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Volume 51, Number 1, February 2018

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


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


 

Corresponding author:

Hsin-Yun Sun, Corresponding author. Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan. 



 

Background and purpose: 

To obtain current epidemiological data for better vaccination policies, this study aimed to assess the incidence and risk factors of herpes zoster in human immunodeficiency virus (HIV)-positive patients initiating combination antiretroviral therapy (cART) in Taiwan. 



 

Methods:

Between June, 2012 and May, 2015, we prospectively identified zoster cases in HIV-positive patients initiating cART. Clinical information was collected on demographics, prior zoster, plasma HIV-1 RNA load (PVL), and CD4 count at baseline and during follow up. A case–control study by 1:2 matched pairs was used to identify the risk factors for zoster development. 



 

Results:

During the 3-year study period, 826 patients with a mean age of 32.9 years were included, and 7.7% had prior zoster. The mean baseline CD4 count and PVL were 286 cells/μL and 4.90 log10 copies/mL, respectively. Fifty-four (6.5%) patients developed zoster after initiation of cART, with 43 episodes (79.6%) occurring within 1 year of cART initiation, which corresponded to an overall incidence rate of 3.61/100 person-years. The multivariate analysis revealed that prior zoster (adjusted odds ratio = 3.143; 95% confidence interval, 1.385–7.133) and baseline CD4 count < 200 cells/μL (adjusted odds ratio = 2.034; 95% confidence interval, 1.020–4.057) were independent risk factors for zoster in HIV-positive patients initiating cART. In case–control study, prior zoster and baseline PVL > 5 log10 copies/mL were risk factors for zoster development after cART initiation in multivariate analysis. 



 

Conclusion:

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 log10 copies/mL. 



 

Key words:

AIDS, dermatologic complications, immunosuppression, varicella-zoster