Silent reactivation of Varicella Zoster virus in hemodialysis patients.: A management dilemma.

Objectives: To determine the seroprevalence of Varicella Zoster virus (VZV) immunoglobulin (Ig)G and IgM antibodies among hemodialysis patients (HDP). Additionally, the presence of VZV viral DNA has been investigated for possible reactivation status.

Methods: Sera from 265 individuals were collected and tested. The study was carried out from November 2023 to February 2024. Enzyme linked immunosorbent assay was accomplished to determine the VZV IgG and IgM antibody levels. The viral DNA was tested by qPCR.

Results: We found a significantly higher proportion of Host defense peptides (HDP) have positive antibody levels compared to healthy controls (HC) (92.0% of HDP have positive immune responses compared to 79.1% of HC, p=0.005). Patients with both hypertension and diabetes showed lower VZV seropositivity (25.6%) than those without (74.4%). Only 3 HDP had positive IgG and IgM levels (1.9%, n=3), while 14 patients (100%) had negative IgG and IgM levels. Additionally, all IgM-positive patients appeared to have detectable viral DNA of the VZV.

Conclusion: In conclusion, significantly higher VZV seroprevalence and antibody levels in HDP indicate greater viral exposure than HC. Screening of hemodialysis (HD) to VZV serologically or at the molecular level is most important to avoid the consequences of viral reactivation, especially in those with asymptomatic HDP.