Increased prevalence of polyomavirus BK viruria that correlates with thrombocytopenia in patients with systemic lupus erythematosus on intensive immunosuppressive therapy.
The prevalence of polyomavirus BK (BKV) reactivation is high in patients with systemic lupus erythematosus (SLE) on long-term immunosuppressants compared to normal population. However, only a few studies are available for the possible correlation of BKV reactivation and clinical manifestations in SLE patients. In the present study, we tried to correlate BKV viruria, clinical manifestations, laboratory findings, and medications in patients with SLE. The urine BKV viral DNA copies were detected from 95 patients with SLE and 32 healthy volunteers by real-time PCR. We found that the prevalence rate of BKV viruria in SLE patients was significantly higher than normal group (71.6% vs. 18.6%, p < 0.001) as well as the urine BKV DNA viral load (4.74 +/- 3.17 vs. 1.08 +/- 2.33 by log scale, p < 0.001). Interestingly, BKV viruria (+) SLE patients had more thrombocytopenic events than BKV viruria ( - ) group (32.4% vs. 3.7%, p = 0.008 after adjustment by age and sex). The patients with BKV viruria DNA copy number >3,200,000/ml exhibited more thrombocytopenia risk than BKV viruria <==3,200,000 copy number/ml or BKV viruria ( - ). The use of potent immunosuppressants may increase BKV viruria. In a refractory thrombocytoponeic case, the add-on of anti-BKV medication, leflunomide 20 mg/day rapidly decreased BKV viruria and recovered platelet counts. In conclusion, our study demonstrated that patients with SLE had higher prevalence rate of BKV reactivation that is correlated with thrombocytopenic episode. Intensive immunosuppressive therapy in SLE may increase the risk of BKV viruria.
Lu
Ming-Chi
MC
Buddhist Dalin Tzu-Chi General Hospital, Dalin Town, Chia-Yi, Taiwan, ROC.
Yu
Chia-Li
CL
Yin
Wen-Yao
WY
Tung
Chien-Hsueh
CH
Huang
Kuang-Yung
KY
Liu
Su-Qin
SQ
Lai
Ning-Sheng
NS
D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D001739:BK Virus / Q000302:isolation & purification*; D005260:Female; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects*; D007555:Isoxazoles / Q000627:therapeutic use; D000077339:Leflunomide; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D027601:Polyomavirus Infections / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology*; D015995:Prevalence; D012307:Risk Factors; D013921:Thrombocytopenia / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology*; D014556:Urine / Q000821:virology*; D055815:Young Adult
D000998:Antiviral Agents; D007555:Isoxazoles; D000077339:Leflunomide