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

Abstract

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.

Varicella-Zoster Virus Reactivation and Increased Vascular Risk in People Living with HIV: Data from a Retrospective Cohort Study

“…In people living with HIV, herpes zoster can be categorized as an opportunistic infection. In this population, its occurrence is not only more prevalent but also more likely to be accompanied by complications compared to the general population, even among individuals who are receiving effective ART [11,12]. Although limited data are available on the current seroprevalence of VZV infection in PLWH, some studies indicate a prevalence of VZV-positive serological patients of approximately 95% [13].…”

Neurologic infections in people with HIV: shifting epidemiological and clinical patterns

“…Likely due to high rates of pneumococcal vaccine uptake (free as government funded) by our PWH we had only one case of S. pneumoniae meningitis. Similarly, low use of zoster vaccines (unfunded) may account for several avoidable VZV CNS infections [30]. Due to small numbers, particularly of non-AIDS defining neurologic infections trends in incidence rate over time may be difficult to interpret, also comparative analytics were not stratified by AIDS and non-AIDS defining neurologic infections.…”

Incomplete immune reconstitution and its predictors in people living with HIV in Wuhan, China

“…HZ is caused by a variety of diseases that affect immunity, and its incidence increases with decreasing immune levels [ 41 , 42 ]. Hawkins et al [ 43 ] and Zou et al [ 44 ] found that PLWH with lower CD4 and unsuppressed HIV-1 RNA have the higher risk of HZ. Therefore, we speculate that HZ represents a manifestation of immune suppression, to some extent.…”