Herpes Zoster Rates Continue to Decline in People Living With Human Immunodeficiency Virus but Remain Higher Than Rates Reported in the General US Population

Gilbert, Laura; Wang, Xun; Deiss, Robert; Okulicz, Jason F.; Maves, Ryan C; Schofield, Christina; Ferguson, Tomas; Whitman, Timothy J.; Kronmann, Karl; Agan, Brian K.; Ganesan, Anuradha

doi:10.1093/cid/ciy1041

Cited by 10 publications

(11 citation statements)

References 13 publications

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“…A gradient for these factors was noted, as worse markers were related to increased risk of hospitalizations over an ED/UC visit. This is generally consistent with the published literature [ 15 , 19 ]. Even among patients who did not experience VZV-related illness during the study period, there was a significant proportion of patients (37%) who were not actively on ART, illustrative of potential challenges with follow-up in our cohort of PWH that may pose an additional barrier to increasing HZ vaccine uptake.…”

Section: Discussionsupporting

confidence: 93%

“…Due to small numbers who received HZ vaccines, we cannot document their ability to reduce incidence or complications of VZV infection in PWH, and, while presumed, it requires further study. We note that, as reported by others, the age at presentation or our PWH was younger (median age, 41 years, with 82% presenting <50 years) compared with a median age of 59 typically seen in general population [ 14 , 15 , 19 , 22 ]. This suggests that earlier timing of HZ immunization in PWH is appropriate [ 8 , 9 , 14 ].…”

Section: Discussionsupporting

confidence: 76%

“…The uptake of both live and conjugate vaccines for HZ has been studied in PWH, with 1 study having examined live zoster vaccine uptake and subsequent HZ incidence and among PWH in the US Military. They reported low vaccine uptake, with only 11% of patients being immunized, and further vaccine uptake of 3.4% following HZ [ 15 ]. Low vaccine uptake has been suggested to be related to limited provider awareness regarding the higher rates of VZV incidence in PWH, unclear practice guidelines surrounding vaccination in PWH, and provider confidence in PWH care [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

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Seropositivity, Risks, and Morbidity From Varicella-Zoster Virus Infections in an Adult PWH Cohort From 2000–2020

Zou

Krentz

Lang

et al. 2022

Open Forum Infectious Diseases

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Background Varicella-zoster virus (VZV) infection disproportionately affects people with HIV (PWH) primarily presenting as Herpes Zoster. However, VZV seroprevalence, its association with zoster, and clinical outcomes, remain understudied in era of modern antiretroviral therapy (ART). We assessed VZV seroprevalence, rates of VZV illness, and associated healthcare costs in a large PWH cohort over 20 years. Methods We performed retrospective chart reviews of patients followed at a regional HIV clinic from 1/1/2000-12/31/2020. Serological, immunization, clinical, and costing data were extracted from in-house databases. VZV-related inpatient admissions, emergency department (ED), and urgent care (UC) visits were identified using relevant ICDN codes and validated where possible by two-physicians. Healthcare utilization costs were adjusted to 2020 Cdn$. Results Of 3006 PWH, VZV serology was available for 2628; of these 2503 (95.2%) were seropositive. Only 39% of known seronegative patients were subsequently immunized for varicella. During 29,768 years of patient follow-up, 38 hospitalizations and 138 ED/UC visits due to VZV infection were identified. Most occurred in VZV seropositive PWH <50 years of age (82%), unimmunized (99.2%) and not on ART (64.8%). Nearly 25% of hospitalizations were due to laboratory confirmed VZV meningitis/encephalitis. The average admission cost was $33,001 Canadian dollars (Cdn$); the total measured cost of VZV illness was $1,258,718 Cdn$. Discussion Despite ART and vaccines for chickenpox and shingles, VZV still caused significant costs and morbidity for PWH, occurring at younger ages and often as encephalitis/meningitis. Supporting ART adherence may reduce VZV illness and hospitalization costs in PWH, and the cost-effectiveness of expanding shingles vaccine use warrants further study.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 99%

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Seropositivity, Risks, and Morbidity From Varicella-Zoster Virus Infections in an Adult PWH Cohort From 2000–2020

Zou

Krentz

Lang

et al. 2022

Open Forum Infectious Diseases

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“…Accordingly, while the incidence of HZ ranges between 3-5/1000 person-years in the general population, 16 the incidence in HIV-infected individuals reached 32/1000 person-years in the pre-antiretroviral therapy (ART) era, and remains at 10-11/1000 person-years, even in the ART era. 4,17,18 Solid organ transplant recipients represent a distinct group of IC patients. To prevent allograft rejection, their immune systems are suppressed by chronic therapies, resulting in a mixed immunodeficiency, consisting mainly of T-cellmediated immunity impairment.…”

Section: Introductionmentioning

confidence: 99%

“…Accordingly, while the incidence of HZ ranges between 3–5/1000 person-years in the general population, 16 the incidence in HIV-infected individuals reached 32/1000 person-years in the pre-antiretroviral therapy (ART) era, and remains at 10–11/1000 person-years, even in the ART era. 4 , 17 , 18 …”

Section: Introductionmentioning

confidence: 99%

Immune responses to the adjuvanted recombinant zoster vaccine in immunocompromised adults: a comprehensive overview

Dagnew

Vink

Dramé

et al. 2021

Human Vaccines & Immunotherapeutics

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Immunocompromised (IC) persons are at increased risk for herpes zoster (HZ) and its complications, mainly due to impairment of cell-mediated immunity (CMI). The adjuvanted recombinant zoster vaccine (RZV) demonstrated efficacy against HZ in autologous hematopoietic stem cell transplant (auto-HSCT) recipients and hematologic malignancy (HM) patients. We review immune responses to RZV in 5 adult IC populations, 4 of which were receiving multiple, concomitant immunosuppressive medications: auto-HSCT and renal transplant recipients, HM and solid tumor patients, and human immunodeficiency virusinfected adults. Although administered in most cases when immunosuppression was near its maximum, including concomitantly with chemotherapy cycles, RZV induced robust and persistent humoral and, more importantly, CMI responses in all 5 IC populations. Based on the overall clinical data generated in older adults and IC individuals, RZV is expected to provide benefit in a broad adult population at risk for HZ.

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Human Herpesviruses: Varicella and Herpes Zoster

Gnann

2023

Viral Infections of Humans

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Herpes Zoster Rates Continue to Decline in People Living With Human Immunodeficiency Virus but Remain Higher Than Rates Reported in the General US Population

Cited by 10 publications

References 13 publications

Seropositivity, Risks, and Morbidity From Varicella-Zoster Virus Infections in an Adult PWH Cohort From 2000–2020

Seropositivity, Risks, and Morbidity From Varicella-Zoster Virus Infections in an Adult PWH Cohort From 2000–2020

Immune responses to the adjuvanted recombinant zoster vaccine in immunocompromised adults: a comprehensive overview

Human Herpesviruses: Varicella and Herpes Zoster

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