title: Incidence and risk factors of herpes zoster in human immunodeficiency virus-positive patients initiating combination antiretroviral therapy in Taiwan.
abstract: OBJECTIVE
  To obtain current epidemiological data for better vaccination policies, this study aimed to assess the incidence and risk factors of herpes zoster in human immunodeficiency virus (HIV)-positive patients initiating combination antiretroviral therapy (cART) in Taiwan.
  
  
  METHODS
  Between June, 2012 and May, 2015, we prospectively identified zoster cases in HIV-positive patients initiating cART. Clinical information was collected on demographics, prior zoster, plasma HIV-1 RNA load (PVL), and CD4 count at baseline and during follow up. A case-control study by 1:2 matched pairs was used to identify the risk factors for zoster development.
  
  
  RESULTS
  During the 3-year study period, 826 patients with a mean age of 32.9 years were included, and 7.7% had prior zoster. The mean baseline CD4 count and PVL were 286 cells/μL and 4.90 log10copies/mL, respectively. Fifty-four (6.5%) patients developed zoster after initiation of cART, with 43 episodes (79.6%) occurring within 1 year of cART initiation, which corresponded to an overall incidence rate of 3.61/100 person-years. The multivariate analysis revealed that prior zoster (adjusted odds ratio = 3.143; 95% confidence interval, 1.385-7.133) and baseline CD4 count < 200 cells/μL (adjusted odds ratio = 2.034; 95% confidence interval, 1.020-4.057) were independent risk factors for zoster in HIV-positive patients initiating cART. In case-control study, prior zoster and baseline PVL > 5 log10copies/mL were risk factors for zoster development after cART initiation in multivariate analysis.
  
  
  CONCLUSIONS
  Herpes zoster occurred in 6.5% of HIV-positive Taiwanese patients after initiation of cART, which was associated with prior zoster and baseline CD4 count < 200 cells/μL or baseline PVL > 5 log10copies/mL.
authors.affiliation: Department of Internal Medicine, Lotung Poh-Ai Hospital, Lo-Hsu Medical Foundation, I-Lan, Taiwan.
authors.forename: Yi-Chieh
authors.initials: YC
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: Chien-Ching
authors.initials: CC
authors.lastname: Hung
authors.affiliation: Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
authors.forename: Mao-Song
authors.initials: MS
authors.lastname: Tsai
authors.affiliation: Center of Infection Control, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Jun-Yu
authors.initials: JY
authors.lastname: Zhang
authors.affiliation: Center of Infection Control, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Pei-Ying
authors.initials: PY
authors.lastname: Wu
authors.affiliation: Center of Infection Control, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Shang-Ping
authors.initials: SP
authors.lastname: Yang
authors.affiliation: Center of Infection Control, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Yu-Zhen
authors.initials: YZ
authors.lastname: Luo
authors.affiliation: Center of Infection Control, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Hsi-Yen
authors.initials: HY
authors.lastname: Chang
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: Wen-Chun
authors.initials: WC
authors.lastname: Liu
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan. Electronic address: hysun@ntu.edu.tw.
authors.forename: Hsin-Yun
authors.initials: HY
authors.lastname: Sun
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: Shan-Chwen
authors.initials: SC
authors.lastname: Chang
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D016022:Case-Control Studies; D015331:Cohort Studies; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy* / Q000453:epidemiology; D006562:Herpes Zoster / Q000150:complications* / Q000453:epidemiology*; D014645:Herpesvirus 3, Human / Q000472:pathogenicity; D006801:Humans; D015994:Incidence; D008297:Male; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology; D019562:Viral Load; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents
keywords: AIDS; dermatologic complications; immunosuppression; varicella-zoster