Cytomegalovirus and Epstein–Barr Virus Infection: Two Triggers flaring up Systemic Lupus Erythematosus Patients

Background: Systemic lupus erythematosus (SLE) is an autoimmune, multi-system, chronic inflammatory disease The effect of Cytomegalovirus(CMV) and Epstein-Barr virus(EBV) in triggering SLE has been investigated for many years. Objectives: To study the association of viral load of CMV-EBV in the serum of SLE patients’ with SLE disease parameters. Methodology: 48SLE patients and 40controls were enrolled. Disease activity was assessed using SLE disease activity index (SLEDAI). Quantitation of CMV and EBV-DNA in serum were detected by real-time polymerase chain reaction. Results: Patients were 91.8% females and 8.2%males. Mean age was 26.6±8.0 years, mean disease duration 4.5±3.1 years, and age at onset 22.1±7.8 years. 41.7% of SLE patients had CMV-DNA, 54.2% patients had EBV-DNA. Neither EBV-DNA nor CMV-DNA were found in the healthy controls. Copy numbers of CMV and EBV found in the serum of SLE patients were 26827±25879copies/μl, and 25309±22852copies/μl, respectively. Regarding SLEDAI; 83.3% showed high disease activity. Renal biopsy revealed that, 66.7% of the patients had lupus nephritis; 50% with CMV-DNA, and 56.25% with EBV-DNA. Regarding the association between CMV and EBV with different disease parameters in SLE patients; we found significant associations with: photosensitivity, Raynaud’s and thrombocytopenia (pvalue<0.05). EBV-DNA were significantly associated with: pyuria, oral ulcers, photosensitivity, vasculitis and involvement of nervous system (r=0.43, p=0.002), (r=0.36, p=0.01), (r=0.42, p=0.003), (r=-0.33, p=0.023), (r=0.32, p=0.029) respectively. Conclusions: A high incidence of CMV and EBV was detected in SLE patients with increased viral load. Disease activity of SLE patients is significantly higher in patients infected with CMV and EBV compared to non-infected.