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Non-Mycobacterial Opportunistic Infections
Tuesday, 1:30 - 3:30 pm
Background: Herpes zoster (HZ) occurs at a wide range of CD4 counts in HIV-infected patients. While some studies found increased HZ incidence shortly after initiating HAART, the long-term effect of HAART on HZ is unknown. We hypothesized that the risk of self-reported HZ in HIV-infected women, even with longer-term use of HAART, would remain higher than HIV-uninfected women in the Women's Interagency HIV Study (WIHS) cohort.
Methods: The WIHS is a prospective cohort study of HIV-infected and uninfected high-risk women followed at 6-month intervals (semesters). Beginning at the 2nd visit (4/95-8/96), we calculated the probability of reporting HZ at any study semester by HIV serostatus and CD4 stratum among HIV-infected women. HIV seroconverters were excluded. Generalized estimating equations assessed the effect of age, race, log CD8, CD4, nadir pre-HAART CD4, HIV RNA, and HAART (modeled in an intent-to-treat fashion) on HZ incidence, adjusted for time between visits.
Results: We studied 489 HIV-uninfected women (4392 visits) and 2321 HIV-infected women (22,657 visits), of whom 1832 initiated HAART (18,265 visits). The probability of HZ was 0.14% for HIV-uninfected women. For HIV-infected women, the probability of HZ was substantially higher, particularly at lower CD4 counts: 1.2% for CD4 >750, 1.7% for CD4 500 to 749, 2.5% for CD4 350 to 499, 3.2% for 200 to 349, and 4.2% for CD4 <200 cells/mm3. In multivariate analysis including all HIV-infected women, CD4 (odds ratio [OR] 0.90 per 100 cells/mm3, 95% confidence interval [CI] 0.84 to 0.94, p <0.0001) and log HIV RNA (OR 1.10 per log10 copies/mL, CI: 1.00 to 1.23, p = 0.06) were associated with HZ. After adjusting for the effects of HAART on CD4 and HIV RNA, HAART use itself was not associated with HZ (OR 1.05, OR 0.79 to 1.39, p = 0.72). Among HAART users, in a model adjusted for time on HAART, time between visits, and log HIV RNA, only CD4 was associated with HZ (OR 0.89 per 100 cells/mm3, CI: 0.83 to 0.95, p = 0.008). Log CD8, race, age, and nadir CD4 were not statistically significant in these multivariate models.
Conclusions: In HIV-infected women, HAART use was not associated with an increase in HZ incidence. Higher CD4 was protective against HZ among all HIV-infected women and the subset receiving HAART. Even women with CD4 >750, however, are at greatly increased risk of HZ compared to HIV-uninfected women.
Keywords: herpes zoster; women; antiretroviral therapy