Short-Term and Long-Term Effects of Highly Active Antiretroviral Therapy on the Incidence of Herpes Zoster in HIV-Infected Children

Levin, Myron J MD*; Anderson, Jeffrey P MPH†‡; Seage, George R III ScD†‡; Williams, Paige L PhD†§; for the PACTG/IMPAACT 219C Team

From the *Department of Pediatrics, University of Colorado at Denver Health Sciences Center, Aurora, CO; †Center for Biostatistics in AIDS Research; ‡Department of Epidemiology; and §Department of Biostatistics, Harvard School of Public Health, Boston, MA.

Received for publication July 1, 2008; accepted November 14, 2008.

Supported by funding from the Statistical and Data Analysis Center at Harvard School of Public Health, under the National Institute of Allergy and Infectious Diseases cooperative agreement #5 U01 AI41110 with the Pediatric AIDS Clinical Trials Group and #1 U01 AI068616 with the International Maternal Pediatric Adolescent AIDS Clinical Trials Group. Overall support for International Maternal Pediatric Adolescent AIDS Clinical Trials was provided by the National Institute of Allergy and Infectious Diseases [U01 AI068632] and the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

A portion of this analysis was presented at the 13th Conference on Retroviruses and Opportunistic Infections, February 5-8, 2006, Denver, CO.

All of the authors made substantial contributions to the conception, design, acquisition of data, and analysis and interpretation of data for this article; contributed substantially to the drafting and revision of this article; and have given final approval for submission of this article.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Allergy and Infectious Diseases or the National Institutes of Health.

Background: Highly active antiretroviral therapy (HAART) has reduced herpes zoster (HZ) incidence in HIV-infected children, yet it remains common.

Methods: We evaluated perinatally HIV-infected youth with varicella infection enrolled between 1993 and 2006 in a prospective cohort study. Incidence rates (IRs) and 95% confidence intervals of HZ were estimated by calendar year, age group, and HAART use. The effect of initiating HAART was also evaluated by fitting Cox survival models adjusted for potential confounders.

Results: Among 536 perinatally infected children with documented prior varicella (median follow-up = 6.8 years), 116 (22%) developed HZ (IR = 3.2 events/100 person-years, confidence interval: 2.6 to 3.8). IRs increased from 1993 to 1996 and then declined significantly through 2006 (P <>

Conclusions: Although HAART has markedly reduced the IR of HZ, it remains a frequent complication in HIV-infected children. The risk of HZ is similar in the 90 days before and after initiating HAART.