Frequency and associated factors of herpes zoster infection in SLE patients from Latin America: data from the GLADEL 2.0 cohort

Objective: The aim of this study was to assess the epidemiological and clinical characteristics of herpes zoster (HZ) and to identify the factors associated with its first episode in Latin American SLE patients. Methods: GLADEL 2.0 (Grupo Latino Americano De Estudio del Lupus) is a multiethnic, Latin American observational cohort of SLE patients. Demographic, clinical, laboratory, treatment and disease activity/damage data were compared between patients with and without HZ; its prevalence was assessed at cohort entry, incidence rates of first and recurrent HZ infections were calculated based on person-years of follow-up. Logistic regression was used to identify factors associated with HZ events, while Cox regression was used to determine the variables associated with time to first event. Results: Among 1083 SLE patients, the HZ cumulative incidence after its diagnosis was 11.5%, with a prevalence of 8.6% at cohort entry. During 5-year of follow-up, the incidence of HZ was 2.9% and 16.8% patients had recurrent episodes. Patients with HZ showed higher frequencies of alopecia, psychosis and seizures, along with higher disease activity, damage accrual, proteinuria and higher daily prednisone doses prior to the event. Multivariate analyses identified female sex, higher SLE Disease Activity Index 2000 (SLEDAI-2K) and higher daily prednisone dose as independent predictors of HZ occurrence. Older age at diagnosis, psychosis, disease activity and a higher daily prednisone dose were associated with a shorter time to HZ onset. Conclusion: In the GLADEL 2.0 cohort, the high burden of HZ in SLE, together with its association with active disease, corticosteroid exposure and neuropsychiatric manifestations, underscores the need for proactive risk stratification in clinical practice.