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Study Explores Risk for Shingles in the Current Era

February 19, 2015

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Trends -- Gender

Among HIV-positive people, there were always more cases of shingles in men than women. However, this difference decreased in more recent years.


Rebuilding the Immune System

Untreated HIV infection significantly weakens the immune system. As a result, the immune system may not recognize some germs; even in cases when it does, the immune system may sometimes fail to produce an effective immune response against germs. This dysfunction allows germs to accumulate in the body.

Once a person initiates ART their immune system begins to gradually improve its ability to detect germs and rapidly respond to them. Depending on the degree of pre-ART immunological dysfunction and injury, during the first six months after initiating ART, immunological responses toward germs may not be ideal.

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IRIS

People who have accumulated a high degree of immunological injury prior to initiating ART have an increased risk of inflammatory reactions in the first three months after initiating ART. Such reactions are called immune reconstitution inflammatory syndrome (IRIS). This occurs because the recovering immune system is still somewhat dysfunctional but thanks to ART it can now recognize germs and mount a response to attack them. The response is often exaggerated, perhaps partly driven by a high amount of a particular germ, perhaps driven in part by immunological dysfunction. Whatever the underlying reason, IRIS can cause tissue injury.

Symptoms of IRIS can vary depending on the organ system affected and can range from mild fever and lack of energy to more serious symptoms that can resemble an infection. IRIS reactions are more common in people whose lowest pre-ART CD4+ counts were less than 100 cells/mm3. In all cases, IRIS is driven by an exaggerated inflammatory reaction to a germ. Doctors may prescribe anti-inflammatory agents such as the temporary use of corticosteroids to reduce the intensity of IRIS.


Starting ART and Shingles

In the FHDB study, researchers noticed that after 1996 (when ART became available in France) cases of shingles would sometimes occur within three months of participants initiating ART. This is likely the result of participants initiating ART when their immune systems were weakened.


Comparisons

Among HIV-negative people in France, researchers found that half of people with shingles were 60 years or older. Also, shingles in this population was more common in women than in men.

The researchers also found that, overall, HIV-positive people, regardless of gender, were generally three-fold more likely to develop shingles than HIV-negative people. The risk for shingles among HIV-positive people was greatest for people aged 15 to 44 years. In this group, the risk for shingles was six-fold greater than among HIV-negative people.

Once HIV-positive people reached the age of 65 years, their risk for shingles was similar to that of HIV-negative people.

Due to the high risk of shingles among relatively young HIV-positive people, the French researchers stated that "the benefits and safety of VZV vaccination should be studied in [this population]."

They concluded their report by stating: "Clinicians and patients should be aware that ART temporarily increases the risk of shingles during the first six months of treatment."


About Chickenpox and Shingles

Below is some brief information about these conditions.

Chickenpox

VZV, a member of the herpes virus family, causes chickenpox and shingles.

Chickenpox was formerly a common childhood infection, but is now less common due to routine vaccination of all children in Canada and many high-income countries. In most cases, chickenpox results in a skin rash, low-grade fever and lack of energy. Generally, chickenpox itself is not life threatening. However, because the rash results in skin lesions that can be very itchy, affected children are prone to scratching them, which makes the underlying soft tissue susceptible to infection by bacteria that normally live on the skin. Such so-called secondary bacterial infections can be serious, rarely leading to "flesh-eating disease" (necrotizing fasciitis) and/or toxic shock syndrome. Pneumonia and inflammation of the brain (encephalitis) can also be complications of chickenpox.

According to the Public Health Agency of Canada (PHAC), "complications are more common in adolescents, adults and people with conditions that compromise their immune system who have higher rates of pneumonia, encephalitis and death." It is also dangerous to infants whose mothers develop chickenpox around the time of delivery.

The virus that causes chickenpox is easily spread through the air when people with chickenpox sneeze or cough. It can also be spread by touching the fluid that comes from chickenpox lesions and by kissing. A person with chickenpox is no longer contagious once all the skin lesions have crusted over.

After signs and symptoms of chickenpox clear, the virus that causes it can go into a state of latency.

Shingles

Shingles occurs when latent VZV infection becomes reactivated. Although shingles can occur at any age, it is generally most common in adults who are 50 years and older.


In General

Shingles in adults initially appears as an intense tingling or burning pain on one side of the body. This pain is followed by the appearance of red patches and the formation of small sores. Blisters form and these eventually become crusted, dry and fall off. The pain and blisters are usually along the parts of the skin supplied by a single nerve that was latently infected with VZV which has reactivated. While scars from shingles are not common, older adults can sometimes develop persistent burning or tingling pain where their shingles appeared; this is called "post-herpetic neuralgia" and may require treatment. During shingles some people develop symptoms similar to a flu. An episode of shingles usually lasts for between one and two weeks.

Shingles is not spread through the air like chickenpox, but can be spread when a person touches the fluid from a blister. Keeping blisters covered greatly helps to reduce the possible spread of shingles. People with shingles are not infectious before the appearance of blisters or after blisters have become crusted.

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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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