Herpes Zoster Among Persons Living With HIV in the Current Antiretroviral Therapy Era

Departments of *Medicine †Neurology, Johns Hopkins University School of Medicine, Baltimore, MD.
JAIDS Journal of Acquired Immune Deficiency Syndromes (Impact Factor: 4.56). 07/2012; 61(2):203-7. DOI: 10.1097/QAI.0b013e318266cd3c
Source: PubMed


: Previously, herpes zoster (HZ) was found to occur at a higher rate in the HIV population than the general population. However, there are limited data about the incidence, risk factors, and clinical outcomes of HZ in the current antiretroviral therapy (ART) era.
: We identified HZ episodes in an urban HIV clinic cohort between 2002 and 2009. Three controls were matched to each case, and conditional logistic regression was used to assess for risk factors associated with incident HZ cases. Logistic regression was used to assess for factors associated with complicated HZ.
: One hundred eighty-three new HZ cases were identified in 4353 patients with 19,752 person-years (PY) of follow-up-an incidence rate 9.3/1000 PY. Cases were majority men (62%) and African American (75%), with a mean age of 39 years (interquartile range, 32-44 years). Fifty patients (28%) had complicated HZ with 12% developing postherpetic neuralgia. In multivariate regression, factors associated with the increased risk of HZ were having started ART within 90 days of the episode [adjusted odds ratio (AOR), 4.02; 95% confidence interval (CI), 1.31 to 12.41], having a viral load of >400 copies per milliliter (AOR, 1.49; 95% CI, 1.00 to 2.24), and having a CD4 <350 cells per cubic millimeter (AOR, 2.46; 95% CI, 1.42 to 4.23) or 350 to 500 cells per cubic millimeter (AOR, 2.02; 95% CI, 1.14 to 3.57) as compared with CD4 >500 cells per cubic millimeter.
: The incidence of HZ is lower than previously reported in HIV cohorts but remains higher than the general population. Over one fourth of patients developed complicated HZ, which is remarkable given the young age of our population. Risk factors for HZ include markers of poor immune function, suggesting that appropriate ART may reduce the burden of HZ in this population.

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Available from: Michael Polydefkis, Oct 13, 2014
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    • "It is common in the United States, with more than one million cases reported annually (Blank, Polydefkis, Moore, & Gebo, 2012). While most cases of zoster (also referred to as shingles) in the general population occur in adults 60 years of age and older, the infection can be seen in HIV-infected adults at any age and often is related to immune suppression (greatest risk at CD41 T cell counts , 350 cells/ mm 3 ) and during immune reconstitution following the initiation of ART (Blank et al., 2012). Zoster manifests as a painful skin rash limited to one dermatome of the body and usually resolves within 1-2 weeks. "
    The Journal of the Association of Nurses in AIDS Care: JANAC 03/2015; 26(2):201-7. DOI:10.1016/j.jana.2014.11.006 · 1.27 Impact Factor
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    • "The waning of virus-specific cell-mediated immunity (CMI) is believed to be a major cause of VZV reactivation. This can occur as part of the aging process or as a result of medical conditions associated with immunosuppression such as HIV infection, transplantation, cancer, and immune mediated diseases [4–9]. At the population level, about two-thirds of HZ cases occur in adults 50 years and older [10] and approximately 90 % of HZ cases occur among otherwise immunocompetent individuals (of all ages) without any identified immunosuppressive condition or treatment [11, 12]. "
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    ABSTRACT: Purpose: To assess whether diabetes is a risk factor for herpes zoster (HZ). Methods: We conducted a retrospective cohort study using the Integrated Health Care Information Services database, during the period 1997-2006. A type I diabetes cohort, a type II diabetes cohort and two non-diabetic cohorts matched for date of enrolment and duration of follow-up were defined. HZ and diabetes were defined using a combination of ICD-9 and prescription drug codes. Individuals with immunosuppressive conditions or treatments were excluded. Cox Proportional Hazards regression analysis using a stepwise method with backward elimination was applied to estimate the hazard ratios (HR) of HZ, including age, gender and co-morbidities as covariates. Results: The study population comprised 380,401 and 20,397 type II and type I diabetic subjects respectively, as well as 1,521,604 and 81,588 matched controls. The median ages were 55, 35, 33 and 29 years, respectively. HZ incidence was 4.59, 2.13, 1.97, and 1.82 per 1,000 person-years, respectively. There was no evidence of an impact of type I diabetes on the risk of HZ. Type II diabetes was associated with an increased risk for HZ in subjects ≥ 65 (HR 3.12; 95 % CI 2.77-3.52, adjusted for gender) and in subjects between 40 and 64 (HR 1.51; 95 % CI 1.42-1.61) years of age. Cardiac disease and chronic pulmonary disease were also risk factors (HR 1.92; 95 % CI 1.73-2.13 and HR 1.52; 95 % CI 1.38-1.67) in non-diabetic subjects. Conclusions: This study suggests that type II diabetes is associated with an increased risk of developing HZ, which was particularly high in adults 65 years and older and moderately increased in adults under 65 years of age.
    Infection 06/2014; 42(4). DOI:10.1007/s15010-014-0645-x · 2.62 Impact Factor
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    • "Although French Guiana is in the tropics where the proportion of persons infected by VSV is lower[14], the reported incidences of herpes zoster in HIV patients were of similar magnitude as the incidences described in the USA and spain [2,8,15-17]. The incidence tended to decrease since the years before HAART was available, as described elsewhere[18]. "
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    ABSTRACT: A retrospective cohort study was conducted on 1541 HIV-infected patients to determine variables associated with the incidence of herpes zoster. A single failure Cox model showed that herpes zoster incidence increased following the first 6 months of antiretroviral treatment adjusted hazard ratio (AHR)=5 (95%CI=2.6-9.2), P<0.001; in the >60 years age group AHR=2 (95%CI=1-4), P=0.04; in patients in the top CD8 quartile AHR=2.1 (95%CI=1.3-3.6), P<0.001; and in patients previously reported to use crack cocaine AHR=5.9, (95%CI=1.4-25), P=0.02. Herpes zoster incidence increased in patients with CD4 counts<500 per mm(3) and gradually declined since 1992-1996, with AHR=0.3 (95%CI=0.2-0.5), P<0.001 for the 1997-2002 period and AHR=0.24 (95%CI=0.14-0.4), P<0.001 for the 2002-2008 period. Contrary to what has been described elsewhere, there was no specific effect of protease inhibitors on herpes zoster incidence. The present study is the first to suggest that crack cocaine is associated with an increased incidence of herpes zoster. The neurological or immunological effects of crack are discussed.
    PLoS ONE 11/2013; 8(11):e80187. DOI:10.1371/journal.pone.0080187 · 3.23 Impact Factor
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