Clinical Research Center, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Am J Trop Med Hyg. 2018 Feb;98(2):396-401. doi: 10.4269/ajtmh.17-0568. Epub 2018 Jan 4.
We examined the incidence of herpes zoster (HZ) before and after the initiation of antiretroviral therapy (ART), and risk factors for HZ among human immunodeficiency virus (HIV)-infected individuals in Tanzania. A cohort study was conducted among HIV-positive individuals enrolled in HIV care and treatment clinics in Dar es Salaam, Tanzania. A Cox proportional hazard model was used to examine the effect of ART on the risk of HZ after adjusting for sociodemographics and time-varying clinical and nutritional factors. Among 72,670 HIV-positive individuals, 2,312 incident cases of HZ (3.2%) occurred during the median follow-up of 15 months (interquartile range: 3-35). The incidence rate of HZ significantly declined from 48.9 (95% confidence interval [CI] = 46.7-51.0) per 1,000 person-years before ART to 3.7 (95% CI = 3.3-4.1) per 1,000 person-years after the initiation of ART ( < 0.001). The risk of HZ declined with longer duration on ART. Low CD4 cell count, older age, female sex, district of Dar es Salaam, and year of enrollment were independently associated with the risk of HZ in the multivariate analysis. Low body mass index and anemia were not associated with the risk of HZ. The risk of HZ substantially declined after ART initiation in this large cohort of HIV-infected individuals. Earlier initiation of ART could reduce the risk of HZ and other opportunistic infections among HIV-infected individuals in sub-Saharan Africa.
我们研究了坦桑尼亚艾滋病毒感染者在开始抗逆转录病毒治疗（ART）前后带状疱疹（HZ）的发病率，以及 HZ 的危险因素。这项队列研究在坦桑尼亚达累斯萨拉姆的 HIV 护理和治疗诊所招募了 HIV 阳性个体。使用 Cox 比例风险模型，在调整了社会人口统计学和随时间变化的临床及营养因素后，研究了 ART 对 HZ 风险的影响。在 72670 名 HIV 阳性个体中，在中位随访 15 个月（四分位间距：3-35）期间，发生了 2312 例 HZ （3.2%）。在开始 ART 之前，HZ 的发病率为 48.9（95%置信区间 [CI] = 46.7-51.0），每 1000 人年，而在开始 ART 后，发病率降至 3.7（95%CI = 3.3-4.1），每 1000 人年（<0.001）。随着 ART 持续时间的延长，HZ 的风险下降。在多变量分析中，低 CD4 细胞计数、年龄较大、女性、达累斯萨拉姆区和登记年份与 HZ 的风险独立相关。低体重指数和贫血与 HZ 的风险无关。在这个大型 HIV 感染者队列中，ART 开始后 HZ 的风险显著下降。在撒哈拉以南非洲，早期开始 ART 可能会降低 HIV 感染者 HZ 和其他机会性感染的风险。
