Immune Dysregulation in Acute Herpes Zoster: Predictive Factors for Postherpetic Neuralgia

BACKGROUND Postherpetic neuralgia (PHN) is closely related to the host immune response. This study explored the cellular and humoral immune functions of acute immunocompetent herpes zoster (HZ) patients and their relationship with PHN. MATERIAL AND METHODS We selected 188 patients with acute HZ admitted to our hospital and 79 individuals who underwent physical examinations during the same period. We measured and compared the levels of peripheral blood lymphocyte subsets (CD3+, CD4+, CD8+, CD4+/CD8+, CD19+, CD56+), serum immunoglobulins (IgA, IgG, IgM), and complement (C3, C4) between the 2 groups. Based on whether they had neuralgia during follow-up, we divided the patients into an HZ-PHN group and an HZ-control group, and compared their differences in immune functions and their relationship with PHN. RESULTS Compared with the control group, the levels of CD3+ and CD4+ and CD4+/CD8+ ratios of HZ patients were significantly lower (P<0.05). Among 188 HZ patients, 91 (48.4%) developed PHN. The patients in the HZ-PHN group were significantly older (P<0.01) and the levels of CD3+, CD4+, and CD8+ and CD4+/CD8+ ratios were significantly lower than those in the HZ-control group (P<0.05, P<0.01). Binary logistic regression analysis showed that age and CD4+/CD8+ ratios are independent risk factors for determining whether HZ patients develop PHN. CONCLUSIONS Acute immunocompetent HZ patients, especially those who are older and more prone to developing PHN, exhibit significant cellular immune dysregulation. Age and CD4+/CD8+ ratios may be useful predictors of PHN in acute HZ patients.