TY - JOUR
T1 - Incidence and predictors of herpes zoster among antiretroviral therapy-naïve patients initiating HIV treatment in Johannesburg, South Africa
AU - Shearer, Kate
AU - Maskew, Mhairi
AU - Ajayi, Toyin
AU - Berhanu, Rebecca
AU - Majuba, Pappie
AU - Sanne, Ian
AU - Fox, Matthew P.
N1 - Funding Information:
This work was funded through the South Africa Mission of the United States Agency for International Development (USAID) under the terms of Cooperative Agreement 674-A-00-09-00018-00 to Boston University, Cooperative Agreement 674-A-00-02-00018 to Right to Care, and Cooperative Agreement 674-A-12-00029 to the Health Economics and Epidemiology Research Office. Matthew Fox was also supported by Award Number K01AI083097 from the National Institute of Allergy and Infectious Diseases (NIAID). This study was made possible by the generous support of the American people through USAID and the National Institutes of Health (NIH). The contents are the responsibility of the Health Economics and Epidemiology Research Office and do not necessarily reflect the views of USAID, NIH, the United States Government, or the Themba Lethu Clinic.
PY - 2014/6
Y1 - 2014/6
N2 - Objectives: 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/mm3. 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/mm3; 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.
AB - Objectives: 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/mm3. 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/mm3; 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.
KW - Attrition
KW - HIV infection
KW - Herpes zoster
KW - Resource-limited settings
KW - Shingles
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U2 - 10.1016/j.ijid.2013.10.016
DO - 10.1016/j.ijid.2013.10.016
M3 - Article
C2 - 24680820
AN - SCOPUS:84899830794
SN - 1201-9712
VL - 23
SP - 56
EP - 62
JO - International Journal of Infectious Diseases
JF - International Journal of Infectious Diseases
ER -