![]() The VZV immunoglobulin G (IgG) result closest to SAC intake or up to 5 years prior was defined as baseline VZV serology. Through the use of paper charts, electronic medical records, and database extracts, a retrospective review of clinical information including CD4 count, HIV viral load, antiretroviral use, immunization records, VZV serology, and VZV polymerase chain reaction (PCR) results was performed. We also report the incidence and costs of VZV-related morbidity during the study period, presenting as inpatient admissions, ED visits, and urgent care (UC) visits. Through retrospective review of a large, well-established, geographically defined cohort of PWH over a 20-year study period, we aimed to characterize epidemiologic correlates of VZV immunity such as vaccination rates for varicella and HZ as well as VZV seropositivity rates. Given the progressive burden of VZV illness in PWH, further exploration of the impact of modifiable risk factors such as vaccination rates is warranted. Vaccine uptake and the preventable burden and costs of VZV illness in PWH are thus largely unknown. One 300-person case–control study in a US military cohort of PWH showed that quantitative VZV antibody levels were not predictive of zoster reactivation, but lack of ARV use/CD4 counts and exclusion of PWH with negative VZV serology or those who had previously received varicella or shingles vaccination limit its wider applicability. įew data are available on the current seroprevalence of VZV in PWH and its association with outcomes such as hospitalization and health care costs in this population. It has also been reported that the overall incidence of all HZ-related illnesses in PWH may have changed little in the early ART era and that ART use may not reduce rates of zoster complications. While early potent ART regimens may have decreased the incidence of some HIV-associated neurologic complications, the rates of VZV encephalitis seem to be unchanged or increasing. ![]() PWH are also at increased risk of developing serious complications including disseminated zoster, post-herpetic neuralgia, and VZV meningoencephalitis. Even in the era of suppressive antiretroviral therapy (ART), when compared with the general population, PWH have a 4–10-fold greater incidence of HZ and may also develop HZ over a decade earlier on average. ![]() VZV infection can cause substantial morbidity, particularly in immunocompromised individuals, including people with HIV (PWH). In our setting, immunization against HZ, although promoted, is not covered by Alberta Health and requires private coverage or a personal expense to the patient. Although the live attenuated vaccine has been licensed for use in Canada since 2011 and the adjuvant recombinant vaccine since 2017, free coverage under public health care is very limited, curtailing their widespread use. HZ immunization has been shown to blunt the rise in incident HZ cases over time and reduce HZ-related hospitalization and emergency department (ED) visits. Annual costs related to HZ-related illnesses have been estimated in the Canadian province of British Columbia to be >CDN$5 million, and they continue to increase. Despite the availability and effectiveness of both live attenuated and subunit zoster vaccines, the incidence of HZ and its complications, including hospitalization and treatment costs, continues to increase. While primary infection as varicella is nearly ubiquitous in humans, shingles is also common, with an estimated lifetime risk of ∼30%, and predominantly affects individuals >50 years of age in the general population. Varicella-zoster virus (VZV) infection is well known for causing either chickenpox (varicella) or shingles (herpes zoster ).
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