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Study Explores Risk for Shingles in the Current Era

February 19, 2015

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Infection with VZV (varicella zoster virus), a member of the herpes virus family, is relatively common. In general, in childhood VZV causes chickenpox and in adults it recurs to cause shingles. After the signs and symptoms of chickenpox resolve, VZV goes into a state of latent infection inside nerve cells. It is generally held in check by the immune system. However, as the immune system weakens with age, VZV can become reactivated, resulting in shingles (also called herpes zoster). Shingles is a painful skin condition that is most commonly seen in people over the age of 50. However, there are cases when the immune system becomes weakened, such as stress from another infection, that can allow the reactivation of VZV leading to shingles even in younger people.

People dealing with the following health issues can also, sometimes, develop shingles:

  • HIV infection
  • cancer
  • lupus
  • type 2 diabetes
  • organ transplant
  • corticosteroid use


Focus on HIV

In the time before the availability of potent combination anti-HIV therapy (commonly called ART or HAART), rates of shingles were high among HIV-positive people. Fortunately, ART became available in high-income countries in 1996, and since then serious infections arising from weakened immunity are less common among people taking ART.

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HIV, ART and Shingles

To better understand trends in shingles cases as well as the impact of ART, researchers in Paris, France, analysed health-related information collected from both HIV-positive and HIV-negative people. They found that cases of shingles decreased significantly once ART became available in France in 1996. However, even after 1996, researchers found that HIV-positive people had a generally elevated risk for shingles. Shingles is relatively common in older people but in the French study HIV-positive people aged 15 to 44 years were at greatest risk for this condition.


Study Details

Researchers reviewed health-related information collected from major clinics across France and centralized in the French Hospital Database (FHDB). The data from HIV-positive people were collected from 1992 to the end of 2011. Health-related information from HIV-negative people was collected between 2005 and 2008. The data for HIV-negative people was provided by a network of general practitioners (family doctors) called Réseau Sentinelles. This network reports any cases of certain diseases and conditions (including shingles) that occur in France. Other research has shown that this network is broadly reflective of the diseases and conditions that family doctors treat across France.


Results -- Shingles

Researchers analysed data from 91,044 HIV-positive people and found that 7,167 had been diagnosed with shingles. Below is a brief average profile of HIV-positive people with shingles:

  • 72% men, 28% women
  • age -- 38 years
  • CD4+ count -- 304 cells/mm3
  • lowest-ever CD4+ count -- 176 cells/mm3
  • proportion with an HIV viral load less than 500 copies/ml -- 29%

Overall, researchers found that cases of shingles among HIV-positive people fell significantly once ART was introduced.

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This article was provided by Canadian AIDS Treatment Information Exchange. It is a part of the publication CATIE News. Visit CATIE's Web site to find out more about their activities, publications and services.
 

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