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Protocol
Epidemiology
Cardiovascular medicine
Infectious diseases
Neurology
The association between human herpesvirus infections and stroke: a systematic review protocol
  1. Harriet J Forbes1,
  2. Laura Benjamin2,3,
  3. Judy Breuer4,
  4. Martin M Brown3,
  5. Sinéad M Langan1,
  6. Caroline Minassian1,
  7. Liam Smeeth1,
  8. Sara L Thomas1,
  9. Charlotte Warren-Gash1
  1. 1Faculty of Epidemiology & Population Health, London School of Hygiene and Tropical Medicine, London, UK
  2. 2Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
  3. 3Department of Brain Repair and Rehabilitation, Stroke Research Centre, UCL Institute of Neurology, University College London, London, UK
  4. 4UCL Division of Infection & Immunity, UCL, London, UK
  1. Correspondence to Harriet J Forbes; harriet.forbes{at}lshtm.ac.uk

Abstract

Introduction After primary infection, human herpesviruses establish latency and persist lifelong. Periodic virus reactivation can lead to serious inflammatory complications. Recent research suggests that herpesvirus reactivation may also be linked to acute stroke. An improved understanding of this relationship is vital to inform public health prevention strategies. We will review the evidence regarding the role of human herpesviruses in triggering stroke.

Methods and analysis A systematic literature review of published and grey literature studies with a human herpesvirus (infection or reactivation) as an exposure and stroke as an outcome will be carried out. Randomised controlled trials, cohort, case–control, case crossover and self-controlled case series designs will be eligible; no restrictions will be placed on publication status, language and geographical or healthcare setting. The Cochrane Central Register of Controlled Trials, Embase, Global Health, Medline, Scopus and Web of Science will be searched from dates of inception to January 2017. A prespecified search strategy of medical subject headings and free text terms (in the title and abstract) for human herpesviruses AND stroke will be used. Two reviewers will independently screen titles and abstracts for eligible studies, followed by full-text screening. The reviewers will then extract data from the eligible studies using standardised, pilot-tested tables and assess risk of bias in individual studies, in line with the Cochrane Collaboration approach. The data will be synthesised in a narrative format, and meta-analyses considered where there are sufficient data. Quality of evidence will be assessed in line with theGrading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.

Ethics and dissemination As this is a systematic review, ethical approval is not required. The results will be submitted for peer-review publication and presented at national conferences. A lay and short summary will be disseminated on appropriate webpages.

PROSPERO registration number CRD42017054502

  • Herpesviruses
  • Epidemiology
  • Infectious diseases
  • Stroke

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

https://doi.org/10.1136/bmjopen-2017-016427

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    Footnotes

    • Contributors HJF contributed to the design of the study, drafted the methods and analysis and revised the protocol following author comments; LB contributed to the design of the study and revised the paper critically; JB contributed to the conception and design of the study and revised the paper critically; MMB contributed to the design of the study and revised the paper critically; SML contributed to the design of the study and revised the paper critically; CM contributed to the design of the study and revised the paper critically; LS contributed to the conception and design of the study and revised the paper critically; SLT contributed to the design of the study and revised the paper critically; CW-G conceived and designed the study, drafted the introduction and made critical comments on the protocol. All authors approved the final version of the protocol.

    • Funding Funded by a Wellcome Trust Intermediate Clinical Fellowship to Dr C. Warren-Gash (201440/Z/16/Z). The funder played no role in developing the protocol. JB receives funding from the NIHR UCL/UCLH BRC. SML is funded by a Wellcome Trust Senior Research Fellowship in Clinical Science(205039/Z/16/Z). CM is supported by a Wellcome Trust Senior Fellowship in Clinical Science (to LS, grant number: 098504/Z/12/Z). LB is supported by NIHR Clinical Lectureship funding. LS is supported by a Senior Clinical Fellowship from Wellcome. MMB’s Chair in Stroke Medicine is supported by the Reta Lila Weston Trust for Medical Research. Part of this work was undertaken at University College London, which received a proportion of funding from the UK Department of Health’s National Institute for Health Research Biomedical Research Centres funding scheme.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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