Malignancy Risk after Ophthalmic Herpes Infection within a Diverse United States Cohort

Area of Science:

• Ophthalmology
• Oncology
• Infectious Diseases

Background:

• Herpes zoster ophthalmicus (HZO) has been debated as a potential cancer risk marker, with inconsistent findings.
• The association between ophthalmic herpes simplex virus (HSV) and malignancy risk is currently unknown.

Purpose of the Study:

• To evaluate the malignancy risk following herpes zoster ophthalmicus (HZO) and ophthalmic herpes simplex virus (HSV) infections.
• To investigate the role of immune dysregulation in modifying the association between HZO and cancer risk.

Main Methods:

• A retrospective cohort study utilizing electronic health records from the NIH All of Us Research Program.
• Propensity score matching (1:3) was used to compare patients with HZO or ophthalmic HSV to controls.
• Stratified Cox proportional hazards models assessed malignancy risk at various intervals and over the full follow-up period, examining effect modification by immune status.

Main Results:

• Neither HZO nor ophthalmic HSV showed an increased overall risk of malignancy in the study cohort.
• HZO was associated with a significantly increased malignancy risk in participants with pre-existing autoimmune disease or immunodeficient status.
• No significant association or effect modification was found for ophthalmic HSV regarding malignancy risk.

Conclusions:

• Ophthalmic herpes infections, including HZO and HSV, are not linked to an increased overall risk of malignancy.
• HZO may serve as a marker for increased cancer risk specifically in individuals with pre-existing immune dysregulation.
• Heightened oncologic vigilance may be warranted for patients with HZO and underlying immune compromise, refining understanding of this clinical association.