Herpes Zoster and Herpes Zoster Vaccine Rates Among Adults Living With and Without HIV in the Veterans Aging Cohort Study

• Type of Material: Article
• Authors: Kellie L. Hawkins, Denver Public Health; Kirsha S. Gordon, Veterans Affairs Connecticut Healthcare System; Myron J. Levin, University of Colorado; Adriana Weinberg, University of Colorado; Catherine Battaglia, University of Colorado; Maria C. Rodriguez-Barradas, Baylor College of Medicine; Sheldon T. Brown, Mt Sinai School of Medicine; David Rimland, Emory University; Amy Justice, Yale University; Janet Tate, Veterans Affairs Connecticut Healthcare System; Kristine M. Erlandson, University of Colorado
• Language: English
• Date: 2018-12-01
• Publisher: Wolters Kluwer Health, Inc.
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2018 Wolters Kluwer Health, Inc. All rights reserved.
• Final Published Version (URL): http://dx.doi.org/10.1097/QAI.0000000000001846
• Title of Journal or Parent Work: Journal of Acquired Immune Deficiency Syndromes
• Volume: 79
• Issue: 4
• Start Page: 527
• End Page: 533
• Grant/Funding Information: Additional funding was provided through the University of Colorado Department of Medicine Health Services Research Development Grant to KLH and in kind by the US Veterans Health Administration.; This research was supported in part by the National Institutes of Health, through the National Institute on Alcohol Abuse and Alcoholism (U24-AA020794, U01-AA020790, U24-AA022001, and U10-AA13566-completed), the National Heart, Lung, and Blood Institute (T32HL116276 to KH, PI: James Hill and Bob Eckel), and the National Institute of Aging [K23AG050260] to KME.
• Keywords: SUBUNIT VACCINE; POPULATION; herpes zoster vaccine; herpes zoster; INFECTED ADULTS; VARICELLA; Life Sciences & Biomedicine; EFFICACY; HIV; RECOMMENDATIONS; ACTIVE ANTIRETROVIRAL THERAPY; Science & Technology; RISK; Infectious Diseases; Immunology; INCREASING INCIDENCE; ERA
• Research Categories: Health Sciences, Immunology

Abstract

Background:Despite historically high rates of herpes zoster among people living with HIV (PLWH), comparative studies of herpes zoster by HIV serostatus are lacking since the advent of combination antiretroviral therapy and availability of zoster vaccine. Methods:Annual rates (2002-2015) of first-episode herpes zoster and zoster vaccination were calculated for PLWH and uninfected adults in the Veterans Aging Cohort Study and stratified by HIV serostatus and age. Herpes zoster was captured using ICD9 codes and vaccine receipt with procedural codes and pharmacy data. Results:Of 45,177 PLWH and 103,040 uninfected veterans, rates of herpes zoster decreased among PLWH (17.6-8.1/1000) over the study period but remained higher than uninfected adults (4.1/1000) at the end of study period. Rates were higher in PLWH with lower CD4 (<200 vs >500 cells/μL: 18.0 vs 6.8/1000) and unsuppressed vs suppressed HIV-1 RNA (21.8 vs 7.1/1000). Restricted to virologically suppressed participants with CD4 >350 cells per microliter, herpes zoster rates were similar among PLWH aged younger than 60 years and aged 60 years and older in 2015 (6.6 vs 6.7/1000) but higher than all uninfected age groups. At study end, cumulative receipt of zoster vaccine for PLWH aged 60 years and older was less than half that of uninfected veterans: 98.7 vs 215.2/1000. Conclusions:Herpes zoster rates among PLWH have markedly decreased, but, even in cART-treated individuals, remain 50% higher than uninfected adults. Lower rates of zoster vaccine receipt combined with high rates of herpes zoster support the need for a safe and effective vaccine against herpes zoster for PLWH, formal zoster vaccine guidelines for PLWH, and consideration for expanded use at younger ages.