Systematic review and meta-analysis of the association between giant cell arteritis and herpes viruses.

Abstract

Purpose : The aetiology of giant cell arteritis (GCA) remains incompletely understood. Recently, a new hypothesis has emerged proposing an antigen-driven process and viruses have been suggested as potential triggering antigens. Proving such an association would have important implications for the treatment. We performed a systematic review and meta-analysis to evaluate the evidence for the association between GCA and herpes viruses.

Methods : Following a systematic search of PubMed, Medline, Embase, Web of Science and Cochrane databases, suitable studies were identified which investigated the presence of herpes viruses in patients with temporal arteritis. The critical appraisal was performed and included the Newcastle-Ottawa Scale scoring. The heterogeneity was determined by means of the I² statistic, complemented with the Cochran’s Q test. Pooled odds ratios and pooled proportions of GCA patients positive for each virus with 95% confidence intervals were calculated using a random-effect model. Sensitivity analyses were performed were appropriate.

Results : Thirteen observational studies, with 1267 participants, were included in the systematic review and meta-analysis. A statistically significant increased risk of varicella virus presence in GCA patients was identified, with a pooled odds ratio of 7.534 (95%CI: 3.642-15.587; p<0.001). The studies were statistically highly homogenous with the I² of 0.00% (95%CI: 0.00-0.00%; Q=0.1505; p=0.6981). The pooled odds ratios for the presence of HSV and EBV viruses were 4.974 (95%CI: 0.0615-402.069, p=0.474) and 0.183 (95%CI: 0.00325-10.270; p=0.408), respectively. These studies were highly heterogeneous with the I² of 88.69% (95%CI: 57.10-97.02%; Q=8.8386; p=0.0029) and 83.56% (95%CI: 31.83-96.04%; Q=6.0834; p=0.0136) for studies investigating the HSV and EBV presence, respectively. The pooled proportions of virus positive GCA patients were 9.451%, 12.965%, 0.965%, 9.820%, 4.014% and 0.352% for VZV, HSV, CMV, EBV, HHV6 and HHV7, respectively.

Conclusions : The analysis implies a possibility of an increased risk of VZV presence in GCA patients. No significant association was shown between GCA and other herpes viruses. Large methodological differences were noted between the studies and several potential sources of bias were identified. Further robust studies are required to reliably evaluate any association between VZV and other herpes viruses and GCA.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.