TY - JOUR
T1 - Impact of antiretroviral therapy on the risk of herpes zoster among human immunodeficiency virus-infected individuals in Tanzania
AU - Kawai, Kosuke
AU - Hawkins, Claudia A.
AU - Hertzmark, Ellen
AU - Francis, Joel M.
AU - Sando, David
AU - Muya, Aisa N.
AU - Ulenga, Nzovu
AU - Fawzi, Wafaie W.
N1 - Funding Information:
Financial support: This work was supported by the U.S. President’s Emergency Plan for AIDS relief (PEPFAR) through the Harvard School of Public Health and by the Ministry of Health and Social Welfare, Tanzania. K.K. was supported by Boston Children’s Hospital Aerosmith HIV Endowment Fund.
Publisher Copyright:
Copyright © 2018 by The American Society of Tropical Medicine and Hygiene.
PY - 2018
Y1 - 2018
N2 - We examined the incidence of herpes zoster (HZ) before and after the initiation of antiretroviral therapy (ART), and risk factors forHZamong 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 (P < 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.
AB - We examined the incidence of herpes zoster (HZ) before and after the initiation of antiretroviral therapy (ART), and risk factors forHZamong 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 (P < 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.
UR - http://www.scopus.com/inward/record.url?scp=85041552370&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85041552370&partnerID=8YFLogxK
U2 - 10.4269/ajtmh.17-0568
DO - 10.4269/ajtmh.17-0568
M3 - Article
C2 - 29313475
AN - SCOPUS:85041552370
VL - 98
SP - 396
EP - 401
JO - American Journal of Tropical Medicine and Hygiene
JF - American Journal of Tropical Medicine and Hygiene
SN - 0002-9637
IS - 2
ER -
