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. 2015 Jun;123(6):590-6.
doi: 10.1289/ehp.1408731. Epub 2015 Jan 30.

Arsenic exposure and prevalence of the varicella zoster virus in the United States: NHANES (2003-2004 and 2009-2010)

Andres Cardenas  1 , Ellen Smit, E Andres Houseman, Nancy I Kerkvliet, Jeffrey W Bethel, Molly L Kile
Affiliations

Arsenic exposure and prevalence of the varicella zoster virus in the United States: NHANES (2003-2004 and 2009-2010)

Andres Cardenas et al. Environ Health Perspect. 2015 Jun.

Abstract

Background: Arsenic is an immunotoxicant. Clinical reports observe the reactivation of varicella zoster virus (VZV) in people who have recovered from arsenic poisoning and in patients with acute promyelocytic leukemia that have been treated with arsenic trioxide.

Objective: We evaluated the association between arsenic and the seroprevalence of VZV IgG antibody in a representative sample of the U.S.

Methods: We analyzed data from 3,348 participants of the National Health and Nutrition Examination Survey (NHANES) 2003-2004 and 2009-2010 pooled survey cycles. Participants were eligible if they were 6-49 years of age with information on both VZV IgG and urinary arsenic concentrations. We used two measures of total urinary arsenic (TUA): TUA1 was defined as the sum of arsenite, arsenate, monomethylarsonic acid, and dimethylarsinic acid, and TUA2 was defined as total urinary arsenic minus arsenobetaine and arsenocholine.

Results: The overall weighted seronegative prevalence of VZV was 2.2% for the pooled NHANES sample. The geometric means of TUA1 and TUA2 were 6.57 μg/L and 5.64 μg/L, respectively. After adjusting for age, sex, race, income, creatinine, and survey cycle, odds ratios for a negative VZV IgG result in association with 1-unit increases in natural log-transformed (ln)-TUA1 and ln-TUA2 were 1.87 (95% CI: 1.03, 3.44) and 1.40 (95% CI: 1.0, 1.97), respectively.

Conclusions: In this cross-sectional analysis, urinary arsenic was inversely associated with VZV IgG seroprevalence in the U.S.

Population: This finding is in accordance with clinical observations of zoster virus reactivation from high doses of arsenic. Additional studies are needed to confirm the association and evaluate causal mechanisms.

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Conflict of interest statement

The authors declare they have no actual or potential competing financial interests.

Figures

Figure 1
Figure 1
Adjusted odds ratios (aORs) from penalized spline models for negative VZV IgG by TUA. (A) TUA1 unweighted. (B) TUA2 unweighted. (C) TUA1 weighted. (D) TUA2 weighted. aORs are based on penalized splines for ln-transformed total arsenic exposure. Models fully adjusted for age, ln-urinary creatinine, sex, race/ethnicity, family poverty–income ratio, BMI classification, and survey cycle. (A) and (B) are unrestricted splines with 95% CIs; (C) and (D) were estimated from weighted models restricted to knots at the 5th, 25th, 50th, and 95th percentiles of exposure. TUA1 = AsIII + AsV + MMA + DMA. TUA2 = Total As – AsC – AsB.
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