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J Acquir Immune Defic Syndr. 2018 Dec 1;79(4):527-533. doi: 10.1097/QAI.0000000000001846.

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

Author information

Denver Public Health, Denver, CO.
Division of Infectious Diseases, Anschutz Medical Campus, University of Colorado, Aurora, CO.
Veterans Affairs Connecticut Healthcare System, West Haven, CT.
Yale University Schools of Medicine and Public Health, New Haven, CT.
Department of Medicine, Infectious Diseases Section, Michael E. DeBakey Veterans Affairs Medical Center, Baylor College of Medicine, Houston, TX.
Department of Medicine, James J. Peters Veterans Affairs Medical Center, Mount Sinai School of Medicine, New York, NY.
Division of Infectious Diseases, Atlanta Veterans Affairs Medical Center, Emory University School of Medicine, Atlanta, GA.



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.


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.


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/┬ÁL: 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.


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.

[Available on 2019-12-01]

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