585. Incidence of Herpes Zoster in a Large Cohort of Persons Living with HIV
Session: Poster Abstract Session: HIV: General Opportunistic Infections
Thursday, October 5, 2017
Room: Poster Hall CD
Posters
  • LauraGilbert_HerpesZoster_IDWeek2017posterv5.2.pdf (548.9 kB)
  • Background:

    Herpes Zoster (HZ) incidence has decreased over 40% in the United States but remains elevated in persons living with HIV (PLWH). HZ vaccine is not routinely recommended for PLWH and provider-prescribing patterns vary greatly. Updated incidence information in this population is needed to guide vaccine strategies. Using data from the US military HIV Natural History Study (NHS), we evaluated the incidence and risk factors for HZ in the modern ART era.    

    Methods:

    NHS subjects undergo bi-annual visits with laboratory testing, examinations, and records reviewed for clinical diagnosis, including HZ. Analysis was restricted to subjects contributing to follow-up after 2001. Risk factors for HZ (demographic and HIV-specific) were assessed with a multivariate Cox proportional hazards model.  

    Results:

    Of the 2954 subjects meeting inclusion criteria, 237 (8%) were diagnosed with HZ. At HZ diagnosis, the median age, CD4 count, and viral load were 38.6 years [IQR-30.8, 45.8], 461 cells/uL [IQR-333, 638] and 1900 copies/mL [IQR-50, 19580] respectively. The incidence of HZ was highest prior to 1996 at 3.24 cases/100 person years (PY) of follow-up (2.96-3.54) and declined significantly over time with 1.9 (1.6-2.3), 1.4 (1.2-1.8), 1.4 (1.1-1.7), and 0.9 (0.7-1.2) cases/100 PY recorded in 1996-2000, 2001-2005, 2006-2010 and 2011-2016 respectively. In the multivariate model, longer time from HIV diagnosis to ART initiation was associated with HZ. ART use, higher CD4 count, recent year of HIV diagnosis, and older age were protective (Table 1).

    Conclusion:

    HZ remains a common diagnosis in the ART era. NHS subjects with HZ were in the fourth and fifth decades of their life and had preserved CD4 counts highlighting the need for HZ vaccine safety and efficacy studies to help guide provider practice. Delays in ART initiation were associated with HZ emphasizing the need for compliance with current ART guidelines.

    Table 1.

    Risk factor

    Adjusted hazard ratio

    Age (for each year increase)

    0.93 (0.91,0.95)

    HIV diagnosis era

        < 1996

    Ref

        1996-2000

    1.01 (0.62,1.67)

        2001-2005

    0.73 (0.43,1.23)

        2006-2010

    1.11 (0.64,1.93)

        2011-2016

    0.30 (0.12,0.76)

    Time to ART initiation from HIV diagnosis

    1.04 (1.01,1.09)

    Current ART use

    0.45 (0.22,0.93)

    Current CD4 count

    0.78 (0.74,0.83)

    Laura Gilbert, MD1, Xun Wang, MS2, Robert Deiss, MD3, Jason Okulicz, MD4, Thomas O'Bryan, MD5, Ryan Maves, MD, FCCP, FIDSA6, Christina Schofield, MD FACP, FIDSA7, Tomas Ferguson, MD, FIDSA8, Timothy J. Whitman, DO9, Brian Agan, MD10 and Anuradha Ganesan, MD, MPH5, (1)Internal Medicine, U.S. Naval Hospital Guam, Tamuning, AP, Guam, (2)The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, (3)Infectious Diseases Clinical Research Program, Uniformed Services University, Bethesda, MD, (4)Infectious Disease, San Antonio Military Medical Center, Fort Sam Houston, TX, (5)Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, (6)Infectious Diseases, Naval Medical Center San Diego, San Diego, CA, (7)Madigan Army Medical Center, Tacoma, WA, (8)Department of Medicine, Tripler Army Medical Center, Honolulu, HI, (9)Walter Reed National Military Medical Center, Bethesda, MD, (10)Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Rockville, MD

    Disclosures:

    L. Gilbert, None

    X. Wang, None

    R. Deiss, None

    J. Okulicz, None

    T. O'Bryan, None

    R. Maves, None

    C. Schofield, None

    T. Ferguson, None

    T. J. Whitman, None

    B. Agan, None

    A. Ganesan, None

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