Short-Term and Long-Term Effects of Highly Active Antiretroviral Therapy on the Incidence of Herpes Zoster in HIV-Infected Children

Background:Highly active antiretroviral therapy (HAART) has reduced herpes zoster (HZ) incidence in HIV-infected children, yet it remains common. Methods:We evaluated perinatally HIV-infected youth with varicella infection enrolled between 1993 and 2006 in a prospective cohort study. Incidence rates (IRs) and 95% confidence intervals of HZ were estimated by calendar year, age group, and HAART use. The effect of initiating HAART was also evaluated by fitting Cox survival models adjusted for potential confounders. Results:Among 536 perinatally infected children with documented prior varicella (median follow-up = 6.8 years), 116 (22%) developed HZ (IR = 3.2 events/100 person-years, confidence interval: 2.6 to 3.8). IRs increased from 1993 to 1996 and then declined significantly through 2006 (P < 0.001). However, an IR of 1.4-3.1 HZ episodes per 100 person-years persisted from 2001 to 2006. The risk of HZ was higher for those with lower CD4% or in Centers for Disease Control and Prevention clinical class C. The IR of HZ was similar in the 90 days before or after initiation of HAART but declined significantly after more than 90 days of HAART. Conclusions:Although HAART has markedly reduced the IR of HZ, it remains a frequent complication in HIV-infected children. The risk of HZ is similar in the 90 days before and after initiating HAART.

[1]  Chengcheng Hu,et al.  Continuous improvement in the immune system of HIV-infected children on prolonged antiretroviral therapy , 2008, AIDS.

[2]  M. Irwin,et al.  Varicella-zoster virus-specific immune responses in elderly recipients of a herpes zoster vaccine. , 2008, The Journal of infectious diseases.

[3]  Samir S. Shah,et al.  Primary Varicella and Herpes Zoster Among HIV-Infected Children From 1989 to 2006 , 2008, Pediatrics.

[4]  J. Seward,et al.  Prevention of varicella: recommendations of the Advisory Committee on Immunization Practices (ACIP). , 2007, MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports.

[5]  W. Borkowsky,et al.  Immunogenicity, Safety, and Predictors of Response After a Pneumococcal Conjugate and Pneumococcal Polysaccharide Vaccine Series in Human Immunodeficiency Virus-Infected Children Receiving Highly Active Antiretroviral Therapy , 2006, The Pediatric infectious disease journal.

[6]  M. Hughes,et al.  Risk factors for opportunistic illnesses in children with human immunodeficiency virus in the era of highly active antiretroviral therapy. , 2006, Archives of pediatrics & adolescent medicine.

[7]  Paige L. Williams,et al.  Incidence of opportunistic and other infections in HIV-infected children in the HAART era. , 2006, JAMA.

[8]  M. Levin,et al.  Administration of live varicella vaccine to HIV-infected children with current or past significant depression of CD4(+) T cells. , 2006, The Journal of infectious diseases.

[9]  M. Lipman,et al.  Immune reconstitution inflammatory syndrome in HIV , 2006, Current opinion in infectious diseases.

[10]  P. Easterbrook,et al.  Incidence and risk factors for immune reconstitution inflammatory syndrome in an ethnically diverse HIV type 1-infected cohort. , 2006, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[11]  P. Peduzzi,et al.  A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. , 2005, The New England journal of medicine.

[12]  B. LaFleur,et al.  Varicella-Zoster virus-specific cell-mediated immunity in HIV-infected children receiving highly active antiretroviral therapy. , 2004, The Journal of infectious diseases.

[13]  L. Mofenson,et al.  Antimicrobial-specific cell-mediated immune reconstitution in children with advanced human immunodeficiency virus infection receiving highly active antiretroviral therapy. , 2004, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[14]  J. Sleasman,et al.  Varicella zoster as a manifestation of immune restoration disease in HIV-infected children. , 2004, The Journal of allergy and clinical immunology.

[15]  J. Maher,et al.  Evaluation of the impact of an HMO's varicella vaccination program on incidence of varicella. , 2004, Vaccine.

[16]  M. Hughes,et al.  Long-term effects of protease-inhibitor-based combination therapy on CD4 T-cell recovery in HIV-1-infected children and adolescents , 2003, The Lancet.

[17]  N. Noah.  Varicella disease after introduction of varicella vaccine in the US, 1995-2000 , 2002 .

[18]  M. Hughes,et al.  Effect of combination therapy including protease inhibitors on mortality among children and adolescents infected with HIV-1. , 2001, The New England journal of medicine.

[19]  C. Chan,et al.  Immunization of HIV-infected children with varicella vaccine. , 2001, The Journal of pediatrics.

[20]  P. Domingo,et al.  Herpes zoster as an immune reconstitution disease after initiation of combination antiretroviral therapy in patients with human immunodeficiency virus type-1 infection. , 2001, The American journal of medicine.

[21]  J. Gatell,et al.  High incidence of herpes zoster in patients with AIDS soon after therapy with protease inhibitors. , 1998, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[22]  M. Capasso,et al.  Varicella and zoster in children with human immunodeficiency virus infection. , 1998, The Pediatric infectious disease journal.

[23]  L. George,et al.  Race and Stress in the Incidence of Herpes Zoster in Older Adults , 1998, Journal of the American Geriatrics Society.

[24]  S. Lo,et al.  Varicella-zoster virus infection in children with underlying human immunodeficiency virus infection. , 1997, The Journal of infectious diseases.

[25]  J. Manson,et al.  The incidence of herpes zoster. , 1995, Archives of internal medicine.

[26]  K. Schmader,et al.  Racial differences in the occurrence of herpes zoster. , 1995, The Journal of infectious diseases.

[27]  K. Terada,et al.  Varicella-zoster virus (VZV) reactivation is related to the low response of VZV-specific immunity after chickenpox in infancy. , 1994, The Journal of infectious diseases.

[28]  W. Borkowsky,et al.  Varicella‐zoster virus infections in children infected with human immunodeficiency virus , 1989, The Pediatric infectious disease journal.

[29]  T. Quinn,et al.  Herpes zoster in African patients: a clinical predictor of human immunodeficiency virus infection. , 1988, The Journal of infectious diseases.

[30]  P. Ogra,et al.  Increased incidence of herpes zoster in normal children infected with varicella zoster virus during infancy: community-based follow-up study. , 1986, The Journal of pediatrics.

[31]  L. Melton,et al.  Epidemiology of herpes zoster in children and adolescents: a population-based study. , 1985, Pediatrics.

[32]  M. Rowbotham,et al.  Recommendations for the management of herpes zoster. , 2007, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[33]  A. Hall,et al.  For Personal Use. Only Reproduce with Permission from the Lancet. Review Risk Factors for Herpes Zoster What Does Epidemiology Tell Us about Risk Factors for Herpes Zoster? , 2022 .

[34]  Michael T. Brady,et al.  PEDIATRIC AIDS CLINICAL TRIALS GROUP PROTOCOL 219 TEAM. EFFECT OF COMBINATION THERAPY INCLUDING PROTEASE INHIBITORS ON MORTALITY AMONG CHILDREN AND ADOLESCENTS INFECTED WITH HIV-1 , 2001 .

[35]  J. Lindsey,et al.  Correlates of opportunistic infections in children infected with the human immunodeficiency virus managed before highly active antiretroviral therapy. , 2001, The Pediatric infectious disease journal.

[36]  J. Church,et al.  Frequent recurrence and persistence of varicella-zoster virus infections in children infected with human immunodeficiency virus type 1. , 1996, The Journal of pediatrics.