 15 years, over 90% of the population has been infected by varicella in all countries except for Greece (86·6%) and Italy (85·3%). Substantial variability across countries exists in the age-specific annual incidence of varicella primary infection among the <5 years old (from 7052 to 16 122 per 100 000) and 5-9 years old (from 3292 to 11 798 per 100 000). The apparent validity and robustness of our estimates highlight the importance of serological data for the characterization of varicella epidemiology, even in the absence of sampling or assay standardization.
Topics: Age Factors; Chickenpox; Europe; Herpesvirus 3, Human; History, 20th Century; Humans; Immunization; Incidence; Seroepidemiologic Studies
PubMed: 28826422
DOI: 10.1017/S0950268817001546 -
BMC Infectious Diseases Oct 2013Herpes simplex virus type 2 (HSV-2) is a common co-infection among HIV-infected adults that is hypothesized to accelerate HIV disease progression. (Review)
Review
BACKGROUND
Herpes simplex virus type 2 (HSV-2) is a common co-infection among HIV-infected adults that is hypothesized to accelerate HIV disease progression.
METHODS
We searched Medline, EMBASE, relevant conference proceedings (2006-12) and bibliographies of identified studies without language restriction for cohort studies examining the impact of HSV-2 on highly active antiretroviral therapy-untreated HIV disease in adults. The exposure of interest was HSV-2 seropositivity or clinical/laboratory markers of HSV-2 activity. The primary outcome was HIV disease progression, defined as antiretroviral initiation, development of AIDS/opportunistic infection, or progression to CD4 count thresholds (≤ 200 or ≤ 350 cells/mm(3)). Secondary outcomes included HIV plasma viral load and CD4 count.
RESULTS
Seven studies were included. No definitive relationship was observed between HSV-2 seropositivity and time to antiretroviral initiation (n=2 studies), CD4 ≤ 350 (n=1), CD4 ≤ 200 (n=1), death (n=1), viral load (n=6) or CD4 count (n=3). Although two studies each observed trends towards accelerated progression to clinical AIDS/opportunistic infection in HSV-2 seropositives, with pooled unadjusted hazard ratio=1.85 (95% CI=1.12,3.06; I2=2%), most OIs observed in the study for which data were available can occur at high CD4 counts and may not represent HIV progression. In contrast, a single study HSV-2 disease activity found that the presence of genital HSV-2 DNA was associated with a 0.4 log copies/mL increase in HIV viral load.
CONCLUSIONS
Despite an observation that HSV-2 activity is associated with increased HIV viral load, definitive evidence linking HSV-2 seropositivity to accelerated HIV disease progression is lacking. The attenuating effects of acyclovir on HIV disease progression observed in recent trials may result both from direct anti-HIV activity as well as from indirect benefits of HSV-2 suppression.
Topics: CD4 Lymphocyte Count; Coinfection; Disease Progression; HIV Infections; Herpes Genitalis; Herpesvirus 2, Human; Humans; Viral Load
PubMed: 24164861
DOI: 10.1186/1471-2334-13-502 -
PloS One 2019To investigate the epidemiology of herpes simplex virus type 1 (HSV-1) in Latin America and the Caribbean. (Meta-Analysis)
Meta-Analysis
OBJECTIVES
To investigate the epidemiology of herpes simplex virus type 1 (HSV-1) in Latin America and the Caribbean.
METHODS
Systematic review and meta-analytics guided by the Cochrane Collaboration Handbook and reported following the PRISMA guidelines.
RESULTS
Thirty-three relevant reports were identified including 35 overall (and 95 stratified) seroprevalence measures, and five and nine proportions of virus isolation in genital ulcer disease (GUD) and in genital herpes, respectively. Pooled mean seroprevalence was 57.2% (95% CI: 49.7-64.6%) among children and 88.4% (95% CI: 85.2-91.2%) among adults. Pooled mean seroprevalence was lowest at 49.7% (95% CI: 42.8-56.6%) in those aged ≤10, followed by 77.8% (95% CI: 67.9-84.8%) in those aged 10-20, 82.8% (95% CI: 73.1-90.8%) in those aged 20-30, 92.5% (95% CI: 89.4-95.1%) in those aged 30-40, and 94.2% (95% CI: 92.7-95.5%) in those aged ≥40. Age was the strongest source of heterogeneity in seroprevalence, explaining 54% of variation. Evidence was found for seroprevalence decline over time. Pooled mean proportion of HSV-1 isolation was 0.9% (95% CI: 0.0-3.6%) in GUD and 10.9% (95% CI: 4.4-19.4%) in genital herpes.
CONCLUSIONS
HSV-1 is a widely prevalent infection in this region, but its epidemiology may be slowly transitioning, with still limited contribution for HSV-1 in genital herpes.
Topics: Caribbean Region; Female; Herpes Genitalis; Herpes Simplex; Herpesvirus 1, Human; Humans; Latin America; Male; Seroepidemiologic Studies; Ulcer
PubMed: 31009486
DOI: 10.1371/journal.pone.0215487 -
Epidemics Dec 2010HIV prevalence is low in the Middle East and North Africa (MENA) region, though the risk or potential for further spread in the future is not well understood. Behavioral... (Review)
Review
BACKGROUND
HIV prevalence is low in the Middle East and North Africa (MENA) region, though the risk or potential for further spread in the future is not well understood. Behavioral surveys are limited in this region and when available have serious limitations in assessing the risk of HIV acquisition. We demonstrate the potential use of herpes simplex virus-2 (HSV-2) seroprevalence as a marker for HIV risk within MENA.
METHODS
We designed a mathematical model to assess whether HSV-2 prevalence can be predictive of future HIV spread. We also conducted a systematic literature review of HSV-2 seroprevalence studies within MENA.
RESULTS
We found that HSV-2 prevalence data are rather limited in this region. Prevalence is typically low among the general population but high in established core groups prone to sexually transmitted infections such as men who have sex with men and female sex workers. Our model predicts that if HSV-2 prevalence is low and stable, then the risk of future HIV epidemics is low. However, expanding or high HSV-2 prevalence (greater than about 20%), implies a risk for a considerable HIV epidemic. Based on available HSV-2 prevalence data, it is not likely that the general population in MENA is experiencing or will experience such a considerable HIV epidemic. Nevertheless, the risk for concentrated HIV epidemics among several high-risk core groups is present.
CONCLUSIONS
HSV-2 prevalence surveys provide a useful mechanism for identifying and corroborating populations at risk for HIV within MENA. HSV-2 serology offers an effective tool for probing hidden sexual risk behaviors in a region where quality behavioral data are limited.
Topics: Africa, Northern; Disease Outbreaks; Female; Forecasting; HIV Infections; HIV-1; Herpes Simplex; Herpesvirus 2, Human; Homosexuality, Male; Humans; Male; Middle East; Models, Biological; Population Surveillance; Prevalence; Seroepidemiologic Studies; Unsafe Sex
PubMed: 21352788
DOI: 10.1016/j.epidem.2010.08.003 -
The Cochrane Database of Systematic... Aug 2014Genital herpes is caused by herpes simplex virus 1 (HSV-1) or 2 (HSV-2). Some infected people experience outbreaks of genital herpes, typically, characterized by... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Genital herpes is caused by herpes simplex virus 1 (HSV-1) or 2 (HSV-2). Some infected people experience outbreaks of genital herpes, typically, characterized by vesicular and erosive localized painful genital lesions.
OBJECTIVES
To compare the effectiveness and safety of three oral antiviral drugs (acyclovir, famciclovir and valacyclovir) prescribed to suppress genital herpes outbreaks in non-pregnant patients.
SEARCH METHODS
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, the search portal of the World Health Organization International Clinical Trials Registry Platform and pharmaceutical company databases up to February 2014. We also searched US Food and Drug Administration databases and proceedings of seven congresses to a maximum of 10 years. We contacted trial authors and pharmaceutical companies.
SELECTION CRITERIA
We selected parallel-group and cross-over randomized controlled trials including patients with recurrent genital herpes caused by HSV, whatever the type (HSV-1, HSV-2, or undetermined), with at least four recurrences per year (trials concerning human immunodeficiency virus (HIV)-positive patients or pregnant women were not eligible) and comparing suppressive oral antiviral treatment with oral acyclovir, famciclovir, and valacyclovir versus placebo or another suppressive oral antiviral treatment.
DATA COLLECTION AND ANALYSIS
Two review authors independently selected eligible trials and extracted data. The Risk of bias tool was used to assess risk of bias. Treatment effect was measured by the risk ratio (RR) of having at least one genital herpes recurrence. Pooled RRs were derived by conventional pairwise meta-analyses. A network meta-analysis allowed for estimation of all possible two-by-two comparisons between antiviral drugs.
MAIN RESULTS
A total of 26 trials (among which six had a cross-over design) were included. Among the 6950 randomly assigned participants, 54% (range 0 to 100%) were female, mean age was 35 years (range 26 to 45.1), and the mean number of recurrences per year was 11 (range 6.3 to 17.8). Duration of treatment was two to 12 months. Risk of bias was considered high for half of the studies and unclear for the other half. A total of 14 trials compared acyclovir versus placebo, four trials compared valacyclovir versus placebo and 2 trials compared valacyclovir versus no treatment. Three trials compared famciclovir versus placebo. Two trials compared valacyclovir versus famciclovir and one trial compared acyclovir versus valacyclovir versus placebo.We analyzed data from 22 trials for the outcome: risk of having at least one clinical recurrence. We could not obtain the outcome data for four trials. In placebo-controlled trials, there was a low quality evidence that the risk of having at least one clinical recurrence was reduced with acyclovir (nine parallel-group trials, n = 2049; pooled RR 0.48, 95% confidence interval (CI) 0.39 to 0.58), valacyclovir (four trials, n = 1788; pooled RR 0.41, 95% CI 0.24 to 0.69), or famciclovir (two trials, n = 732; pooled RR 0.57, 95% CI 0.50 to 0.64). The six cross-over trials showed larger treatment effects on average than the parallel-group trials. We found evidence of a small-study effect for acyclovir placebo-controlled trials (adjusted pooled RR 0.61, 95% CI 0.49 to 0.75). In analyzing parallel-group trials by daily dose, no clear evidence was found of a dose-response relationship for any drug. In head-to-head trials, the risk of having at least one recurrence was increased with valacyclovir rather than acyclovir (one trial, n = 1345; RR 1.16, 95% CI 1.01 to 1.34) and was not significantly different from that seen with famciclovir as compared with valacyclovir (one trial, n = 320; RR 1.18, 95% CI 0.86 to 1.63).We included 16 parallel-arm trials in a network meta-analysis and we were unable to determine which of the drugs was most effective in reducing the risk of at least one clinical recurrence (after adjustment for small-study effects, pooled RR 0.83, 95% CI 0.61 to 1.11 for valacyclovir vs acyclovir; pooled RR 1.04, 95% CI, 0.71 to 1.49 for famciclovir vs acyclovir; and pooled RR 1.26, 95% CI 0.89 to 1.75 for famciclovir vs valacyclovir). Safety data were sought but were reported as total numbers of adverse events.
AUTHORS' CONCLUSIONS
Owing to risk of bias and inconsistency, there is low quality evidence that suppressive antiviral therapy with acyclovir, valacyclovir or famciclovir in pacients experiencing at least four recurrences of genital herpes per year decreases the number of pacients with at least one recurrence as compared with placebo. Network meta-analysis of the few direct comparisons and the indirect comparisons did not show superiority of one drug over another.
Topics: 2-Aminopurine; Acyclovir; Administration, Oral; Adult; Antiviral Agents; Famciclovir; Female; Herpes Genitalis; Herpesvirus 1, Human; Herpesvirus 2, Human; Humans; Immunocompetence; Middle Aged; Randomized Controlled Trials as Topic; Recurrence; Valacyclovir; Valine
PubMed: 25086573
DOI: 10.1002/14651858.CD009036.pub2 -
Folia Medica Cracoviensia 2017Herpes simplex virus (HSV) encephalitis is an acute infection of the Central Nervous System (CNS). During the last two decades its incidence has a ten-fold increase,...
Herpes simplex virus (HSV) encephalitis is an acute infection of the Central Nervous System (CNS). During the last two decades its incidence has a ten-fold increase, while mortality rate exceeds 70%, if left undiagnosed and thus untreated. Clinical manifestations, imaging studies, cerebrospinal fluid (CSF) analysis and electroencephalogram (EEG) are the basis of diagnostic approach. Even when CSF analysis seems normal, imaging studies are not specific and HSV polymerase chain reaction (PCR) test is negative, the clinician should be more aggressive, if clinical presentation is indicative for HSV encephalitis, by administrating acyclovir early after patient's admission. The aim of this short review article, after systematic research of the relevant up to date literature, is to emphasize the insight of the clinician as for the early diagnosis and the prompt therapeutic intervention, which are crucial for the outcome and vital for the affected patient.
Topics: Antiviral Agents; Cerebrospinal Fluid; DNA, Viral; Encephalitis, Herpes Simplex; Humans; Magnetic Resonance Imaging; Polymerase Chain Reaction; Simplexvirus
PubMed: 29337981
DOI: No ID Found -
Journal of Veterinary Internal Medicine 2024Equine herpes virus type 1 (EHV-1) infection in horses is associated with upper respiratory disease, neurological disease, abortions, and neonatal death. (Review)
Review
BACKGROUND
Equine herpes virus type 1 (EHV-1) infection in horses is associated with upper respiratory disease, neurological disease, abortions, and neonatal death.
OBJECTIVE
To determine if there is an association between the level and duration of EHV-1 viremia and either abortion or equine herpesvirus myeloencephalopathy (EHM) in domesticated horses?
METHODS
A systematic review was performed searching numerous databases to identify peer reviewed reports that evaluated viremia and EHM, or viremia and abortion published before January 19, 2021. Randomized controlled trials and observational studies were assessed for risk of bias or publication quality.
RESULTS
A total of 189 unique studies were identified, of which 34 met the inclusion criteria. Thirty studies evaluated viremia and neurologic outcomes including 4 observational studies. Eight experimental studies examined viremia and abortion, which used the Ab4 and OH03 virus strains or recombinant Ab4 derivatives. Incidence rates for both EHM and abortion in experimental studies varied among the studies as did the level of evidence. Viremia was generally detectable before the onset of either EHM or abortion. Risk of bias was generally low to moderate, sample sizes were small, and multiple studies reported negative outcome data.
CONCLUSIONS AND CLINICAL IMPORTANCE
The results of this study support that viremia is regularly present before EHM or abortion occurs. However, no inferences could be made about the relationship between the occurrence of either neurological signs or abortion and the magnitude or duration of viremia.
Topics: Horses; Animals; Herpesvirus 1, Equid; Horse Diseases; Viremia; Herpesviridae Infections; Abortion, Veterinary; Female; Pregnancy
PubMed: 38069576
DOI: 10.1111/jvim.16948 -
Expert Review of Vaccines Apr 2017Varicella vaccines are highly effective at preventing disease, but varicella may occur among vaccinated persons (termed breakthrough varicella). Breakthrough varicella... (Review)
Review
Varicella vaccines are highly effective at preventing disease, but varicella may occur among vaccinated persons (termed breakthrough varicella). Breakthrough varicella is generally mild, but severe cases have been reported. The objective of this review is to describe severe breakthrough varicella. Areas covered: We conducted a systematic review of articles published during 1974-2016. A total of 34 articles were included in our review: 21 described breakthrough varicella with disseminated varicella-zoster virus (VZV) infection with other organ involvement in addition to skin (none among two-dose vaccinees); 9 described hospitalized breakthrough varicella without mention of other organ involvement in addition to skin (of which 2 reported 4 two-dose vaccinees); and 4 described both. A total of 52-60 unique breakthrough varicella cases with disseminated VZV infection with other organ involvement in addition to skin reported with the following complications, not mutually exclusive: pneumonia (n = 8-9 cases), neurologic (n = 18-24 cases), hematologic (n = 10-11 cases), ocular (n = 5 cases), renal (n = 2 cases), hepatic (n = 3 cases), secondary infection with bacteremia or sepsis (n = 8 cases), and other complication (n = 4 cases). There were 6 cases of fatal breakthrough varicella. Expert commentary: With >31 million doses distributed annually worldwide since 2007, severe breakthrough varicella can occur but they appear to be uncommon.
Topics: Chickenpox; Chickenpox Vaccine; Herpesvirus 3, Human; Humans
PubMed: 28276305
DOI: 10.1080/14760584.2017.1294069