Association between Epstein-Barr virus capsid antigen IgA positivity and increased risk of chronic obstructive pulmonary disease: a retrospective cohort study

Epstein-Barr virus (EBV) is a highly prevalent DNA virus linked to malignancies, autoimmune, and chronic inflammatory diseases. Elevated Epstein-Barr Virus Capsid Antigen IgA (EB‑VCA IgA) has been reported in diseases such as nasopharyngeal carcinoma and Sjögren’s syndrome; however, its relationship with chronic obstructive pulmonary disease (COPD) remains unclear. This retrospective cohort study included 2497 individuals who underwent EB-VCA IgA testing at Cheng Hsin General Hospital between 2013 and 2022. Baseline clinical data, laboratory findings, and comorbidities were analyzed. Logistic regression and Cox proportional hazards models were used to evaluate the association between EB-VCA IgA positivity and COPD risk, adjusting for sex, age, and body mass index (BMI). Individuals with pre-existing COPD were excluded. Among participants, 21% were EB-VCA IgA positive. The positive group had significantly lower hemoglobin levels (p = 0.005) but no differences in other baseline laboratory markers. EB-VCA IgA positivity was associated with increased COPD risk (adjusted OR = 1.86, p = 0.003). After excluding pre-existing COPD cases, EB-VCA IgA-positive individuals exhibited a 2.83-fold higher cumulative incidence of COPD (adjusted HR = 2.83, 95% CI 1.53–5.22). No association was found between EB-VCA IgA and acute COPD exacerbation (p = 0.859). Subgroup analyses demonstrated consistent results across clinical and demographic factors. EB-VCA IgA positivity is significantly associated with increased COPD risk, underscoring the potential role of chronic EBV infection in COPD pathogenesis. Monitoring EB-VCA IgA levels may support early detection and personalized management of COPD.