title: Incidence and predictors of herpes zoster among antiretroviral therapy-naïve patients initiating HIV treatment in Johannesburg, South Africa.
abstract: OBJECTIVE
  To describe the characteristics of HIV-infected patients experiencing herpes zoster after antiretroviral therapy (ART) initiation and to describe the incidence and predictors of a herpes zoster diagnosis.
  
  
  METHODS
  Adult patients initiating ART from April 2004 to September 2011 at the Themba Lethu Clinic in Johannesburg, South Africa were included. Patients were followed from ART initiation until the date of first herpes zoster diagnosis, or death, transfer, loss to follow-up, or dataset closure. Herpes zoster is described using incidence rates (IR) and predictors of herpes zoster are presented as subdistribution hazard ratios (sHR) and 95% confidence intervals (95% CI).
  
  
  RESULTS
  Fifteen thousand and twenty-five patients were included; 62% were female, the median age was 36.6 years, and the median baseline CD4 count was 98 cells/mm(3). Three hundred and forty patients (2.3%) experienced herpes zoster in a median of 26.1 weeks after ART initiation. Most (71.5%) occurred within 1 year of initiation, for a 1-year IR of 18.1/1000 person-years. In an adjusted model, patients with low CD4 counts (<50 vs. ≥200 cells/mm(3); sHR: 1.71, 95% CI: 1.21-2.47) and with a prior episode of herpes zoster (sHR: 1.53, 95% CI: 0.97-2.28) were at increased risk of incident herpes zoster.
  
  
  CONCLUSIONS
  While only 2% of patients were diagnosed with herpes zoster in this cohort, patients with low CD4 counts and those with prior episodes of herpes zoster were at higher risk for a herpes zoster diagnosis.
authors.affiliation: Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand,, Johannesburg, South Africa. Electronic address: kshearer@heroza.org.
authors.forename: Kate
authors.initials: K
authors.lastname: Shearer
authors.affiliation: Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand,, Johannesburg, South Africa.
authors.forename: Mhairi
authors.initials: M
authors.lastname: Maskew
authors.affiliation: Center for Global Health and Development, Boston University, Boston, Massachusetts, USA.
authors.forename: Toyin
authors.initials: T
authors.lastname: Ajayi
authors.affiliation: Right to Care, Johannesburg, South Africa.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Berhanu
authors.affiliation: Right to Care, Johannesburg, South Africa.
authors.forename: Pappie
authors.initials: P
authors.lastname: Majuba
authors.affiliation: Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand,, Johannesburg, South Africa; Right to Care, Johannesburg, South Africa; Clinical HIV Research Unit, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Ian
authors.initials: I
authors.lastname: Sanne
authors.affiliation: Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand,, Johannesburg, South Africa; Center for Global Health and Development, Boston University, Boston, Massachusetts, USA; Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts, USA.
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Fox
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D015992:Body Mass Index; D018791:CD4 Lymphocyte Count; D060085:Coinfection / Q000821:virology; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology*; D006562:Herpes Zoster / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013019:South Africa / Q000453:epidemiology; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents
keywords: Attrition; HIV infection; Herpes zoster; Resource-limited settings; Shingles