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Herpes zoster incidence higher among patients with HIV
Despite declining significantly in the era of ART, the incidence of herpes zoster among patients with HIV was still three times that of the general population, according to data published in Clinical Infectious Diseases.
“The risk of herpes zoster was associated with the degree of immunodeficiency and was greatly reduced by ART,” researchers from the Institut Pierre Louis d’Epidémiologie et de Santé Publique in Paris, wrote. “In addition, among ART-naive patients, we found that the risk of herpes zoster increased moderately during the first months of ART, before falling sharply thereafter.”
The researchers evaluated the incidence of herpes zoster and risk factors among patients with HIV that were followed in the French Hospital Database on HIV from 1992 to 2011. They compared the incidence in this population with that of the general population from 2005 to 2008, which was determined using the Sentinelles general practitioner surveillance network. They also evaluated the risk for herpes zoster among patients with HIV after initiating ART.
The study included 91,044 patients with HIV for 583,125 person-years at risk. Herpes zoster was diagnosed in 7,167 patients from 1992 to 2011. The incidence rate declined significantly from 2,955 per 100,000 person-years in the pre-ART era (1992-1996) to 628 per 100,000 person-years in the recent ART era (2009-2011). The decline was explained by ART use (RR=0.6; 95% CI, 0.57-0.64). Factors associated with the risk for herpes zoster included low CD4 counts, high HIV RNA levels, low CD4/CD8 ratios and a history of AIDS.
In an analysis of ART-naive patients, the risk for herpes zoster was significantly higher within the first 6 months of ART. In a model that adjusted for current CD4 count and plasma HIV RNA measurement, the risk was significantly higher between 3 months and 6 months of treatment (RR=1.39; 95% CI, 1.16-1.66).
The incidence rate of herpes zoster among the general population from 2005 to 2008 increased with age, contrary to the patients with HIV. After adjusting for sex and age, the risk for herpes zoster was 2.7 times higher among those with HIV. The standardized incidence ratios were highest among patients aged 15 to 44 years.
“The overall decrease in the incidence of herpes zoster among HIV-infected patients in the ART era is probably related to improved immune restoration and viral control,” the researchers wrote. “This trend may continue in the future as ART is initiated earlier and at higher CD4 cell counts, as recommended by most recent guidelines. However, clinicians and patients should be aware that ART transiently increases the risk of herpes zoster during the first 6 months of treatment.”
Disclosure: See the study for a full list of relevant financial disclosures.