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Varicella-zoster virus immune status in CAPD and chronic hemodialysis patients
Z Smetana1, S Leventon-Kriss, A Broide
1Central Virology Laboratory, Chaim Sheba Medical Center, Holon, Israel.
Insights
Patients on dialysis show normal immune cell response to varicella-zoster virus (VZV). However, VZV reactivates frequently without causing illness, indicated by antibody changes.
Area of Science:
- Immunology
- Virology
- Nephrology
Background:
- Patients undergoing chronic dialysis often have impaired immunity.
- Severe varicella-zoster virus (VZV) infection is common in immunocompromised individuals.
Purpose of the Study:
- To investigate VZV-specific lymphocyte proliferative activity in patients on continuous ambulatory peritoneal dialysis (CAPD).
- To assess VZV reactivation and antibody responses in CAPD patients.
Main Methods:
- Compared VZV-specific cellular immune response in 16 CAPD patients and healthy controls.
- Analyzed lymphocyte subsets (CD3, CD4, CD8) in CAPD patients.
- Monitored anti-VZV IgA, IgM, and IgG antibody levels over six months.
Main Results:
- CAPD patients exhibited normal in vitro lymphocyte proliferation to VZV antigens (mean stimulation index 7.06 vs. 3.68).
- Lymphocyte subsets in CAPD patients were within normal ranges.
- VZV reactivation was detected in some patients via antibody changes (IgA, IgM, IgG) without clinical symptoms.
- CAPD and hemodialysis patients showed significantly higher anti-VZV titers compared to controls.
Conclusions:
- Patients on chronic dialysis maintain a competent cellular response to VZV.
- Frequent asymptomatic VZV reactivation occurs in patients on long-term dialysis (CAPD and HD).
- This suggests a complex interplay between immune status and viral latency in dialysis patients.
Abstract:
Patients on chronic dialysis who are supposed to disclose an impairment of the immune potential, seldom show clinical viral illnesses. Since severe varicella-zoster virus (VZV) infection develops in immunocompromised patients, we have examined the proliferative activity to VZV in the blood lymphocytes of 16 patients on continuous ambulatory peritoneal dialysis (CAPD) and compared it to healthy matched controls. The cellular in vitro response of these patients to specific VZV antigens was essentially normal. The mean stimulation index for CAPD patients was 7.06, and for matched controls 3.68 (p greater than 0.05). The mean percentage of lymphocytes in CAPD patients as determined by CD3 monoclonal antibodies was 57%, the CD4 helper and CD8 suppressor cells were 41 and 21%, respectively. When those 16 CAPD patients were followed up for the presence of anti-VZV IgA, IgM and IgG immunofluorescent antibody to membrane antigen antibodies during a period of 6 months, the recrudescence of VZV was documented by the appearance of IgA and IgM antibodies and/or fourfold increase in IgG titer in some patients, but no clinical illness was observed. The frequent reactivation of the virus without clinical symptoms in patients undergoing long-term intermittent chronic hemodialysis (HD) or CAPD was strengthened by the presence of increased anti-VZV geometric mean titers (52.68 and 53.00, respectively) in these patients as compared to control subjects (11.75).