Varicella Zoster Virus in Giant Cell Arteritis: Evidence From a Systematic Review and Meta-Analytic Synthesis

Area of Science:

• Rheumatology
• Infectious Diseases
• Pathology

Background:

• Giant cell arteritis (GCA) is a serious vasculitis affecting older adults, with unknown causes.
• Varicella zoster virus (VZV) is a suspected trigger for GCA due to its properties, but evidence is conflicting.

Purpose of the Study:

• To systematically review and synthesize evidence on VZV presence in arterial tissues of GCA patients.
• To evaluate the strength and consistency of the association between VZV and GCA.

Main Methods:

• A systematic review and meta-analysis adhering to PRISMA guidelines.
• Searched major databases for studies using immunohistochemistry, PCR, or molecular methods to detect VZV in GCA tissues.
• Calculated pooled log odds ratios (LogORs) using a random-effects model, assessing heterogeneity and publication bias.

Main Results:

• Eighteen studies with 606 GCA cases and 589 controls were included.
• A statistically significant association was found between VZV presence and GCA (pooled LogOR: 1.03; p=0.003), with moderate heterogeneity.
• The association was significant in U.S. studies but not European cohorts, suggesting geographical dependence and potential publication bias.

Conclusions:

• A significant but heterogeneous association exists between VZV and GCA, influenced by geography and methodology.
• Current evidence does not support routine antiviral treatment for GCA.
• Further standardized, multicenter research is needed to clarify VZV's role in GCA pathogenesis.