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Abstract
The incidence of herpes zoster (HZ) in patients infected with HIV is higher than that of the general population. However, the incidence of HZ in HIV patients receiving antiretroviral therapy (ART) remains unclear. This meta-analysis aimed to estimate the pooled incidence rate and risk factors for HZ in the post-ART era. We identified studies assessing the incidence of HZ in the post-ART era between 1 January 2000 and 28 February 2021, from four databases. Pooled risk ratios were calculated from 11 articles using a random-effects model. The heterogeneity of the included trials was evaluated by visually inspecting funnel plots, performing random-effects meta-regression and using I2 statistics. Of the 2111 studies screened, we identified 11 studies that were eligible for final inclusion in the systematic review and 8 studies that were eligible for a meta-analysis. The pooled incidence of HZ in the post-ART era (after the introduction of ART in 1997) was 2.30 (95% confidence interval (CI): 1.56–3.05) per 100 person years (PYs). The risks of incidence of HZ among people living with HIV included male sex (AOR: 4.35 (95% CI: 054–2.41)), men who have sex with men (AOR: 1.21 (95% CI: −0.76–1.13)), CD4 count < 200 cells/μL (AOR: 11.59 (95% CI: 0.53–4.38)) and not receiving ART (AOR: 2.89 (95% CI: −0.44–2.56)). The incidence of HZ is substantially lower among HIV infected patients receiving ART than those not receiving ART. Initiating ART immediately after diagnosis to treat all HIV-positive individuals is crucial to minimize the disease burden of HZ.
Highlights
Herpes zoster (HZ), known as shingles, is caused by the reactivation of varicella zoster virus (VZV), which remains latent in the sensory ganglia following varicella infection [1]
Our study found that HZ risk in the human immunodeficiency virus (HIV)-infected population substantially decreased following antiretroviral therapy (ART) initiation, and ART was previously associated with a reduction in the risk of herpes zoster and other opportunistic infections [7]
This systematic review with meta-regression provides a global estimate of the incidence of HZ among the HIV infected population in the post-ART era
Summary
Herpes zoster (HZ), known as shingles, is caused by the reactivation of varicella zoster virus (VZV), which remains latent in the sensory ganglia following varicella infection [1]. HZ is a human immunodeficiency virus (HIV)-associated opportunistic infection. A systematic review and meta-analysis of the HZ incidence in ART-naive patients was 9.4%. During the first year of ART, the incidence was 2.3%, but this reduction was not statistically significant [7]. Even though the introduction of ART has improved the survival of those living with HIV, the incidence of HZ among HIV cohorts remains higher than that of the general population [4,8]. The incidence of HZ in the HIV cohort was 9.3–141 per 1000 patient years (PY)s [8,9,10]; but the incidence of HZ in the general population is only 3–5 per 1000 PYs [11]. The general population lifetime risk for HZ is between 23.8% and 30% and affects approximately one in four people in Europe; for those aged >85 years, the risk increases to one in two people [12]
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