Association between herpes simplex virus type 2 infection and 1-year risk of ischemic stroke recurrence: a prospective cohort study

Objective To investigate the association between herpes simplex virus type 2 (HSV-2) infection and 12-month recurrence of acute ischemic stroke (AIS).Methods A prospective cohort study was conducted, enrolling 286 patients with AIS from January 2019 to December 2023. Serum HSV-2-immunoglobulin M (IgM) levels were measured upon admission. Based on these levels, patients were categorized into two groups: the HSV-2-IgM (+) group, consisting of 72 patients, and the HSV-2-IgM(-) group, with 214 patients. Follow-up lasted 12 months, and the primary outcome was stroke recurrence. Logistic regression models were employed to evaluate whether HSV-2-IgM positivity was an independent predictor of AIS recurrence. Additionally, receiver operating characteristic (ROC) curve analysis was performed to determine the optimal cut-off value of serum HSV-2-IgM concentration for predicting AIS recurrence.Results The recurrence rate of AIS was significantly higher in the HSV-2-IgM (+) group compared to the HSV-2-IgM (-) group (p = 0.0016). Multivariate Logistic regression analysis indicated that HSV-2-IgM positivity was an independent risk factor for AIS recurrence. Moreover, the 12-month recurrence risk for AIS patients with HSV-2-IgM positivity was approximately four times higher than that of patients with HSV-2-IgM negativity (adjusted odds ratio [OR] = 4.3, 95% confidence interval [CI]: 2.26 - 9.43, p = 0.0002). Furthermore, the area under the ROC curve for HSV-2-IgM was 0.758, suggesting that a serum HSV-2-IgM concentration of 4.135 PEIU/ml could serve as a threshold for predicting ischemic stroke recurrence.Conclusion This study reveals that HSV-2-IgM positivity significantly increases the risk of AIS recurrence within 12 months. Additionally, a serum HSV-2-IgM concentration of 4.135PEIU/ml can be utilized as a reference indicator for predicting stroke recurrence.