title: Herpes zoster among persons living with HIV in the current antiretroviral therapy era.
abstract: BACKGROUND
  Previously, herpes zoster (HZ) was found to occur at a higher rate in the HIV population than the general population. However, there are limited data about the incidence, risk factors, and clinical outcomes of HZ in the current antiretroviral therapy (ART) era.
  
  
  METHODS
  We identified HZ episodes in an urban HIV clinic cohort between 2002 and 2009. Three controls were matched to each case, and conditional logistic regression was used to assess for risk factors associated with incident HZ cases. Logistic regression was used to assess for factors associated with complicated HZ.
  
  
  RESULTS
  One hundred eighty-three new HZ cases were identified in 4353 patients with 19,752 person-years (PY) of follow-up--an incidence rate 9.3/1000 PY. Cases were majority men (62%) and African American (75%), with a mean age of 39 years (interquartile range, 32-44 years). Fifty patients (28%) had complicated HZ with 12% developing postherpetic neuralgia. In multivariate regression, factors associated with the increased risk of HZ were having started ART within 90 days of the episode [adjusted odds ratio (AOR), 4.02; 95% confidence interval (CI), 1.31 to 12.41], having a viral load of >400 copies per milliliter (AOR, 1.49; 95% CI, 1.00 to 2.24), and having a CD4 <350 cells per cubic millimeter (AOR, 2.46; 95% CI, 1.42 to 4.23) or 350 to 500 cells per cubic millimeter (AOR, 2.02; 95% CI, 1.14 to 3.57) as compared with CD4 >500 cells per cubic millimeter.
  
  
  CONCLUSIONS
  The incidence of HZ is lower than previously reported in HIV cohorts but remains higher than the general population. Over one fourth of patients developed complicated HZ, which is remarkable given the young age of our population. Risk factors for HZ include markers of poor immune function, suggesting that appropriate ART may reduce the burden of HZ in this population.
authors: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
authors: Leah J
authors: LJ
authors: Blank
authors: Michael J
authors: MJ
authors: Polydefkis
authors: Richard D
authors: RD
authors: Moore
authors: Kelly A
authors: KA
authors: Gebo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D023241:Antiretroviral Therapy, Highly Active; D016022:Case-Control Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006562:Herpes Zoster / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D012307:Risk Factors; D014505:Urban Population; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents