title: Zoster incidence in human immunodeficiency virus-infected hemophiliacs and homosexual men, 1984-1997. District of Columbia Gay Cohort Study. Multicenter Hemophilia Cohort Study.
abstract: Zoster is an important clinical problem for human immunodeficiency virus type 1 (HIV)-infected patients. Risk factors for zoster and trends in incidence in HIV-infected hemophiliacs and homosexual men (n=1218) were examined. From 1984 to 1997, 174 zoster cases were identified (average yearly incidence, 2.5%). Prior zoster episodes were associated with increased risk for a subsequent episode (relative risk [RR], 4.30; 95% confidence interval [CI], 3.11-5.95). Among hemophiliacs, children and adolescents had the highest zoster risk, and zoster risk declined with age (RR, 0.80 per decade; 95% CI, 0.68-0.93). These findings suggest that HIV-infected persons do not produce or maintain adequate booster responses after varicella zoster virus exposure. Zoster risk was relatively constant when CD4 cell counts >200 cells/mm3 but increased steeply below this level. During the 14 years of follow-up, zoster incidence declined 9% per year. This trend occurred despite decreasing CD4 cell counts and was unexplained by zidovudine or acyclovir use.
authors.affiliation: Viral Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD 20822, USA. engelse@exchange.nih.gov
authors.forename: E A
authors.initials: EA
authors.lastname: Engels
authors.forename: P S
authors.initials: PS
authors.lastname: Rosenberg
authors.forename: R J
authors.initials: RJ
authors.lastname: Biggar
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D018791:CD4 Lymphocyte Count; D002648:Child; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology; D015497:HIV-1; D006467:Hemophilia A / Q000150:complications* / Q000453:epidemiology; D006562:Herpes Zoster / Q000150:complications* / Q000453:epidemiology*; D018451:Homosexuality, Male; D006801:Humans; D015994:Incidence; D008297:Male; D015999:Multivariate Analysis; D012307:Risk Factors