{"id":60981,"date":"2024-09-30T11:42:20","date_gmt":"2024-09-30T11:42:20","guid":{"rendered":"https:\/\/biomedpharmajournal.org\/?p=60981"},"modified":"2024-10-09T17:56:05","modified_gmt":"2024-10-09T17:56:05","slug":"monitoring-the-seroprevalence-of-herpes-simplex-virus-1-among-egyptian-hemodialysis-patients","status":"publish","type":"post","link":"https:\/\/biomedpharmajournal.org\/staging\/vol17no3\/monitoring-the-seroprevalence-of-herpes-simplex-virus-1-among-egyptian-hemodialysis-patients\/","title":{"rendered":"Monitoring the Seroprevalence of Herpes Simplex Virus-1 Among Egyptian Hemodialysis Patients"},"content":{"rendered":"\n

Introduction<\/strong><\/p>\n\n\n\n

Herpes simplex virus (HSV) infections are\nwidespread globally, affecting a considerable portion of the population. HSV\ninfections are caused by two main types: HSV-1, typically linked to orolabial\nlesions, and HSV-2, which is primarily responsible for genital herpes 1,8<\/sup>.\nWhile most HSV infections are self-limiting in individuals with normal immune\nfunction, they can cause severe complications in immunocompromised populations,\nincluding those with end-stage renal disease (ESRD) undergoing hemodialysis 2,6<\/sup>.<\/p>\n\n\n\n

Hemodialysis patients are particularly\nvulnerable due to impaired immune function, which may be exacerbated by uremia,\nmalnutrition, and various comorbid conditions. This weakened immune system\nheightens their susceptibility to infections, including those caused by HSV. In\nthis group, HSV infections can range from mild mucocutaneous lesions to severe,\nlife-threatening disseminated diseases 3,17<\/sup>.<\/p>\n\n\n\n

Despite the risk of serious complications,\nthere is a paucity of data on the prevalence and clinical manifestations of HSV\ninfections in hemodialysis patients4,5,14<\/sup>. Preliminary studies\nindicate that the seroprevalence of HSV may be higher in hemodialysis patients\ncompared to the general population, underscoring the necessity for further\nresearch6<\/sup>. Gaining a deeper understanding of the epidemiology and\nrisk factors for HSV infection in this high-risk group is essential for the\ndevelopment of effective prevention and management strategies5,6,18<\/sup>.<\/p>\n\n\n\n

This study aims to assess the\nseroprevalence of HSV-1 among Egyptian hemodialysis patients. The outcomes of\nthis research will enhance our understanding of the burden of HSV infection in\nhemodialysis patients and will support the development of targeted\ninterventions to improve their care and clinical outcomes.<\/p>\n\n\n\n

Materials and Methods<\/strong><\/p>\n\n\n\n

Ethical Approval<\/strong><\/p>\n\n\n\n

The study was approved by the Review Board\nof Ain Shams University with an approval date of February 2, 2023.<\/p>\n\n\n\n

Study Design and Population<\/strong><\/p>\n\n\n\n

 This cross-sectional study aims to determine the seroprevalence of HSV-1 among hemodialysis patients. The study included 218 participants, comprising 116 females and 102 males, aged 29 to 65 years (mean age 39.32\u00b114.45 years). Blood samples were collected from several hospitals: Al-Demerdash, Wadi Alneil, Sayed Galal, Beni Suef University, and Sohag General Hospital. Participants were divided into two groups: 132 patients with renal failure undergoing hemodialysis and 86 control subjects with normal kidney function, negative for HCV, CMV, and HIV antibodies. Informed consent, including information on name, age, gender, and blood transfusion history, was obtained from each subject before sample collection. Serum samples were tested for IgG and IgM antibodies against HSV-1. The data are not publicly available due to the privacy agreements made with the study participants. However, anonymized data may be available from the corresponding author upon reasonable request.<\/p>\n\n\n\n

Sampling Method<\/strong><\/p>\n\n\n\n

    Participants were selected using a random sampling method from several hospitals as mentioned above, ensuring the sample is representative of the Egyptian hemodialysis patient population. The sample was stratified into two groups: hemodialysis patients and control subjects with normal kidney function and no infections such as HCV, CMV, or HIV. This stratification helped in comparing the seroprevalence rates between immunocompromised and immunocompetent individuals.<\/p>\n\n\n\n

Sample Size Determination<\/strong><\/p>\n\n\n\n

The sample size for this study was\ncalculated based on an estimated 50% seroprevalence of HSV-1 in\nimmunocompromised populations, particularly hemodialysis patients. Using a 95%\nconfidence level, a 5% margin of error, and the formula for sample size\ncalculation N= [Z2<\/sup> * P(1 – P)] \/ E2<\/sup>. In this equation, N=\nrequired sample size – Z = Z-value (1.96 for 95% confidence) – P = estimated\nprevalence (50%) – E = margin of error (5%), the required sample size was\napproximately 218 participants<\/p>\n\n\n\n

Laboratory Testing<\/strong><\/p>\n\n\n\n

Serum samples were analyzed for the\npresence of IgG antibodies specific to HSV-1 by enzyme-linked immunosorbent assays\n(ELISA) technique\nusing commercially available HSV-1-IgG and IgM kits Enzygnost\u00ae\nELISA Kit (Behring, Marburg, Germany). Tests were done according to the manufacturer\ninstructions and results of HSV-1-IgG and IgM were expressed as optical density (O.D)\nunits.<\/p>\n\n\n\n

Data Analysis<\/strong><\/p>\n\n\n\n

   Data\nanalysis was performed using SPSS software version 23.0 (Armonk, NY: IBM Corp).\nThe statistical analysis will begin with descriptive statistics to summarize\npatient demographics (age, gender, dialysis duration, vaccination history) and\ncalculate HSV-1 seroprevalence (IgG, IgM). Bivariate analysis will compare\nseroprevalence rates across demographic factors using chi-square tests for\ncategorical variables and t-tests or ANOVA for continuous ones. Multivariate\nanalysis with logistic regression will identify independent factors associated\nwith HSV-1 seropositivity. Correlation analysis will examine relationships\nbetween HSV-1 seropositivity and renal function. P-values (<0.05) and 95%\nconfidence intervals will be reported for significance and effect estimates.<\/p>\n\n\n\n

Results<\/strong><\/p>\n\n\n\n

Total HSV-1-IgG Antibodies Responses<\/strong><\/p>\n\n\n\n

Among the 132\npatient cases, 111 (84.1%) were positive for HSV-1-IgG antibodies, while 15.9%\nwere negative. In the control group of 86 individuals, 57 (66.3%) tested\npositive for HSV-1-IgG antibodies, with 33.7% testing negative. (table.1)<\/p>\n\n\n\n

Table 1: HSV-1- IgG rates in Hemodialysis and Control cases.<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n
\n

 <\/p>\n<\/td>\n

\n

Total No. of Cases<\/strong><\/p>\n<\/td>\n

\n

HSV-1-IgG<\/strong><\/p>\n<\/td>\n

\n

P-value<\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

Positive    <\/strong><\/p>\n<\/td>\n

\n

Negative <\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

No.<\/strong><\/p>\n<\/td>\n

\n

%<\/strong><\/p>\n<\/td>\n

\n

N<\/strong><\/p>\n<\/td>\n

\n

%<\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

Hemodialysis cases<\/p>\n<\/td>\n

\n

132<\/p>\n<\/td>\n

\n

111<\/p>\n<\/td>\n

\n

84.1%<\/p>\n<\/td>\n

\n

21<\/p>\n<\/td>\n

\n

15.9%<\/p>\n<\/td>\n

\n

<0.001<\/p>\n<\/td>\n<\/tr>\n

\n

Control cases<\/p>\n<\/td>\n

\n

86<\/p>\n<\/td>\n

\n

57<\/p>\n<\/td>\n

\n

66.3%<\/p>\n<\/td>\n

\n

29<\/p>\n<\/td>\n

\n

33.7%<\/p>\n<\/td>\n

\n

<0.05<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n\n\n

Total HCMV-IgG Antibodies Responses<\/strong><\/p>\n\n\n\n

In the\nhemodialysis group, 55 of 132 patients (41.6%) were positive for HSV-1-IgM\nantibodies, whereas 58.4% were negative. For the control group, 28 out of 86\nindividuals (32.6%) showed detectable HSV-1-IgM antibodies, while 67.4% were\nnegative. (Table 2)<\/p>\n\n\n\n

Table 2: HSV-1-IgM antibodies rates in Hemodialysis and Control cases.<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n
\n

 <\/p>\n<\/td>\n

\n

Total No. of Cases<\/strong><\/p>\n<\/td>\n

\n

HSV-1-<\/strong>IgM<\/strong>  <\/strong><\/p>\n<\/td>\n

\n

P-value<\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

Positive    <\/strong><\/p>\n<\/td>\n

\n

Negative <\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

No.<\/strong><\/p>\n<\/td>\n

\n

%<\/strong><\/p>\n<\/td>\n

\n

N<\/strong><\/p>\n<\/td>\n

\n

%<\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

Hemodialysis cases<\/p>\n<\/td>\n

\n

132<\/p>\n<\/td>\n

\n

55<\/p>\n<\/td>\n

\n

41.6%<\/p>\n<\/td>\n

\n

77<\/p>\n<\/td>\n

\n

58.4%<\/p>\n<\/td>\n

\n

<0.05<\/p>\n<\/td>\n<\/tr>\n

\n

Control cases<\/p>\n<\/td>\n

\n

86<\/p>\n<\/td>\n

\n

28<\/p>\n<\/td>\n

\n

32.6%<\/p>\n<\/td>\n

\n

58<\/p>\n<\/td>\n

\n

67.4%<\/p>\n<\/td>\n

\n

<0.05<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n\n\n

HSV-1 Antibodies Responses in Different Ages for the Study Populations<\/strong><\/p>\n\n\n\n

The data presented in Table 3 clearly demonstrated a decrease in HCV-IgG response by decreasing the age range, where IgG response increased in elderly patients. There is opposite trend toward HSV-IgM rates, where IgM response in young cases of control group was the same as that in older cases. Also, the results displayed in Table 3 showed HSV-IgG antibody in control cases, whose age ranged 55:65 years, had the highest response. <\/p>\n\n\n\n

Table 3: HSV-1- antibodies rates in Hemodialysis and Control cases according to Gender and Age.<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n
\n

Age range<\/strong><\/p>\n<\/td>\n

\n

Gender<\/strong><\/p>\n<\/td>\n

\n

Hemodialysis Cases (n=132)<\/strong><\/p>\n<\/td>\n

\n

Control Cases (n=86)<\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

HSV-1-IgG<\/strong><\/p>\n<\/td>\n

\n

HSV-1-IgM<\/strong><\/p>\n<\/td>\n

\n

HSV-1-IgG<\/strong><\/p>\n<\/td>\n

\n

HSV-1-IgM<\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

29-39<\/p>\n

(n=55)<\/p>\n<\/td>\n

\n

Male<\/p>\n<\/td>\n

\n

9 (8.1%)<\/p>\n<\/td>\n

\n

 4 (7.3%)<\/p>\n<\/td>\n

\n

9 (15.8%)<\/p>\n<\/td>\n

\n

7 (25%)<\/p>\n<\/td>\n<\/tr>\n

\n

Female<\/p>\n<\/td>\n

\n

15 (13.5%)<\/p>\n<\/td>\n

\n

6 (11%)<\/p>\n<\/td>\n

\n

7 (12.3%)<\/p>\n<\/td>\n

\n

6 (21.4%)<\/p>\n<\/td>\n<\/tr>\n

\n

40-54<\/p>\n

(n=73)<\/p>\n<\/td>\n

\n

Male<\/p>\n<\/td>\n

\n

18 (16.2%)<\/p>\n<\/td>\n

\n

8 (14.5%)<\/p>\n<\/td>\n

\n

8 (14%)<\/p>\n<\/td>\n

\n

2 (7.1%)<\/p>\n<\/td>\n<\/tr>\n

\n

Female<\/p>\n<\/td>\n

\n

20 (18%)<\/p>\n<\/td>\n

\n

10 (18.2%)<\/p>\n<\/td>\n

\n

9 (15.8%)<\/p>\n<\/td>\n

\n

2 (7.1%)<\/p>\n<\/td>\n<\/tr>\n

\n

55-65<\/p>\n

(n=90)<\/p>\n<\/td>\n

\n

Male<\/p>\n<\/td>\n

\n

19 (17.1%)<\/p>\n<\/td>\n

\n

12 (21.8%)<\/p>\n<\/td>\n

\n

13 (22.8)<\/p>\n<\/td>\n

\n

6 (21.4%)<\/p>\n<\/td>\n<\/tr>\n

\n

Female<\/p>\n<\/td>\n

\n

30 (27%)<\/p>\n<\/td>\n

\n

15 (27.3%)<\/p>\n<\/td>\n

\n

11 (19.3%)<\/p>\n<\/td>\n

\n

5 (17.6%)<\/p>\n<\/td>\n<\/tr>\n

\n

Total<\/p>\n<\/td>\n

\n

total<\/p>\n<\/td>\n

\n

111 (84.1%)<\/p>\n<\/td>\n

\n

55 (41.6%)<\/p>\n<\/td>\n

\n

57 (66.3%)<\/p>\n<\/td>\n

\n

28 (32.6%)<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n

Discussion<\/strong><\/p>\n\n\n\n

Herpes Simplex Virus 1 (HSV-1) is a\nubiquitous virus that primarily causes oral herpes (cold sores). While it is\ngenerally benign in most individuals, it can pose significant health risks for\nimmunocompromised patients, including those on hemodialysis7,9,10<\/sup>. <\/p>\n\n\n\n

This study examines the seroprevalence of\nHSV-1 among Egyptian patients with renal failure who are undergoing\nhemodialysis. The findings showed that the rates of seropositivity for\nHSV-1-IgG and IgM were significantly greater (P<0.05) among hemodialysis\npatients compared to the control group, which included individuals with normal\nkidney function and no HCV, CMV, or HIV infections.<\/p>\n\n\n\n

The prevalence of HSV-1 infections is\nnotably high among hemodialysis patients. As seen in our results, 84.1% of\nhemodialysis patients tested positive for HSV-1-IgG antibodies, indicating past\nexposure, while 41.6% had detectable HSV-1-IgM antibodies, suggesting recent or\nongoing infection. This is higher compared to the control group, where 66.3%\nwere positive for HSV-1-IgG and 32.6% had HSV-1-IgM antibodies.<\/p>\n\n\n\n

Other studies have shown that in\nimmunocompromised individuals, such as those undergoing hemodialysis, the\nprevalence of HSV infections might be higher due to the altered immune\nresponses [1, 8]. HSV infections in patients undergoing hemodialysis can\npresent with more frequent or severe episodes, contributing to a higher\nprevalence of IgM antibodies 7,13,14<\/sup>. <\/p>\n\n\n\n

There are several factors that contribute\nto the increased prevalence of HSV-1 infections in hemodialysis patients. Hemodialysis\npatients often have compromised immune systems due to uremia, malnutrition, and\nother coexisting conditions, which increases their susceptibility to\ninfections, including HSV-111,12,23<\/sup>. <\/p>\n\n\n\n

 Regular\nvisits to healthcare facilities for dialysis and potential exposure to\ninfectious agents in these settings also increase the risk of HSV-1 infection7,13,16<\/sup>.\nDialysis patients often have skin changes and immune dysfunction that can\nfacilitate HSV-1 entry and replication14,21<\/sup>. The presence of\nHSV-1-IgM antibodies in hemodialysis patients suggests recent infection, which\nmay present as oral lesions or, less commonly, as more severe manifestations\nlike encephalitis or disseminated disease12,15<\/sup>. HSV-1 can cause\nserious complications, including encephalitis, particularly in\nimmunocompromised individuals 2,13,16<\/sup>.<\/p>\n\n\n\n

 Across\nall age groups, both HSV-1 IgG and HSV-1 IgM positivity are consistently higher\nin the hemodialysis group compared to the control group. The seroprevalence of\nHSV-1 IgG increases with age, reflecting more lifetime exposure to HSV-1. For\ninstance, IgG positivity in the 55-65 age range is 44.1% in the hemodialysis\ngroup compared to 42.1% in the control group. Additionally, the highest\nproportion of IgM-positive cases is seen in the 55-65 age group among\nhemodialysis patients (49.1%), suggesting increased viral reactivation or new\ninfections in older patients, which is consistent with other studies showing\nolder age as a risk factor for viral reactivation. These findings align with\nprevious research highlighting that as age increases, the likelihood of viral\ncoinfections, including HSV-1, also rises due to cumulative exposure and a\nweakened immune system25,26<\/sup>. Older patients, particularly those with\ncompromised health, such as those undergoing hemodialysis, are more susceptible\nto reactivation of latent viral infections because of declining immune function\n18,22,24<\/sup>.<\/p>\n\n\n\n

  Females\nin the hemodialysis group exhibit higher IgG and IgM positivity rates compared\nto males. For example, in the 55-65 age group, IgG positivity is 27% for\nfemales compared to 17.1% for males. A similar pattern is observed for IgM.\nThese gender differences in HSV-1 seroprevalence are consistent with research\nshowing that women may have higher rates of infection, possibly due to\ndifferences in immune response. These findings align with previous research\nhighlighting that hormonal and immunological differences between males and\nfemales may influence the susceptibility and response to viral infections,\nincluding HSV-1 17.20<\/sup>.<\/p>\n\n\n\n

 The\ncontrol group shows consistently lower seroprevalence rates for both IgG and\nIgM across all age and gender groups compared to the hemodialysis group. This\ndifference highlights the increased susceptibility of hemodialysis patients to\nboth past and recent infections, reinforcing the need for regular monitoring\nand preventive strategies in this population.<\/p>\n\n\n\n

The immunosuppressed state of hemodialysis patients can lead to recurrent HSV infections, which are often more severe and harder to manage compared to those in immunocompetent individuals 19, 21<\/sup>. <\/p>\n\n\n\n

Conclusion<\/strong><\/p>\n\n\n\n

The findings of this study reveal a\nsignificant prevalence of HSV infection among Egyptian hemodialysis patients.\nThe seroprevalence of HSV-1 was found to be higher compared to the general\npopulation, emphasizing the vulnerability of this group to HSV infection<\/p>\n\n\n\n

The higher prevalence of HSV-1-IgG antibodies\namong hemodialysis patients indicates a greater historical exposure to HSV-1.\nThe elevated levels of HSV-1-IgM antibodies in the same group suggest ongoing\nor recent infections, potentially exacerbated by their immunocompromised state.\n<\/p>\n\n\n\n

These findings highlight the significant\nburden of HSV infection among hemodialysis patients. The findings underscore\nthe importance of considering HSV infection in the differential diagnosis of\nclinical presentations in this population and emphasize the need for proactive\nmeasures to prevent and manage HSV infections effectively. By addressing the\nunique challenges faced by hemodialysis patients, we can strive towards\nimproving their overall health outcomes and quality of life.<\/p>\n\n\n\n

Acknowledgment<\/strong><\/p>\n\n\n\n

The author expresses sincere gratitude to Dr. Mohamed Saleh Alhadi, a Biochemistry specialist at the Central Lab, Wadii Al-Neil Hospital, for his supervision of the practical aspects of the research. Furthermore, the author is deeply appreciative of the hospital managers mentioned in this paper for granting permission to collect blood samples.<\/p>\n\n\n\n

Conflict of Interest<\/strong> <\/p>\n\n\n\n

The author does not have any conflict of interest <\/p>\n\n\n\n

Funding Sources<\/strong><\/p>\n\n\n\n

The author received no financial support for the research, authorship, and\/or publication of this article.<\/p>\n\n\n\n

Data Availability Statement<\/strong><\/p>\n\n\n\n

This statement does not apply\nto this article.<\/p>\n\n\n\n

Ethics statement<\/strong><\/p>\n\n\n\n

The study protocol was approved by the Ethics Review Committee of Ain\nShams University, Cairo, Egypt.<\/p>\n\n\n\n

Informed Consent Statement <\/strong><\/p>\n\n\n\n

All participants were enrolled following written informed consent, <\/p>\n\n\n\n

Authors\u2019 Contribution<\/strong><\/p>\n\n\n\n

The sole author was responsible for the conceptualization, methodology,\ndata collection, analysis, writing, and final approval of the manuscript<\/p>\n\n\n\n

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