Herpesviruses in etiopathogenesis of aggressive periodontitis: A meta-analysis based on case-control studies

<div><p>Objective</p><p>Previous studies have found that herpesviruses are associated with aggressive periodontitis (AgP). However, these findings are controversial. This meta-analysis was aimed at clarifying the association between herpesviruses and AgP.</p><p>Methods</p><p>We identified eligible case–control studies evaluating the association between herpesviruses and AgP from PubMed and Embase databases in October 2015. Original data were extracted and quality assessment was done. Overall odds ratios (ORs) and 95% confidence intervals (CIs) were estimated. Random-effects model was determined. The stability was evaluated by sensitivity analysis. Finally, Egger’s funnel plot was used to investigate the publication bias.</p><p>Results</p><p>Twelve case-control studies involving 322 patients and 342 controls were included in the present meta-analysis. The included case-control studies were assessed as high quality. The quantitative synthesis results for Epstein–Barr virus (EBV) showed significance (10 studies: <i>p</i> = 0.0008, OR = 6.11, 95% CI = 2.13–17.51); nevertheless, evidence of publication bias for EBV was considerable (EBV: Egger’s test, <i>p</i><0.001). Human cytomegalovirus (HCMV) and Herpes simplex virus type 1 (HSV-1) had significant association with AgP (12 studies for HCMV: <i>p</i> = 0.009, OR = 3.63, 95% CI = 2.15–6.13; 4 studies for HSV-1: <i>p</i><0.001, OR = 19.19, 95% CI = 4.16–79.06). Sensitivity analyses showed the results yielded consistency, and no significant publication bias was observed for HCMV. The association between Herpes simplex virus type 2 (HSV-2) and AgP was inconclusive (2 studies: <i>p</i> = 0.20, OR = 3.46, 95% CI = 0.51–23.51).</p><p>Conclusion</p><p>This meta-analysis suggests that HCMV and HSV-1 are significantly associated with AgP. However, due to the heterogeneity among studies these conclusions should be cautiously interpreted. There is insufficient evidence to draw any conclusion between EBV, HSV-2 and AgP based on the currently limited data.</p></div

Flow chart for the study selection process.

<p>Flow chart for the study selection process.</p

Forest plot of the association between herpesviruses and risk of chronic periodontitis (CP): (A) EBV and CP risk, (B) HCMV and CP risk, (C) HSV and CP risk.

<p>Forest plot of the association between herpesviruses and risk of chronic periodontitis (CP): (A) EBV and CP risk, (B) HCMV and CP risk, (C) HSV and CP risk.</p

Sensitivity analysis of the association between herpesviruses and risk of chronic periodontitis (CP): (A) EBV and CP risk, (B) HCMV and CP risk.

<p>Sensitivity analysis of the association between herpesviruses and risk of chronic periodontitis (CP): (A) EBV and CP risk, (B) HCMV and CP risk.</p

Forest plots of the association between herpesviruses and risk of AgP.

<p>(A) EBV and AgP risk, (B) HCMV and AgP risk, (C) HSV-1 and AgP risk, (D) HSV-2 and AgP risk.</p

Sensitivity analysis of the association between herpesviruses and risk of AgP.

<p>(A) EBV and AgP risk, (B) HCMV and AgP risk, (C) HSV-1 and AgP risk.</p

Egger’s funnel plot of the association between herpesviruses and risk of AgP.

<p>(A) EBV and AgP risk, (B) HCMV and AgP risk, (C) HSV-1 and AgP risk.</p

The characteristics of studies included in the meta-analysis.

<p>The characteristics of studies included in the meta-analysis.</p