Herpes Zoster Risk Declines Among HIV-Positive Patients

Patients with HIV are at increased risk for herpes zoster, though the incidence of herpes zoster in this population has declined since the introduction of combined antiretroviral therapy, according to findings published in Clinical Infectious Diseases.

Herpes zoster (HZ) has declined among human immunodeficiency virus (HIV)-positive patients since the introduction of combined antiretroviral therapy (cART), but remains high in the general population, according to findings published in Clinical Infectious Diseases.

Researchers from the Institut Pierre Louis d’Epidémiologie et de Santé Publique in Paris studied HZ incidence and risk factors among patients recruited from the French Hospital Database on HIV between 1992 and 2011. The researchers wrote that recently, studies have indicated that there is a decrease in the incidence of HZ among HIV-positive patients since the cART era, and that their research would contribute to the void that is currently in the research field.

The researchers found a total of 7,167 incidents of HZ diagnosed among 91,044 individuals, but the incidence had declined significantly when broken down over the years. From 1992 to 1996, there were 2,955 cases per 100,000 person years, but between 2009 and 2011, there were 628 cases per 100,000 person years. The risk of HZ was associated with low CD4 cell counts, high HIV RNA levels, low CD4/ CD8 ratios, and prior AIDS infection. For the general population, between 2005 and 2008, the risk for HZ increased with age, which was the opposite of the HIV positive population.

The researchers attributed this significant decline to the introduction of cART. However, the risk for HZ was higher in HIV positive patients, particularly those aged 15 to 44 years. For antiretroviral therapy (ART) naïve patients, there was a moderate increase for the risk of HZ in the first 6 months after the introduction of cART, with a peak at 3 months from baseline. After the adjustment for current CD4 cell counts, however, that no longer was statistically significant.

“The risk of HZ has declined markedly among HIV infected patients in the cART era, but remains 3 times higher than in the general population,” the authors wrote. “The risk increases moderately during the first 6 months of cART.”