Risk of developing antiphospholipid antibodies following viral infection: a systematic review and meta-analysis

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Abstract

Objective: The objective of this paper is to conduct a systematic review and meta-analysis on the risk of developing elevated antiphospholipid (aPL) antibodies and related thromboembolic and/or pregnancy events following a viral infection. Method: We searched Medline, EMBASE, Web of Science, PubMed ePubs, and Cochrane Central Register of Controlled Trials through June 2016. Independent observational studies of elevated aPL antibodies in patients with a viral infection compared with controls or patients with lupus were included. Results: We analyzed 73 publications for 60 studies. Human immunodeficiency virus (HIV) and hepatitis C virus (HCV) were most commonly reported. Compared with healthy controls, patients with HIV were more likely to develop elevated anticardiolipin (aCL) antibodies (risk ratio (RR) 10.5, 95% confidence interval (CI) 5.6–19.4), as were those with HCV (RR 6.3, 95% CI 3.9–10.1), hepatitis B virus (HBV) (RR 4.2, 95% CI 1.8–9.5), and Epstein-Barr virus (EBV) (RR 10.9 95% CI 5.4–22.2). The only statistically significant increased risk for anti-β2-glycoprotein I (anti-β2-GPI) antibodies was observed in patients with HCV (RR 4.8 95% CI 1.0–22.3). Compared with patients with lupus, patients with HIV were more likely to develop elevated aCL antibodies (RR 1.8, 95% CI 1.3–2.6), and those with EBV, elevated anti-β2-GPI antibodies (RR 2.2, 95% CI 1.3–3.9). Thromboembolic events were most prevalent in patients with elevated aPL antibodies who had HCV (9.1%, 95% CI 3.0–18.1), and HBV (5.9%, 95% CI 2.0–11.9) infections, and pregnancy events were most prevalent in those with parvovirus B19 (16.3%, 95% CI 0.78–45.7). However, compared to virus-infected patients with negative aPL antibodies, the only statistically significant increased risk was observed in those with HCV and positive aPL. Conclusions: Viral infection can increase the risk of developing elevated aPL antibodies and associated thromboembolic events. Results are contingent on the reported information.

Original languageEnglish (US)
Pages (from-to)572-583
Number of pages12
JournalLupus
Volume27
Issue number4
DOIs
StatePublished - Apr 1 2018

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Keywords

  • Antiphospholipid syndrome
  • anticardiolipin antibodies
  • infection
  • meta-analysis
  • observational studies
  • systematic review
  • thromboembolic events

ASJC Scopus subject areas

  • Rheumatology

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