Results From the FHDH-ANRS CO4 Cohort

Results From the FHDH-ANRS CO4 Cohort

Identification of perceptions about herpes zoster (HZ) disease, vaccine effectiveness and safety, and vaccine recommendations may impact immunization practices of physicians for HIV-infected patients. The licensing of herpes zoster vaccine has demonstrated that therapeutic vaccination can help control chronic viral infection. Researchers from the London School of Hygiene & Tropical Medicine used data from over 144,000 UK adults diagnosed with shingles between 2000 and 2011, and compared this with a group of patients without shingles, to explore whether patients with certain medical conditions may be at increased risk of developing shingles. VZV-specific cell-mediated immunity is also a component of primary responses to varicella vaccine administered to susceptible children and adults and has been used to evaluate candidate vaccines to prevent herpes zoster in immunocompromised and elderly individuals [6-9]. Incident cases were less likely than recurrent cases to be on ART at the time of the event (odds ratio, 0.42; P = 0.004). The patient had intense pain, headache, fever, chills, and nausea, but denied vomiting. Very few HIV-1 vaccine clinical trials have made it past the phase I or phase II trials.

Significantly stronger HIV-specific T-cell responses against Gag, Pol, and Env, with increased polyfunctionality and a broadened epitope-specific CTL repertoire, were observed after vaccination. Manufacturer(s) have sought approval of the vaccine(s) and provided evidence as to its safety and efficacy only when it is used in accordance with the product monographs. This has been demonstrated in quite a few clinical trials, which have influenced US policy makers to recommend the vaccination for everyone over the age of 60. Conclusions: Education about HZ is needed among providers. Most vaccines recommended for routine use can be administered safely to HIV-exposed or HIV-infected children. Compared to the general population, the risk of HZ was higher in HIV-infected patients (overall SIR, 2.7; 95% CI, 2.6–2.9), particularly those aged 15–44 years (SIR, 4–6). In ART-naive patients, a moderate increase in the HZ risk was observed during the first 6 months of cART, with a peak at 3 months (RR, 1.47; 95% CI, 1.26–1.73), a finding that disappeared after adjustment for the current CD4 cell count (RR, 1.03; 95% CI, .81–1.32).
Results From the FHDH-ANRS CO4 Cohort

Single-copy viral loads and frequencies of latently infected CD4+ T cells were determined. Currently, a live attenuated zoster vaccine (ZOSTAVAX™; Merck & Co., Inc., Whitehouse Station, NJ) is approved for prevention of HZ in immunocompetent individuals ≥50 years [10]. The risk increases moderately during the first 6 months of cART. Herpes zoster (HZ) is due to reactivation of latent varicella zoster virus (VZV). A better understanding of the effects of vaccination with a potent immunogen on existing HIV-specific immunity would facilitate the design of future therapeutic trials. Before the advent of combined antiretroviral therapy (cART), the incidence of HZ in human immunodeficiency virus type 1 (HIV-1)–infected patients was 10–30 times higher than in HIV-seronegative individuals [3–5]. The data of the vaccine recipients (open triangles), derived from 27 healthy children …

Since the advent of cART, most complications of HIV infection have changed dramatically in terms of their incidence and clinical presentation, but little is known of the impact of cART on the incidence of and risk factors for HZ. The patient was given a diagnosis of HIV infection 7 years before presentation and had been on ART for 4 years. The RV144 trial, the largest HIV vaccine randomized, multicenter, double blind, placebo controlled efficacy trial conducted so far, enrolled a total of 16,395 men and women in Thailand, at risk for HIV-1 infection via heterosexual exposure. However, HIV infection remains a significant risk factor for HZ, even in the higher CD4 cell strata (>750 cells/µL) [7]. MMR vaccine was not co-administered in this study. Understanding the efficacy of any treatment or vaccination is vital, as no clinician would like to put a patient into unnecessary risk. As HZ is caused by VZV reactivation, VZV vaccination might help to prevent it.

A live attenuated VZV vaccine is licensed in several countries for HZ prevention in persons aged >50 years but is contraindicated in immunodeficient individuals. Two candidate vaccines are currently in development for the prevention of HZ in immunocompromised populations, including HIV-infected patients [18]. To better inform vaccination policies in Europe, we studied the HZ incidence rate and risk factors in HIV-1–infected patients followed in the French Hospital Database on HIV (FHDH-ANRS CO4 [hereafter referred to as FHDH]) during the years 1992–2011, compared with the general population during the years 2005–2008. We also studied the early impact of cART initiation in a subgroup of naive patients.

You may also like