Incidence and risk factors of herpes zoster among hiv-positive patients in the german competence network for HIV/AIDS (KompNet): a cohort study analysis

Abstract

BackgroundHIV infection is a risk factor for the development of Herpes zoster (HZ) and its complications. Prior to antiretroviral therapy (ART), HZ incidence in HIV-infected individuals ranged from 2.9–5.1/100 person-years. There is limited evidence for the impact of ART on HZ occurrence among HIV-infected adults. We analysed the incidence of, and risk factors for, HZ in a large cohort of German HIV-positive patients.MethodsThe study population was taken from the German KompNet cohort, a nationwide multicenter HIV cohort study. The study population was defined by age (≥ 18 years), year of first positive HIV diagnosis, CD4 values ± 6 months from HIV diagnosis (t0), and month of HZ diagnosis. Incidences were estimated using a Poisson distribution, and uni- and multivariate Cox proportional Hazard ratio (HR) regression models were fitted to identify risk factors for developing an initial HZ episode. Independent variables were sex, age at HIV diagnosis, route of HIV transmission, ART status, CD4 count before HZ episode, immunosuppressive medication, and mode of data documentation (retrospective or prospective).ResultsHZ incidence in the overall study population was 1.2/100 person-years. In a subset of patients for that we were able to examine risk factors the following was observed: We examined 3,757 individuals whose mean age at t0 was 38 years. Of those individuals, 96% were diagnosed with HIV in 1996 or later, with a mean observation time of 5.8 years. HZ episodes (n = 362) were recorded in 326 patients (8.7%), resulting in annual HZ incidences of 1.7/100 person-years overall, and 1.6/100 person-years for initial HZ cases. The main risk factors associated with an initial HZ episode were: not partaking in ART compared with an ART regimen containing a non-nucleoside reverse-transcriptase inhibitor (HR 0.530, p < 0.001) or a protease inhibitor (HR 0.624, p = 0.004); and lower CD4 count by 100 cells/μl (HR 0.918, p=0.001).ConclusionsHZ incidence was 4-11-fold higher than in non HIV-infected individuals, but in our study HZ incidences were lower than in previous studies relating to HIV-positive patients. We showed that ART is an important protective factor for HZ episodes.

Incidence and predictors of herpes zoster among antiretroviral therapy-naïve patients initiating HIV treatment in Johannesburg, South Africa

“…In a recent study of HIV-infected patients conducted in Germany, the incidence of herpes zoster was 12/1000 person-years, while a cohort in the USA experienced herpes zoster at a rate of 9/1000 person-years. 11,12 These estimates are both substantially higher than the incidence rate in the general population of resource-rich countries, which ranges from 2/1000 person-years to approximately 5/1000 person-years. 10,13 …”

Sociodemographic characteristics and chronic medical conditions as risk factors for herpes zoster

“…26 In cohort studies conducted before the introduction of highly active antiretroviral therapy, incidence rates of 29.4-51.5 per 1000 person years had been reported among HIV-infected adults, reflecting 12-to 17-fold increase compared with HIV-negative persons. 1,12 More recent studies have detected lower incidence rates than previously (9.0-12.2 per 1000 person-years), 46,47 showing that appropriate antiretroviral therapy is an important protective factor for HZ. 47 The increased incidence of HZ in patients with hematological malignancies and solid tumors has been known for years, and both the nature of the underlying cancer and the type of treatment determine the magnitude of risk.…”

“…1,12 More recent studies have detected lower incidence rates than previously (9.0-12.2 per 1000 person-years), 46,47 showing that appropriate antiretroviral therapy is an important protective factor for HZ. 47 The increased incidence of HZ in patients with hematological malignancies and solid tumors has been known for years, and both the nature of the underlying cancer and the type of treatment determine the magnitude of risk. 1,22 It has been demonstrated recently that, although HZ risk declined with time following a cancer diagnosis, it was still significant at least 5 y afterwards.…”

Serological evidence of increased susceptibility to varicella-zoster virus reactivation or reinfection in natalizumab-treated patients with multiple sclerosis

“…Probably this finding is attributed to the comparably small group size (n = 95): Because we cover a cumulative observation period of only 56 person-years, our finding corresponds to an incidence of < 1.79 per 100 person-years, which is still in line with the literature reporting herpes zoster incidences of 0.9-1.7 per 100 person-years in the current antiretroviral therapy era. 26,27 Furthermore, we cannot exclude that a pronounced immunodeficiency in this group may blunt rises of anti-VZV IgG levels, in response to VZV reactivation.…”

“…25 Besides age dependency, incidence increases with certain conditions that impair cell-mediated immunity, for example infection with human immunodeficiency virus (HIV), leading to an incidence of 2.9-5.1 per 100 person-years in HIV-infected patients, prior to the introduction of highly-active antiretroviral therapy; and 0.9-1.7 per 100 person-years in the current antiretroviral therapy era. 26,27 We performed statistical simulations, assuming a base-line incidence of herpes zoster in healthy people of 0.003 per person-year and a hypothetical 50% increase in herpes zoster incidence in MS patients treated with novel DMDs. These simulations indicated that 64,913 person-years of follow-up would be required per patient group to observe a relative risk (RR) of 1.5 at a global significance level of 0.05, with a power of 0.8.…”