Risk factors and vaccination gaps for herpes zoster in people living with HIV: A multicenter multivariable study

Abstract

Purpose

The primary aim of this study was to determine the frequency of prior herpes zoster and its associated clinical and immunovirological factors, while secondary aims included evaluating varicella-zoster virus serostatus and vaccination rates.

Methods

In this multicenter, retrospective, and partially observational study, data from 1,289 people living with HIV between January 2020 and December 2024 were analyzed. Attitudes toward vaccination were also examined.

Results

A history of herpes zoster was identified in 5% of participants (n = 65). Individuals with an herpes zoster history were significantly older than those without (45.5 ± 13.1 vs 38.1 ± 12.9 years; p < 0.001). Herpes zoster history was strongly associated with advanced disease stage at diagnosis (p < 0.001), lower CD4 percentages (p = 0.020), reduced absolute CD4 counts (p < 0.001), and lower CD4/CD8 ratios (p = 0.006) in univariate analysis.Other factors significantly associated with herpes zoster history included prior viremia (p < 0.001), chronic lung disease (p = 0.006), syphilis (p = 0.016), hepatitis B virus coinfection (p < 0.001), malignancy (p < 0.001), and immunomodulatory drug use (p = 0.031). Lack of childhood varicella vaccination was also significantly associated with herpes zoster history (p = 0.003). In multivariable logistic regression analysis, lower CD4 count (aOR 0.992; p = 0.001), history of viremia (aOR 5.74; p = 0.004), malignancy (aOR 8.51; p = 0.007), and hepatitis B virus coinfection (aOR 23.56; p = 0.002) were independently associated with herpes zoster. herpes zoster-related pain was reported in 24 patients (36.9%) and was most frequently treated with non-steroidal anti-inflammatory drugs. Herpes zoster vaccination coverage was notably low, and willingness to be vaccinated remained similarly limited in both groups.

Conclusion

Herpes zoster history among people living with HIV was associated with older age, advanced immunosuppression, viremia, and comorbidities, particularly hepatitis B virus and syphilis. Despite the considerable burden of herpes zoster and its complications, vaccination rates remain low. These findings highlight the need to identify high-risk groups and implement targeted vaccination strategies to reduce herpes zoster-related morbidity among people living with HIV.