Incidence and risk factors of herpes zoster in human immunodeficiency virus-positive patients initiating combination antiretroviral therapy in Taiwan

Lee, Yi‐Chieh; Hung, Chien‐Ching; Tsai, Mao‐Song; Zhang, Junyu; Wu, Pei‐Ying; Yang, Shang-Ping; Luo, Yi; Chang, Hsi-Yen; Liu, Wen-Chun; Sun, Hsin‐Yun; Chang, Shan‐Chwen

doi:10.1016/j.jmii.2016.04.011

Cited by 6 publications

(4 citation statements)

References 21 publications

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“…The included studies were from Asia ( n = 44), Northern America ( n = 20), Europe ( n = 13) and the Middle East ( n = 3). Most studies were from Taiwan ( n = 30) [ 40 , 41 , 43 , 44 , 50 , 54 , 58 – 63 , 68 , 76 – 79 , 81 , 83 – 85 , 87 , 90 , 96 – 98 , 100 , 104 , 105 , 115 ] and the US ( n = 19) [ 36 , 37 , 39 , 46 , 47 , 55 , 57 , 64 , 73 , 75 , 80 , 88 , 89 , 99 , 101 , 102 , 106 , 112 , 113 ]. In sum a total study population of 796,796,295 was included, with 10,904,736 HZ cases reported in the included studies.…”

Section: Resultsmentioning

confidence: 99%

Risk factors for herpes zoster infections: a systematic review and meta-analysis unveiling common trends and heterogeneity patterns

Steinmann,

Lampe,

Grosser

et al. 2024

Infection

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Purpose The burden of herpes zoster (HZ) is substantial and numerous chronic underlying conditions are known as predisposing risk factors for HZ onset. Thus, a comprehensive study is needed to synthesize existing evidence. This study aims to comprehensively identify these risk factors. Methods A systematic literature search was done using MEDLINE via PubMed, EMBASE and Web of Science for studies published from January 1, 2003 to January 1, 2023. A random-effects model was used to estimate pooled Odds Ratios (OR). Heterogeneity was assessed using the I2 statistic. For sensitivity analyses basic outlier removal, leave-one-out validation and Graphic Display of Heterogeneity (GOSH) plots with different algorithms were employed to further analyze heterogeneity patterns. Finally, a multiple meta-regression was conducted. Results Of 6392 considered records, 80 were included in the meta-analysis. 21 different conditions were identified as potential risk factors for HZ: asthma, autoimmune disorders, cancer, cardiovascular disorders, chronic heart failure (CHF), chronic obstructive pulmonary disorder (COPD), depression, diabetes, digestive disorders, endocrine and metabolic disorders, hematological disorders, HIV, inflammatory bowel disease (IBD), mental health conditions, musculoskeletal disorders, neurological disorders, psoriasis, renal disorders, rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and transplantation. Transplantation was associated with the highest risk of HZ (OR = 4.51 (95% CI [1.9–10.7])). Other risk factors ranged from OR = 1.17–2.87, indicating an increased risk for all underlying conditions. Heterogeneity was substantial in all provided analyses. Sensitivity analyses showed comparable results regarding the pooled effects and heterogeneity. Conclusions This study showed an increased risk of HZ infections for all identified factors.

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Section: Resultsmentioning

confidence: 99%

Risk factors for herpes zoster infections: a systematic review and meta-analysis unveiling common trends and heterogeneity patterns

Steinmann,

Lampe,

Grosser

et al. 2024

Infection

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“…However, the only marker of CMI assessed clinically is CD4 count which is associated with development of HZ but not always predictive. For example, a higher prevalence of HZ has been observed in those with VL suppression and CD4 > 750 cells/μL compared to HIV-uninfected persons [ 1 , 7 , 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…Although our study showed no association between VZV antibody levels and clinical HZ in an HIV-infected population, we validated findings from prior studies demonstrating that that lower CD4 count and lack of ART use were risk factors for the development of HZ. Other risk factors described in this population include high VL and prior history of HZ [ 6 , 7 ]. In order to reduce the morbidity associated with HZ in HIV-infected persons, additional clinical markers of risk are needed as well as VZV vaccine safety and efficacy studies in younger patients with preserved CD4 counts.…”

Section: Discussionmentioning

confidence: 99%

“…Cell mediated immunity appears to play a role in preventing HZ, as waning CD4 count is associated with development of HZ [ 1 , 4 ]. Conversely, effective ART results in immune reconstitution and CD4 gains which reduce the risk of VZV reactivation [ 6 , 7 ]. Even though the association between reduced CMI and VZV reactivation has been well established, it remains difficult to predict disease, as it can occur at any CD4 count, and the risk of HZ remains high in the HIV-infected population even in the ART era [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

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Association between quantitative varicella-zoster virus antibody levels and zoster reactivation in HIV-infected persons

Pomerantz

White

et al. 2018

AIDS Res Ther

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BackgroundVaricella-zoster virus (VZV) reactivation is common but difficult to predict in HIV-infected persons.ObjectiveSince qualitative VZV antibodies can determine past VZV disease or vaccination, we evaluated whether quantitative VZV antibody levels over time can predict future zoster.Study designUS Military HIV Natural History (NHS) participants with a zoster diagnosis at least 5 years after HIV diagnosis (n = 100) were included. Zoster-negative controls (n = 200) were matched by age, race, gender, and CD4 count at HIV diagnosis. Repository plasma specimens collected at baseline and prior to zoster diagnosis were evaluated using a quantitative anti-VZV ELISA assay. Differences in quantitative VZV levels were analyzed by Wilcoxon Mann–Whitney and Fisher’s exact tests.ResultsMedian CD4 count at HIV diagnosis was similar for cases and controls (535 [IQR 384–666] vs. 523 [IQR 377–690] cells/μL; p = 0.940), but lower for cases at zoster diagnosis (436 [IQR 277–631] vs. 527 [IQR 367–744] cells/μL; p = 0.007). Antiretroviral therapy (ART) use prior to zoster diagnosis was lower for cases (52.0%) compared to controls (64.5%; p = 0.025). Cases had similar mean VZV antibody levels prior to zoster diagnosis compared to controls [2.25 ± 0.85 vs. 2.44 ± 0.96 index value/optical density (OD) ratio; p = 0.151] with no difference in the change in antibody levels over time (0.08 ± 0.71 vs. 0.01 ± 0.94 index value/OD per year; p = 0.276).ConclusionQuantitative VZV antibody levels are stable in HIV-infected persons and do not predict zoster reactivation. Low CD4 count and lack of ART use appear to be better predictors of future zoster diagnosis.

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Monitoring early developed low bone mineral density in HIV-infected patients by intact parathyroid hormone and circulating fibroblast growth factor 23

Chen

Wang

Lin

et al. 2019

Journal of Microbiology, Immunology and Infection

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Incidence and risk factors of herpes zoster in human immunodeficiency virus-positive patients initiating combination antiretroviral therapy in Taiwan

Abstract: Herpes zoster occurred in 6.5% of HIV-positive Taiwanese patients after initiation of cART, which was associated with prior zoster and baseline CD4 count < 200 cells/μL or baseline PVL > 5 log copies/mL.

Cited by 6 publications

References 21 publications

Risk factors for herpes zoster infections: a systematic review and meta-analysis unveiling common trends and heterogeneity patterns

Risk factors for herpes zoster infections: a systematic review and meta-analysis unveiling common trends and heterogeneity patterns

Association between quantitative varicella-zoster virus antibody levels and zoster reactivation in HIV-infected persons

Monitoring early developed low bone mineral density in HIV-infected patients by intact parathyroid hormone and circulating fibroblast growth factor 23

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