title: Short-term and long-term effects of highly active antiretroviral therapy on the incidence of herpes zoster in HIV-infected children.
abstract: BACKGROUND
  Highly active antiretroviral therapy (HAART) has reduced herpes zoster (HZ) incidence in HIV-infected children, yet it remains common.
  
  
  METHODS
  We evaluated perinatally HIV-infected youth with varicella infection enrolled between 1993 and 2006 in a prospective cohort study. Incidence rates (IRs) and 95% confidence intervals of HZ were estimated by calendar year, age group, and HAART use. The effect of initiating HAART was also evaluated by fitting Cox survival models adjusted for potential confounders.
  
  
  RESULTS
  Among 536 perinatally infected children with documented prior varicella (median follow-up = 6.8 years), 116 (22%) developed HZ (IR = 3.2 events/100 person-years, confidence interval: 2.6 to 3.8). IRs increased from 1993 to 1996 and then declined significantly through 2006 (P < 0.001). However, an IR of 1.4-3.1 HZ episodes per 100 person-years persisted from 2001 to 2006. The risk of HZ was higher for those with lower CD4% or in Centers for Disease Control and Prevention clinical class C. The IR of HZ was similar in the 90 days before or after initiation of HAART but declined significantly after more than 90 days of HAART.
  
  
  CONCLUSIONS
  Although HAART has markedly reduced the IR of HZ, it remains a frequent complication in HIV-infected children. The risk of HZ is similar in the 90 days before and after initiating HAART.
authors.affiliation: Pediatric Infectious Diseases Section, University of Colorado at Denver Health Sciences Center, Mailstop C227, Building 401, (Room R09-108), 1784 Racine Street, Aurora, CO 80045-0508, USA. myron.levin@uchsc.edu
authors.forename: Myron J
authors.initials: MJ
authors.lastname: Levin
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Anderson
authors.forename: George R
authors.initials: GR
authors.lastname: Seage
authors.forename: Paige L
authors.initials: PL
authors.lastname: Williams
mesh_terms: D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D002648:Child; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000276:immunology; D006562:Herpes Zoster / Q000453:epidemiology* / Q000209:etiology / Q000821:virology; D014645:Herpesvirus 3, Human / Q000502:physiology*; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000453:epidemiology* / Q000276:immunology; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016016:Proportional Hazards Models; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome