{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T13:33:26Z","timestamp":1790948006578,"version":"4.1.0"},"reference-count":21,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T00:00:00Z","timestamp":1772496000000},"content-version":"unspecified","delay-in-days":61,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Lupus Sci Med"],"accepted":{"date-parts":[[2026,2,15]]},"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Systemic lupus erythematosus (SLE) is associated with increased susceptibility to infections, including herpes zoster (HZ), due to the immune dysregulation experienced and frequent use of immunosuppressive therapy. Data on HZ incidence and risk factors in SLE patients from Southeast Asia remain limited. This study determines the incidence and clinical risk factors of HZ among adult patients with SLE in a tertiary referral centre in Indonesia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective cohort study was conducted among adult SLE patients with at least 6\u2009months of follow-up. Participants were recruited through systematic random sampling from an allergy-immunology outpatient clinic and followed for a total of 733 person-years (median 5.6 years). HZ history was assessed via structured interviews aided by clinical photographs and subsequently confirmed by medical records. The incidence rate was calculated per 1000 person-years. Bivariate and multivariate binomial regression analyses were used to identify independent predictors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 130 patients were enrolled, with one patient declining. The cumulative incidence of HZ was 16.5% (21\/130 patients), with an incidence rate of 28.7 per 1000 person-years. Multivariate analysis identified disease duration of \u22641 year (RR: 3.23; 95%\u2009CI 1.58 to 6.63; p=0.001) and mycophenolate use (RR: 3.23; 95%\u2009CI 1.18 to 8.87; p=0.023) as independent risk factors. Other variables, including corticosteroid dose and comorbidities, were not found to be significantly associated with HZ.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The incidence of HZ in this Southeast Asian SLE cohort was high, particularly in patients with recent diagnoses and those receiving mycophenolate. These findings highlight subgroups of patients who may be at increased risk and underscore the need for further prospective studies to better define causal pathways and inform preventive strategies in settings with limited access to zoster vaccination.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/lupus-2025-001797","type":"journal-article","created":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T15:25:14Z","timestamp":1772551514000},"page":"e001797","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["High incidence of herpes zoster among SLE patients in Indonesia: a retrospective cohort study"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8403-4616","authenticated-orcid":false,"given":"Muhammad Reza","family":"Febriliant","sequence":"first","affiliation":[{"name":"Internal Medicine, Universitas Indonesia Fakultas Kedokteran, Jakarta, Indonesia"},{"name":"Internal Medicine, Syiah Kuala University Faculty of Medicine, Banda Aceh, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6650-0559","authenticated-orcid":false,"given":"Evy","family":"Yunihastuti","sequence":"additional","affiliation":[{"name":"Internal Medicine, Universitas Indonesia Fakultas Kedokteran, Jakarta, Indonesia"},{"name":"Internal Medicine, Hospital Dr Cipto Mangunkusumo, Central Jakarta, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadia Ayu","family":"Mulansari","sequence":"additional","affiliation":[{"name":"Internal Medicine, Universitas Indonesia Fakultas Kedokteran, Jakarta, Indonesia"},{"name":"Internal Medicine, Hospital Dr Cipto Mangunkusumo, Jakarta, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pringgodigdo","family":"Nugroho","sequence":"additional","affiliation":[{"name":"Internal Medicine, Hospital Dr Cipto Mangunkusumo, Jakarta, Indonesia"},{"name":"Internal Medicine, University of Indonesia, Depok, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hamzah","family":"Shatri","sequence":"additional","affiliation":[{"name":"Internal Medicine, Universitas Indonesia Fakultas Kedokteran, Jakarta, Indonesia"},{"name":"Internal Medicine, Hospital Dr Cipto Mangunkusumo, Jakarta, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sukamto","family":"Koesnoe","sequence":"additional","affiliation":[{"name":"Internal Medicine, Universitas Indonesia Fakultas Kedokteran, Jakarta, Indonesia"},{"name":"Internal Medicine, Hospital Dr Cipto Mangunkusumo, Jakarta, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rudy","family":"Hidayat","sequence":"additional","affiliation":[{"name":"Internal Medicine, Universitas Indonesia Fakultas Kedokteran, Jakarta, Indonesia"},{"name":"Internal Medicine, Hospital Dr Cipto Mangunkusumo, Jakarta, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonard","family":"Nainggolan","sequence":"additional","affiliation":[{"name":"Internal Medicine, Universitas Indonesia Fakultas Kedokteran, Jakarta, Indonesia"},{"name":"Internal Medicine, Hospital Dr Cipto Mangunkusumo, Jakarta, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,3,3]]},"reference":[{"key":"2026030307250814000_13.1.e001797.1","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1007\/s13555-024-01101-7","article-title":"Herpes Zoster Recurrence: A Narrative Review of the Literature","volume":"14","author":"Parikh","year":"2024","journal-title":"Dermatol Ther (Heidelb)"},{"key":"2026030307250814000_13.1.e001797.2","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1097\/01.JAA.0000892712.73041.ae","article-title":"Herpes zoster: A primary care approach to diagnosis and treatment","volume":"35","author":"Kelley","year":"2022","journal-title":"JAAPA"},{"key":"2026030307250814000_13.1.e001797.3","doi-asserted-by":"crossref","DOI":"10.3390\/v14020192","article-title":"Herpes zoster: A Review of Clinical Manifestations and Management","volume":"14","author":"Patil","year":"2022","journal-title":"Viruses"},{"key":"2026030307250814000_13.1.e001797.4","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/jiab387"},{"key":"2026030307250814000_13.1.e001797.5","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1097\/01.JAA.0000694948.01963.f4","article-title":"Infectious disease considerations in immunocompromised patients","volume":"33","author":"McGrath","year":"2020","journal-title":"JAAPA"},{"key":"2026030307250814000_13.1.e001797.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2007.08.046"},{"key":"2026030307250814000_13.1.e001797.7","doi-asserted-by":"crossref","first-page":"1553","DOI":"10.1007\/s40121-023-00822-0","article-title":"Systematic Literature Review of Herpes Zoster Disease Burden in Southeast Asia","volume":"12","author":"San Martin","year":"2023","journal-title":"Infect Dis Ther"},{"key":"2026030307250814000_13.1.e001797.8","doi-asserted-by":"crossref","DOI":"10.1136\/lupus-2021-000574","article-title":"Herpes zoster in SLE: prevalence, incidence and risk factors","volume":"9","author":"Kwan","year":"2022","journal-title":"Lupus Sci Med"},{"key":"2026030307250814000_13.1.e001797.9","doi-asserted-by":"crossref","first-page":"1019","DOI":"10.1007\/s10067-022-06450-2","article-title":"Prevalence and risk factors of herpes zoster infection in patients with rheumatic diseases not receiving biologic or targeted therapies","volume":"42","author":"Mok","year":"2023","journal-title":"Clin Rheumatol"},{"key":"2026030307250814000_13.1.e001797.10","first-page":"6222","article-title":"Herpes zoster in patients with systemic lupus erythematosus: Clinical features, complications and risk factors","volume":"14","author":"Chen","year":"2017","journal-title":"Exp Ther Med"},{"key":"2026030307250814000_13.1.e001797.11","doi-asserted-by":"crossref","DOI":"10.3390\/vaccines9040325","article-title":"Humoral Immunity to Varicella Zoster Virus in Patients with Systemic Lupus Erythematosus and Rheumatoid Arthritis Compared to Healthy Controls","volume":"9","author":"Krasselt","year":"2021","journal-title":"Vaccines (Basel)"},{"key":"2026030307250814000_13.1.e001797.12","doi-asserted-by":"publisher","DOI":"10.1158\/1055-9965.EPI-12-0815"},{"key":"2026030307250814000_13.1.e001797.13","first-page":"764","article-title":"Herpes Zoster Infections in Solid-Organ Transplant Recipients","volume":"21","author":"Sar\u0131","year":"2023","journal-title":"Exp Clin Transplant"},{"key":"2026030307250814000_13.1.e001797.14","doi-asserted-by":"crossref","DOI":"10.3892\/br.2023.1636","article-title":"Disease duration and herpes zoster infection related to neutropenia in patients with systemic lupus erythematosus","volume":"19","author":"Tipsing","year":"2023","journal-title":"Biomed Rep"},{"key":"2026030307250814000_13.1.e001797.15","doi-asserted-by":"crossref","DOI":"10.3390\/jcm12113639","article-title":"Steroids in Lupus: Enemies or Allies","volume":"12","author":"Enr\u00edquez-Merayo","year":"2023","journal-title":"J Clin Med"},{"key":"2026030307250814000_13.1.e001797.16","doi-asserted-by":"crossref","DOI":"10.3389\/fimmu.2025.1544218","article-title":"Prevalence, incidence, and risk factors for herpes zoster in systemic lupus erythematosus: a systematic review and meta-analysis","volume":"16","author":"Wang","year":"2025","journal-title":"Front Immunol"},{"key":"2026030307250814000_13.1.e001797.17","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1016\/j.jaad.2015.12.059","article-title":"Immunosuppressive medication use and risk of herpes zoster (HZ) in patients with systemic lupus erythematosus (SLE): A nationwide case-control study","volume":"75","author":"Hu","year":"2016","journal-title":"J Am Acad Dermatol"},{"key":"2026030307250814000_13.1.e001797.18","doi-asserted-by":"crossref","first-page":"145","DOI":"10.3892\/br.2025.2023","article-title":"Efficacy of tacrolimus and other immunosuppressants in the treatment of systemic lupus erythematosus: A systematic review and meta-analysis","volume":"23","author":"Li","year":"2025","journal-title":"Biomed Rep"},{"key":"2026030307250814000_13.1.e001797.19","first-page":"963","article-title":"Comorbidities of systemic lupus erythematosus prior to and following diagnosis in different age-at-onset groups","volume":"31","author":"Yu","year":"2022","journal-title":"Lupus (Los Angel)"},{"key":"2026030307250814000_13.1.e001797.20","doi-asserted-by":"crossref","first-page":"5042","DOI":"10.1093\/rheumatology\/keab538","article-title":"Use of disease-modifying antirheumatic drugs and the subsequent risk of herpes zoster in older adults","volume":"60","author":"Qian","year":"2021","journal-title":"Rheumatology (Oxford)"},{"key":"2026030307250814000_13.1.e001797.21","doi-asserted-by":"crossref","unstructured":"Marra F , Parhar K , Huang B , et al . Risk Factors for Herpes Zoster Infection: A Meta-Analysis. Open Forum Infect Dis 2020;7. doi:10.1093\/ofid\/ofaa005","DOI":"10.1093\/ofid\/ofaa005"}],"container-title":["Lupus Science &amp; Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/lupus-2025-001797","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T15:25:20Z","timestamp":1772551520000},"score":1,"resource":{"primary":{"URL":"https:\/\/lupus.bmj.com\/lookup\/doi\/10.1136\/lupus-2025-001797"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":21,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,3,3]]},"published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1136\/lupus-2025-001797"],"URL":"https:\/\/doi.org\/10.1136\/lupus-2025-001797","relation":{},"ISSN":["2053-8790"],"issn-type":[{"value":"2053-8790","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]}}}