title: Herpes zoster in immunocompromised patients: incidence, timing, and risk factors.
abstract: OBJECTIVE
  To evaluate the risk factors for herpes zoster as well as the incidence and timing of this complication in patients who were treated with immunosuppression because of active Wegener's granulomatosis.
  
  
  METHODS
  We studied the 180 Wegener's granulomatosis patients in the Wegener's Granulomatosis Etanercept Trial (WGET). Herpes zoster events during WGET were documented prospectively. Follow-up questionnaires were employed to describe the location, treatment, and complication(s) of herpes zoster and its therapy. Univariate and multivariate analyses were performed to evaluate risk factors, including history of herpes zoster, for the occurrence of herpes zoster during the trial. All analyses were based on the time to first occurrence of herpes zoster.
  
  
  RESULTS
  Eighteen patients (10% of the WGET cohort) suffered a total of 19 herpes zoster episodes over a mean follow-up period of 27 months. The annual incidence of herpes zoster in the WGET cohort was 45 cases/1000 patient-years (95% confidence interval [CI]: 27, 70). The median time from enrollment to the occurrence of herpes zoster in the subgroup of patients with that complication was 16.5 months (+/- 9.4). Fifteen of the 19 herpes zoster events (79%) occurred between months 6 and 36, many months after the period of most intensive immunosuppression. In univariate analyses, history of serum creatinine > or =1.5 mg/dL before enrollment was associated with a relative risk (RR) of 3.0 (95% CI: 1.1, 7.8) for herpes zoster during WGET (P=.03). In multivariate analyses, serum creatinine > or =1.5 mg/dL was associated with an RR of 6.3 (95% CI: 2.0, 19.8; P=.002), and female sex with an RR of 4.6 (95% CI: 1.6, 13.2; P=.004).
  
  
  CONCLUSIONS
  Renal dysfunction and female sex were consistently strong risk factors for herpes zoster events in this population. Contrary to expectation, most herpes zoster events did not occur during periods of most intensive immunosuppression. These data may inform studies of interventions designed to prevent herpes zoster in patients on treatment for immune-mediated diseases.
authors.affiliation: Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, Md, USA.
authors.forename: Peter K
authors.initials: PK
authors.lastname: Wung
authors.forename: Janet T
authors.initials: JT
authors.lastname: Holbrook
authors.forename: Gary S
authors.initials: GS
authors.lastname: Hoffman
authors.forename: Andrea K
authors.initials: AK
authors.lastname: Tibbs
authors.forename: Ulrich
authors.initials: U
authors.lastname: Specks
authors.forename: Y-I
authors.initials: YI
authors.lastname: Min
authors.forename: Peter A
authors.initials: PA
authors.lastname: Merkel
authors.forename: Robert
authors.initials: R
authors.lastname: Spiera
authors.forename: John C
authors.initials: JC
authors.lastname: Davis
authors.forename: E William
authors.initials: EW
authors.lastname: St Clair
authors.forename: Joseph
authors.initials: J
authors.lastname: McCune
authors.forename: Steven R
authors.initials: SR
authors.lastname: Ytterberg
authors.forename: Nancy B
authors.initials: NB
authors.lastname: Allen
authors.forename: John H
authors.initials: JH
authors.lastname: Stone
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000068800:Etanercept; D005260:Female; D014890:Granulomatosis with Polyangiitis / Q000188:drug therapy*; D006562:Herpes Zoster / Q000453:epidemiology* / Q000209:etiology*; D006801:Humans; D016867:Immunocompromised Host; D007074:Immunoglobulin G / Q000009:adverse effects / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D015994:Incidence; D008297:Male; D008875:Middle Aged; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use; D012307:Risk Factors; D013997:Time Factors
chemical_list: D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D018124:Receptors, Tumor Necrosis Factor; D000068800:Etanercept