Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
J Acquir Immune Defic Syndr. 2012 Oct 1;61(2):203-7. doi: 10.1097/QAI.0b013e318266cd3c.
Previously, herpes zoster (HZ) was found to occur at a higher rate in the HIV population than the general population. However, there are limited data about the incidence, risk factors, and clinical outcomes of HZ in the current antiretroviral therapy (ART) era.
We identified HZ episodes in an urban HIV clinic cohort between 2002 and 2009. Three controls were matched to each case, and conditional logistic regression was used to assess for risk factors associated with incident HZ cases. Logistic regression was used to assess for factors associated with complicated HZ.
One hundred eighty-three new HZ cases were identified in 4353 patients with 19,752 person-years (PY) of follow-up--an incidence rate 9.3/1000 PY. Cases were majority men (62%) and African American (75%), with a mean age of 39 years (interquartile range, 32-44 years). Fifty patients (28%) had complicated HZ with 12% developing postherpetic neuralgia. In multivariate regression, factors associated with the increased risk of HZ were having started ART within 90 days of the episode [adjusted odds ratio (AOR), 4.02; 95% confidence interval (CI), 1.31 to 12.41], having a viral load of >400 copies per milliliter (AOR, 1.49; 95% CI, 1.00 to 2.24), and having a CD4 <350 cells per cubic millimeter (AOR, 2.46; 95% CI, 1.42 to 4.23) or 350 to 500 cells per cubic millimeter (AOR, 2.02; 95% CI, 1.14 to 3.57) as compared with CD4 >500 cells per cubic millimeter.
The incidence of HZ is lower than previously reported in HIV cohorts but remains higher than the general population. Over one fourth of patients developed complicated HZ, which is remarkable given the young age of our population. Risk factors for HZ include markers of poor immune function, suggesting that appropriate ART may reduce the burden of HZ in this population.
此前，在艾滋病毒人群中发现带状疱疹（HZ）的发生率高于一般人群。然而，在当前的抗逆转录病毒治疗（ART）时代，关于 HZ 的发病率、危险因素和临床结局的数据有限。
我们在 2002 年至 2009 年间在一家城市艾滋病毒诊所队列中确定了 HZ 发作病例。每例病例匹配了 3 名对照，采用条件逻辑回归评估与 HZ 病例相关的危险因素。采用逻辑回归评估与复杂 HZ 相关的因素。
在 4353 名患者的 19752 人年（PY）随访中，共发现 183 例新的 HZ 病例，发病率为 9.3/1000 PY。病例多数为男性（62%）和非裔美国人（75%），平均年龄为 39 岁（四分位距，32-44 岁）。50 例（28%）患者发生复杂 HZ，其中 12%发生带状疱疹后神经痛。多变量回归分析显示，HZ 风险增加的相关因素包括在发作后 90 天内开始 ART[调整优势比（AOR），4.02；95%置信区间（CI），1.31 至 12.41]、病毒载量>400 拷贝/毫升（AOR，1.49；95%CI，1.00 至 2.24）以及 CD4 细胞<350 个/立方毫米（AOR，2.46；95%CI，1.42 至 4.23）或 350 至 500 个/立方毫米（AOR，2.02；95%CI，1.14 至 3.57）与 CD4>500 个/立方毫米。
HZ 的发病率低于之前在艾滋病毒队列中报告的发病率，但仍高于一般人群。超过四分之一的患者发生了复杂的 HZ，考虑到我们人群的年轻年龄，这一比例令人瞩目。HZ 的危险因素包括免疫功能不良的标志物，这表明适当的 ART 可能会降低该人群 HZ 的负担。
