Background: While the incidence of herpes zoster has been studied in the general population, the manifestations of zoster in HIV patients have yet to be fully understood. A study in the pre-HAART era found the incidence of herpes zoster to be 3.2 per 100 person years of follow-up. However, the incidence and complications of zoster in the post-HAART era have not been previously described.

Methods: We conducted a retrospective cohort study of patients enrolled in an urban HIV clinic between January 1, 1997, and December 31, 2001. Patients (pts) with an episode of herpes zoster during this period were identified and their charts reviewed for clinical characteristics, complications, CD4 count and viral load, and HAART usage. Post-herpetic neuralgia was defined as the presence of neuropathic pain greater than 4 weeks after rash healing.

Results: We identified 282 episodes of herpes zoster in 239 pts. Of these episodes, 124 were recurrent zoster events and 158 were incident cases. The incidence of zoster during the study period was 3.2 per 100 person yrs of follow-up. The majority of pts were male (63%), African American (77%), and had injection drug use as their HIV risk factor (49%). The mean age was 41 yrs. Over 60% used tobacco, approximately 50% used alcohol, and nearly 50% used illicit drugs. Mean CD4 count and viral load were, 283 cells/mm³ and 125,129 copies/ml, respectively. Two-thirds (2/3) had single dermatomal involvement, and 33% involved the thorax. Twenty-eight (28) pts developed PHN, and 33 pts (21%) had other complications including: ocular (10), headache (9), zoster recurrence within 6 months of incident zoster event (8), bacterial superinfection (6), Ramsay Hunt Syndrome (4), transverse myelitis (1), meningitis (1), and trigeminal neuralgia (1).

Conclusions: Our results suggest that zoster infection rates have not changed in the post-HAART era, but that a significant percentage of pts develop complications, particularly PHN, which is quite remarkable considering the young age of our population.