title: Incidence of herpes zoster in HIV-infected adults in the combined antiretroviral therapy era: results from the FHDH-ANRS CO4 cohort.
abstract: BACKGROUND
  Recent studies have shown a decrease in the incidence of herpes zoster (HZ) among human immunodeficiency virus (HIV)-infected patients since the combined antiretroviral therapy (cART) era, but more data are needed on a possible increase in the risk early after cART initiation.
  
  
  METHODS
  We studied HZ incidence and risk factors among patients followed in the French Hospital Database on HIV (FHDH) between 1992 and 2011. Standardized incidence ratios (SIRs) were used for comparison with the general population between 2005 and 2008. The risk of HZ following cART initiation (0-5 and ≥6 months) was studied with Poisson regression models.
  
  
  RESULTS
  A total of 7167 cases of incident HZ were diagnosed among 91 044 individuals (583 125 person-years [PY]). The incidence declined significantly, from 2955 per 100 000 PY in 1992-1996 to 628 per 100 000 PY in 2009-2011. This decline was mainly explained by cART (relative risk [RR], 0.60; 95% confidence interval {CI}, .57-.64). The risk of HZ was associated with low CD4 cell counts, high HIV RNA levels, low CD4/CD8 ratios, and prior AIDS. Compared to the general population, the risk of HZ was higher in HIV-infected patients (overall SIR, 2.7; 95% CI, 2.6-2.9), particularly those aged 15-44 years (SIR, 4-6). In ART-naive patients, a moderate increase in the HZ risk was observed during the first 6 months of cART, with a peak at 3 months (RR, 1.47; 95% CI, 1.26-1.73), a finding that disappeared after adjustment for the current CD4 cell count (RR, 1.03; 95% CI, .81-1.32).
  
  
  CONCLUSIONS
  The risk of HZ has declined markedly among HIV-infected patients in the cART era, but remains 3 times higher than in the general population. The risk increases moderately during the first 6 months of cART.
authors.affiliation: INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique Sorbonne Universités, UPMC Université Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique Assistance Publique Hôpitaux de Paris (AP-HP), Groupe Hospitalier Cochin Broca Hôtel-Dieu, Unité de biostatistique et d'épidémiologie Université Paris Descartes, Sorbonne Paris Cité
authors.forename: Sophie
authors.initials: S
authors.lastname: Grabar
authors.affiliation: Centre Hospitalier Universitaire de Rennes, Hôpital Pontchaillou, Service de maladies infectieuses et réanimation médicale, INSERM U835, Université Rennes-I.
authors.forename: Pierre
authors.initials: P
authors.lastname: Tattevin
authors.affiliation: INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique Sorbonne Universités, UPMC Université Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique.
authors.forename: Hana
authors.initials: H
authors.lastname: Selinger-Leneman
authors.affiliation: Centre Hospitalier Universitaire de Caen.
authors.forename: Arnaud
authors.initials: A
authors.lastname: de La Blanchardiere
authors.affiliation: Hôpital Raymond Poincaré, Garches.
authors.forename: Pierre
authors.initials: P
authors.lastname: de Truchis
authors.affiliation: Centre Hospitalier Universitaire de Nancy.
authors.forename: Christian
authors.initials: C
authors.lastname: Rabaud
authors.affiliation: Centre Hospitalier Universitaire de Strasbourg.
authors.forename: David
authors.initials: D
authors.lastname: Rey
authors.affiliation: Hôpital Max Fourestier, Nanterre.
authors.forename: Vincent
authors.initials: V
authors.lastname: Daneluzzi
authors.affiliation: AP-HP, Hôpital Saint Louis, Service de maladies infectieuses et tropicales, Paris.
authors.forename: Samuel
authors.initials: S
authors.lastname: Ferret
authors.affiliation: AP-HP, Hôpital Henri Mondor, Créteil.
authors.forename: Anne-Sophie
authors.initials: AS
authors.lastname: Lascaux
authors.affiliation: AP-HP, Hôpital Ambroise Paré, Service de médecine interne, Boulogne.
authors.forename: Thomas
authors.initials: T
authors.lastname: Hanslik
authors.affiliation: INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique Sorbonne Universités, UPMC Université Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique.
authors.forename: Dominique
authors.initials: D
authors.lastname: Costagliola
authors.affiliation: Université Paris Descartes, Sorbonne Paris Cité AP-HP, Groupe Hospitalier Cochin Broca Hôtel-Dieu, Fédération d'Infectiologie, Paris, France.
authors.forename: Odile
authors.initials: O
authors.lastname: Launay
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D015331:Cohort Studies; D005260:Female; D005602:France / Q000453:epidemiology; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006562:Herpes Zoster / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents
keywords: HIV; cohort; epidemiology; herpes zoster; immune reconstitution