HIV: Herpes Zoster is down, but not out

  • Gilbert L & al.
  • Clin Infect Dis
  • 18 Dec 2018

  • curated by Liz Scherer
  • Clinical Essentials
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Takeaway

  • Herpes Zoster (HZ) rates in people living with HIV (PLWH) continue to decline but remain roughly 3 times higher than in the general US population.

Why this matters

  • Offer/discuss HZ vaccination with HIV-infected patients.
  • Availability of recombinant subunit vaccine should eliminate concerns regarding live attenuated vaccine use.

Key results

  •  Overall HZ incidence has declined significantly over time, from 3.2 cases (95% CI, 3-3.5) before 1996 to 0.9 cases (95% CI, 0.7-1.1) in 2011-2016, respectively (P=.001).
  • 8% (234/2954) participants had first HZ episode post-2001; at diagnosis, median age, CD4 cell count, viral load (VL) were 38.8 (interquartile range [IQR], 30.9-45.8) years, 459 cells/mL (IQR, 333-637), 1950 copies/mL (IQR, 50-19,023).
    • Median time from antiretroviral therapy (ART) initiation to HZ diagnosis was 5.6 (IQR 2.6-9.2) years; 76.5% of HZ cases were receiving ART at time of diagnosis.
  • 9% (21/234) had subsequent episode, 3% (7/234) were hospitalized.
  • Delayed ART initiation (HR, 1.04/year delay; 95% CI, 1.01-1.09), higher VL (HR, 1.76/log increase, 95% CI, 1.56-1.99) were independently associated with HZ.

Study design

  • Retrospective cohort analysis of HZ incidence, risk factors among US Military HIV Natural History Study participants.
  • Funding: National Institute of Allergy and Infectious Diseases.

Limitations

  • Retrospective.
  • Limited generalizability.

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