447. Herpes Zoster among HIV Patients in the Current HAART Era
Session: Poster Abstract Session: HIV Challenges and Complications
Friday, October 21, 2011
Room: Poster Hall B1

Background:  Herpes zoster (HZ) has occurred at a higher rate in the HIV population than the general population; however little is known about the incidence, risk factors and clinical outcomes of HZ in the current HAART era.

Methods: We conducted a cohort study of patients enrolled in an urban HIV clinic between January 1, 2002 and December 31, 2009. Patients with HZ during this period were identified, and their medical charts reviewed.  3 controls were matched to each case on time of entry, CD4 at entry, and follow-up time. We used conditional logistic regression to assess for risk factors for incident HZ cases.

Results: 173 new episodes of HZ were identified in 4353 patients over 19,752 person-years (PY) of follow-up, with incidence rate 8.8 / 1000 PY.  Cases were majority male (63%), African-American (75%) and had heterosexual sex as their HIV transmission risk factor (52%). Mean age was 39 (IQR 32-45).  66% of patients had single dermatomal involvement, and 62% involved the thorax. 46 patients (27%) had complicated HZ with 21 patients (13%) developing post-herpetic neuralgia (PHN). In multivariate regression, starting HAART within 90 days of the episode, a CD4 <500 cells/mm3 compared to CD4 > 500 cells/mm3, and being on prednisone at the time of the episode were associated with increased risk of HZ.  No patient received varicella vaccine.

Conclusion: The incidence of HZ is lower than has previously been reported in HIV (32 / 1000 PY) from 1997-2001, highlighting the importance of effective HAART in reducing HZ.   However, the rate remains higher than in the general population (3.5 / 1000 PY). Over one fourth of patients developed complications of HZ, particularly PHN, which is remarkable given our young population. 

 

Table: Conditional logistic regression of factors associated with incident HZ

OR (95% CI)

Adjusted OR (95% CI)*

HAART initiation <90 days

     No

     Yes

Ref

4.67 (1.54-14.16)

Ref

4.61 (1.44-14.80)

HIV-1 RNA

     <400 copies/mL

     ≥400 copies/mL

Ref

1.77 (1.20-2.62)

Ref

1.49 (0.98-2.27)

CD4 count

     >500 cells/mm3

     350-500 cells/mm3

     <350 cells/mm3

Ref

2.03 (1.15-3.57)

2.82 (1.67-4.79)

Ref 

2.00 (1.12-3.56)

2.28 (1.31-3.99)

Prednisone use

     No

     Yes

Ref

12.00 (1.34-107.36)

Ref

14.55 (1.54-137.33)

*Adjusted for the above variables and age.


Subject Category: H. HIV/AIDS and other retroviruses

Leah Blank, MPH1, Michael Polydefkis, MD MHS2, Richard Moore, MD, MHS3 and Kellly Gebo, MD, MPH1, (1)Johns Hopkins University, Baltimore, MD, (2)Neurology, Johns Hopkins University, Baltimore, MD, (3)Johns Hopkins University School of Medicine, Baltimore, MD

Disclosures:

L. Blank, None

M. Polydefkis, None

R. Moore, Glaxo Smith Kline: Grant Investigator, Research grant

K. Gebo, None

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