INCIDENCE AND RISK FACTORS OF HERPES ZOSTER INFECTION IN PEDIATRIC SYSTEMIC LUPUS ERYTHEMATOSUS: A 16 YEAR STUDY

O070 / #568 Topic: AS18 - Pediatric SLE ABSTRACT CONCURRENT SESSION 12: PEDIATRIC SLE – ADVANCES IN DISEASE OUTCOMES AND MENTAL HEALTH 24-05-2025 10:40 AM - 11:40 AM Background/Purpose Systemic lupus erythematosus (SLE) is a prototypic chronic multisystem autoimmune disease that is highly heterogenous in its clinical manifestations and severity. Although SLE predominantly affects young women, children and adolescents contribute to 15–20% of this population. 1 Herpes zoster is viral disease caused by reactivation of varicella-zoster virus which remains dormant in the sensory ganglia of the cranial nerve or the dorsal root ganglia after a previous varicella infection. There is limited information on the association of HZ and cSLE. This study aims to determine the risk factors of HZ infection in patients diagnosed with cSLE at a tertiary hospital in the Philippines. Methods This study is a single-center retrospective cohort study which included all patients aged 18 years old and below at the time they were diagnosed with SLE between 2008 and 2023. Results A total of 388 patients were included in the study. The prevalence of herpes zoster was 15.72% (95% CI = 12.24% to 19.73%), with an incidence rate of 38.40 per 100 person-years (95% = 0.316 to 0.469). The median age at cSLE diagnosis was 13 years old (IQR = 11 – 16). Majority of the participants were females (92.78%) and had a median disease duration of 9 years (IQR = 5 – 12). The most common location of the HZ was the upper extremities (18.03%). The median SLEDAI at herpes zoster diagnosis was 4 (IQR = 0 – 12), 16.39% had recurrent HZI, 11.48% had superimposed bacterial infection, and more than two-thirds were treated with the anti-viral acyclovir or valacyclovir (88.52%). The proportion of participants with renal manifestations was significantly higher among those with herpes zoster infection (54.10% vs. 40.37%). Using multivariate analyses, glucocorticoid dosage ≥5 mg (aRR=10.20, p =0.001), azathioprine (aRR=2.07, p =0.009), and intravenous cyclophosphamide (aRR=1.61, p =0.048) significantly predicted the likelihood of developed herpes zoster infection. Conclusions The prevalence and incidence of HZI in cSLE is 15.72% and 38.40 per 100 person-years, respectively. Risk factors identified for HZI among cSLE were lymphopenia, lupus nephritis, and immunosuppressive agents. In particular, IV cyclophosphamide, azathioprine, and glucocorticoid dose of ≥5 mg increased the risk for development of HZI by 1.61, 2.07, 10.20 times, respectively.