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Zachariah S, Sullivan A, Donato A. Shingles: a harbinger of chronic HIV infection. J Community Hosp Intern Med Perspect 2021; 11:871-873. [PMID: 34804410 PMCID: PMC8604460 DOI: 10.1080/20009666.2021.1969080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Early diagnosis and treatment are essential to reduce the risk of community transmission and morbidity and mortality of individuals infected with HIV. A 49-year-old woman presented with a painful, vesicular rash on the left side of her neck after being treated with valacyclovir for a separate perianal rash. She admitted recent weight loss and diffuse lymphadenopathy. She reported one family member with HIV but denied intravenous drug use or recently new sexual partners. Serum HIV-1 antibody screen was positive. Herpes zoster reactivation is associated with waning immunity in chronic HIV and should prompt testing. Delays in treatment impacts short-term and long-term prognosis for patients infected with HIV.
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Affiliation(s)
- S Zachariah
- Department of Internal Medicine, Reading Hospital - Tower Health System, West Reading, PA
| | - A Sullivan
- Department of Internal Medicine, Reading Hospital - Tower Health System, West Reading, PA
| | - A Donato
- Department of Internal Medicine, Reading Hospital - Tower Health System, West Reading, PA
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2
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Incidence of Herpes Zoster in HIV-Infected Patients Undergoing Antiretroviral Therapy: A Systematic Review and Meta-analysis. J Clin Med 2021; 10:jcm10112300. [PMID: 34070645 PMCID: PMC8198877 DOI: 10.3390/jcm10112300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/18/2021] [Accepted: 05/20/2021] [Indexed: 11/17/2022] Open
Abstract
The incidence of herpes zoster (HZ) in patients infected with HIV is higher than that of the general population. However, the incidence of HZ in HIV patients receiving antiretroviral therapy (ART) remains unclear. This meta-analysis aimed to estimate the pooled incidence rate and risk factors for HZ in the post-ART era. We identified studies assessing the incidence of HZ in the post-ART era between 1 January 2000 and 28 February 2021, from four databases. Pooled risk ratios were calculated from 11 articles using a random-effects model. The heterogeneity of the included trials was evaluated by visually inspecting funnel plots, performing random-effects meta-regression and using I2 statistics. Of the 2111 studies screened, we identified 11 studies that were eligible for final inclusion in the systematic review and 8 studies that were eligible for a meta-analysis. The pooled incidence of HZ in the post-ART era (after the introduction of ART in 1997) was 2.30 (95% confidence interval (CI): 1.56-3.05) per 100 person years (PYs). The risks of incidence of HZ among people living with HIV included male sex (AOR: 4.35 (95% CI: 054-2.41)), men who have sex with men (AOR: 1.21 (95% CI: -0.76-1.13)), CD4 count < 200 cells/μL (AOR: 11.59 (95% CI: 0.53-4.38)) and not receiving ART (AOR: 2.89 (95% CI: -0.44-2.56)). The incidence of HZ is substantially lower among HIV infected patients receiving ART than those not receiving ART. Initiating ART immediately after diagnosis to treat all HIV-positive individuals is crucial to minimize the disease burden of HZ.
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Bandara HMHN, Samaranayake LP. Viral, bacterial, and fungal infections of the oral mucosa: Types, incidence, predisposing factors, diagnostic algorithms, and management. Periodontol 2000 2019; 80:148-176. [PMID: 31090135 DOI: 10.1111/prd.12273] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
For millions of years, microbiota residing within us, including those in the oral cavity, coexisted in a harmonious symbiotic fashion that provided a quintessential foundation for human health. It is now clear that disruption of such a healthy relationship leading to microbial dysbiosis causes a wide array of infections, ranging from localized, mild, superficial infections to deep, disseminated life-threatening diseases. With recent advances in research, diagnostics, and improved surveillance we are witnessing an array of emerging and re-emerging oral infections and orofacial manifestations of systemic infections. Orofacial infections may cause significant discomfort to the patients and unnecessary economic burden. Thus, the early recognition of such infections is paramount for holistic patient management, and oral clinicians have a critical role in recognizing, diagnosing, managing, and preventing either new or old orofacial infections. This paper aims to provide an update on current understanding of well-established and emerging viral, bacterial, and fungal infections manifesting in the human oral cavity.
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Affiliation(s)
| | - Lakshman P Samaranayake
- Department of Oral and Craniofacial Health Sciences, College of Dental Medicine, University of Sharjah, Sharjah, UAE
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Affiliation(s)
- Phuc Le
- Center for Value-based Care Research, Cleveland Clinic, Cleveland, OH, USA
| | - Michael Rothberg
- Center for Value-based Care Research, Cleveland Clinic, Cleveland, OH, USA
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Nyamukuru A, Tabuti JR, Lamorde M, Kato B, Sekagya Y, Aduma PR. Medicinal plants and traditional treatment practices used in the management of HIV/AIDS clients in Mpigi District, Uganda. J Herb Med 2017. [DOI: 10.1016/j.hermed.2016.10.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Wu PH, Lin YT, Kuo CN, Chang WC, Chang WP. No increased risk of herpes zoster found in cirrhotic patients: a nationwide population-based study in Taiwan. PLoS One 2014; 9:e93443. [PMID: 24699628 PMCID: PMC3974756 DOI: 10.1371/journal.pone.0093443] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 03/03/2014] [Indexed: 12/24/2022] Open
Abstract
Background The association between liver cirrhosis (LC) and herpes zoster has rarely been studied. We investigated the hypothesis that LC, known as an immunodeficiency disease, may increase the risk of herpes zoster using a national health insurance database in Taiwan. Materials and Methods The study cohort included cirrhotic patients between 1998 and 2005 (n = 4667), and a ratio of 1∶5 randomly sampled age- and gender-matched control patients (n = 23,335). All subjects were followed up for 5 years from the date of cohort entry to identify whether or not they had developed herpes zoster. Cox proportional-hazard regressions were performed to evaluate 5-year herpes zoster-free survival rates. Results Of all patients, 523 patients developed herpes zoster during the 5-year follow-up period, among whom 82 were LC patients and 441 were in the comparison cohort. The adjusted hazard ratio (AHR) of herpes zoster in patients with LC was not higher (AHR: 0.77, 95% confidence interval: 0.59–1.01, p = 0.06) than that of the controls during the 5-year follow-up. No increased risk of herpes zoster was found in LC patients after stratification by age, gender, urbanization level, income, geographic region, and all comorbidities. Conclusions This large nationwide population-based cohort study suggests that there is no increased risk for herpes zoster among people who have LC compared to a matching population.
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Affiliation(s)
- Ping-Hsun Wu
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Ting Lin
- Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chun-Nan Kuo
- Department of Pharmacy, Taipei Medical University-Wanfang Hospital, Taipei, Taiwan
- Department of Clinical Pharmacy, School of Pharmacy, Taipei Medical University, Taipei, Taiwan
| | - Wei-Chiao Chang
- Department of Pharmacy, Taipei Medical University-Wanfang Hospital, Taipei, Taiwan
- Department of Clinical Pharmacy, School of Pharmacy, Taipei Medical University, Taipei, Taiwan
- * E-mail: (WCC); (WPC)
| | - Wei-Pin Chang
- Department of Healthcare Management, Yuanpei University, Hsinchu, Taiwan
- * E-mail: (WCC); (WPC)
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Predictive factors of herpes zoster HIV-infected patients: another adverse effect of crack cocaine. PLoS One 2013; 8:e80187. [PMID: 24244647 PMCID: PMC3823845 DOI: 10.1371/journal.pone.0080187] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 09/28/2013] [Indexed: 12/01/2022] Open
Abstract
A retrospective cohort study was conducted on 1541 HIV-infected patients to determine variables associated with the incidence of herpes zoster. A single failure Cox model showed that herpes zoster incidence increased following the first 6 months of antiretroviral treatment adjusted hazard ratio (AHR)=5 (95%CI=2.6-9.2), P<0.001; in the >60 years age group AHR=2 (95%CI=1-4), P=0.04; in patients in the top CD8 quartile AHR=2.1 (95%CI=1.3-3.6), P<0.001; and in patients previously reported to use crack cocaine AHR=5.9, (95%CI=1.4-25), P=0.02. Herpes zoster incidence increased in patients with CD4 counts<500 per mm3 and gradually declined since 1992-1996, with AHR=0.3 (95%CI=0.2-0.5), P<0.001 for the 1997-2002 period and AHR=0.24 (95%CI=0.14-0.4), P<0.001 for the 2002-2008 period. Contrary to what has been described elsewhere, there was no specific effect of protease inhibitors on herpes zoster incidence. The present study is the first to suggest that crack cocaine is associated with an increased incidence of herpes zoster. The neurological or immunological effects of crack are discussed.
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Jansen K, Haastert B, Michalik C, Guignard A, Esser S, Dupke S, Plettenberg A, Skaletz-Rorowski A, Brockmeyer NH. Incidence and risk factors of herpes zoster among hiv-positive patients in the german competence network for HIV/AIDS (KompNet): a cohort study analysis. BMC Infect Dis 2013; 13:372. [PMID: 23937603 PMCID: PMC3751196 DOI: 10.1186/1471-2334-13-372] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 08/05/2013] [Indexed: 12/14/2022] Open
Abstract
Background HIV infection is a risk factor for the development of Herpes zoster (HZ) and its complications. Prior to antiretroviral therapy (ART), HZ incidence in HIV-infected individuals ranged from 2.9–5.1/100 person-years. There is limited evidence for the impact of ART on HZ occurrence among HIV-infected adults. We analysed the incidence of, and risk factors for, HZ in a large cohort of German HIV-positive patients. Methods The study population was taken from the German KompNet cohort, a nationwide multicenter HIV cohort study. The study population was defined by age (≥ 18 years), year of first positive HIV diagnosis, CD4 values ± 6 months from HIV diagnosis (t0), and month of HZ diagnosis. Incidences were estimated using a Poisson distribution, and uni- and multivariate Cox proportional Hazard ratio (HR) regression models were fitted to identify risk factors for developing an initial HZ episode. Independent variables were sex, age at HIV diagnosis, route of HIV transmission, ART status, CD4 count before HZ episode, immunosuppressive medication, and mode of data documentation (retrospective or prospective). Results HZ incidence in the overall study population was 1.2/100 person-years. In a subset of patients for that we were able to examine risk factors the following was observed: We examined 3,757 individuals whose mean age at t0 was 38 years. Of those individuals, 96% were diagnosed with HIV in 1996 or later, with a mean observation time of 5.8 years. HZ episodes (n = 362) were recorded in 326 patients (8.7%), resulting in annual HZ incidences of 1.7/100 person-years overall, and 1.6/100 person-years for initial HZ cases. The main risk factors associated with an initial HZ episode were: not partaking in ART compared with an ART regimen containing a non-nucleoside reverse-transcriptase inhibitor (HR 0.530, p < 0.001) or a protease inhibitor (HR 0.624, p = 0.004); and lower CD4 count by 100 cells/μl (HR 0.918, p=0.001). Conclusions HZ incidence was 4-11-fold higher than in non HIV-infected individuals, but in our study HZ incidences were lower than in previous studies relating to HIV-positive patients. We showed that ART is an important protective factor for HZ episodes.
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Affiliation(s)
- Klaus Jansen
- Competence Network for HIV/AIDS, Ruhr-University, Gudrunstrasse 56, 44791 Bochum, Germany.
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Moanna A, Rimland D. Decreasing incidence of herpes zoster in the highly active antiretroviral therapy era. Clin Infect Dis 2013; 57:122-5. [PMID: 23487391 DOI: 10.1093/cid/cit165] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We evaluated the effect of highly active antiretroviral therapy (HAART) on the incidence of herpes zoster (HZ) in human immunodeficiency virus (HIV)-infected subjects. The annual incidence of HZ per 100 person-years decreased significantly from 6.3 episodes in 1987 to 1.0 episode in 2011, probably reflecting improved immune function.
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Affiliation(s)
- Abeer Moanna
- Department of Veterans Affairs Medical Center, 2Emory University School ofMedicine, Atlanta, Georgia 30033, USA.
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Lasserre A, Blaizeau F, Gorwood P, Bloch K, Chauvin P, Liard F, Blanchon T, Hanslik T. Herpes zoster: family history and psychological stress-case-control study. J Clin Virol 2012; 55:153-7. [PMID: 22824229 DOI: 10.1016/j.jcv.2012.06.020] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Revised: 06/22/2012] [Accepted: 06/28/2012] [Indexed: 11/16/2022]
Abstract
BACKGROUND Several studies have reported risk factors for herpes zoster (HZ), but their results remain controversial and difficult to compare because of their limitations regarding sampling and design. OBJECTIVES This study was aimed to determine risk factors in ambulatory patients aged 50 years or more, by consulting general practitioners (GPs) in France. STUDY DESIGN A prospective, national, matched case-control study was conducted. It involved 121 GPs who recruited 250 cases of HZ and 500 controls (matched by age and sex), aged 50 years and older, between April 2009 and September 2010. GP and patient questionnaires explored the following risk factors: family history of HZ, comorbidities, depression, anxiety, negative life events, physical trauma, alcohol and tobacco consumption, level of education, and various protective factors (such as exposure to children). Odds ratios were estimated using conditional logistic regression. RESULTS In multivariate adjusted analysis, a family history of HZ (OR 3.69, 95% CI 1.81-7.51), a HAD depressive score≥8 (OR 4.15, 95% CI 1.88-9.16), and a recent negative life event (OR 3.40, 95% CI 1.67-6.93) were all significantly associated with HZ. CONCLUSIONS This case-control study conducted in ambulatory patients in general practice reinforced the hypothesis that, in addition to the age-related decline in VZV-specific T-cell-mediated immunity, depression negative life event and familiar history of zoster increase the risk of occurrence of herpes zoster. In people with familiar history, this risk could be prevented by vaccination.
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Affiliation(s)
- Andrea Lasserre
- UPMC Univ Paris 06, 27, Rue de Chaligny, 75571 Paris Cedex 12, France.
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de Juanes J, Arrazola P, García de Codes A, Ariza C, Gil R, San Martín M, Gil A. Hospitalizaciones por herpes zoster y neuralgia postherpética en la Comunidad de Madrid, 1998–2003. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/s1576-9887(11)70020-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Bayas J, Gil R, Llupiá A, Díez C, Conesa A, Ariza C, Gil A, San Martín M. Hospitalizaciones por herpes zoster y neuralgia postherpética en Cataluña, 1998–2003. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/s1576-9887(11)70019-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Gatti A, Pica F, Boccia MTY, De Antoni F, Sabato AF, Volpi A. No evidence of family history as a risk factor for herpes zoster in patients with post-herpetic neuralgia. J Med Virol 2010; 82:1007-11. [PMID: 20419815 DOI: 10.1002/jmv.21748] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Little is known about reactivation of latent varicella zoster virus as herpes zoster in individuals with no underlying immunosuppression. Risk factors include age, sex, ethnicity, exogenous boosting of immunity from varicella contacts, underlying cell-mediated immune disorders, mechanical trauma, psychological stress, and immunotoxin exposure. An association between herpes zoster and family history of zoster has been proposed. A case-control study involving patients affected by post-herpetic neuralgia, which usually follows more severe acute herpes zoster, was performed. The patients with post-herpetic neuralgia were enrolled at the Pain Clinic of the Policlinico Tor Vergata in Rome, Italy, within 1 year from the onset of acute zoster. The controls matched for sex and age were chosen among healthy subjects without a history of herpes zoster presenting at the Internal Medicine Outpatient Clinic for hypertension in the same time period. All the participants in the study gave informed consent and were interviewed by medically trained and blinded investigators using a questionnaire. Similar proportions of the patients and the controls reported a family history of herpes zoster irrespective of the degree of relationship, i.e., 17.4% and 18.2%, respectively, by analyzing only the first-degree relatives [RR 1.03 (CI 95%: 0.78-1.37)], and 28.4% and 29.6%, respectively, by analyzing the total number of relatives [RR 1.03 (CI 95%: 0.81-1.31)]. Further and larger prospective cohort studies are needed to ascertain whether a family history of herpes zoster is really an independent predictor of zoster in different geographical settings.
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Affiliation(s)
- A Gatti
- Department of Surgery, University of Rome Tor Vergata, Rome, Italy
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Herpes Zoster Among HIV-Infected Patients in the Highly Active Antiretroviral Therapy Era: Korean HIV Cohort Study. J Acquir Immune Defic Syndr 2010; 53:417-8. [DOI: 10.1097/qai.0b013e3181b1d6dc] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Opstelten W, Van Essen GA, Schellevis F, Verheij TJM, Moons KGM. Gender as an independent risk factor for herpes zoster: a population-based prospective study. Ann Epidemiol 2006; 16:692-5. [PMID: 16516488 DOI: 10.1016/j.annepidem.2005.12.002] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2005] [Revised: 12/04/2005] [Accepted: 12/27/2005] [Indexed: 11/17/2022]
Abstract
PURPOSE Several studies reported a difference in herpes zoster (HZ) incidence between males and females, but limitations in design and analysis impeded the assessment of gender as an independent risk factor for HZ. This study examines the independent etiologic association between gender and HZ. METHODS A total of 335,714 persons were observed prospectively during 2001. We registered gender and HZ occurrence, as well as other risk factors for HZ. We calculated overall crude and adjusted odds ratios (ORs) and stratified to age. RESULTS The HZ incidence in females was 3.9/1000 patients/year (95% confidence interval [CI], 3.6-4.2), and in males, 2.5/1000 patients/year (95% CI, 2.3-2.8), with a crude OR of 1.53 (95% CI, 1.36-1.74). After adjustment for potential confounders, the adjusted OR was 1.38 (95% CI, 1.22-1.56). The incidence was greater in females in the middle-aged (age, 25 to 64 years; OR range, 1.36 to 1.83) and youngest group (OR, 1.31; 95% CI, 0.90-1.89). Gender effect was inverse in young adults (age, 15 to 24 years; OR, 0.64; 95% CI, 0.41-1.03). CONCLUSION Female gender is an independent risk factor for HZ in the 25- to 64-year-old age groups.
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Thomas SL, Wheeler JG, Hall AJ. Micronutrient intake and the risk of herpes zoster: a case–control study. Int J Epidemiol 2005; 35:307-14. [PMID: 16330478 DOI: 10.1093/ije/dyi270] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Herpes zoster can seriously impair quality of life and may also be a marker for age-related immune decline (immunosenescence). Diets low in micronutrients may increase the risk of zoster by temporarily compromising cell-mediated immune function or by hastening immunosenescence. METHODS Primary objectives were to examine the association between risk of zoster and (i) dietary intake of vitamins A, B(6), C, E, folic acid, zinc, and iron, and (ii) fruit and vegetable consumption. We conducted a community-based case-control study. Cases were adults with incident zoster presenting to 22 general practices in London. Controls were individuals with no zoster history, matched to cases by age, sex, and general practice. Diet was ascertained for 243 cases and 483 controls using an interviewer-administered food-frequency questionnaire. We used conditional logistic regression to estimate odds ratios. RESULTS There was a strong graded association between lower fruit intake and increasing zoster risk; in adjusted analysis, individuals who ate less than one piece of fruit per week had more than three times the risk of zoster compared with individuals who ate more than three portions per day. None of the dietary intakes of the seven micronutrients examined had a statistically significant association with zoster risk when considered singly. However, amongst individuals aged >60 years, a measure of combined micronutrient intake and vegetable intake showed similar dose-related associations with zoster risk. CONCLUSION A cocktail of nutrients such as those found in fruit and vegetables may act together, particularly in older individuals, to maintain immune health and prevent zoster.
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Affiliation(s)
- Sara L Thomas
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
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Abstract
Despite the development of laboratory methods, dermatological symptoms are a basic index of the presence and physical course of HIV infection. HIV infection usually undergoes a long latent period, proceeds to a period of immunodeficiency-related symptoms, and ends in an advanced immunodeficiency state characterized by opportunistic infections and neoplasms. Occasionally, dermatological manifestations can be the first signs of asymptomatic disease, indices of advanced immunodeficiency, or symptoms of opportunistic infections or neoplasms. The variety of symptoms and signs for the skin during the course of HIV infection is a consequence of the progressing immunodeficiency and therefore indicates the underlying disorder. The use of these manifestations is a challenge for clinical praxis.
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Affiliation(s)
- Dimitris Rigopoulos
- Department of Dermatology, University of Athens, A. Sygros Hospital, Athens, Greece
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Visalli RJ. Novel compounds for the treatment of varicella–zoster virus infections. Expert Opin Ther Pat 2004. [DOI: 10.1517/13543776.14.3.355] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Thomas SL, Hall AJ. What does epidemiology tell us about risk factors for herpes zoster? THE LANCET. INFECTIOUS DISEASES 2004; 4:26-33. [PMID: 14720565 DOI: 10.1016/s1473-3099(03)00857-0] [Citation(s) in RCA: 378] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Reactivation of latent varicella zoster virus as herpes zoster is thought to result from waning of specific cell-mediated immunity, but little is known about its determinants in individuals with no underlying immunosuppression. We systematically reviewed studies of zoster epidemiology in adults and analysed data from a large morbidity study to identify factors that might be modulated to reduce the risk of zoster. Annual zoster incidence in population-based studies varied from 3.6-14.2/10(3) in the oldest individuals. Risk factors identified in analytical studies that could explain this variation included age, sex, ethnicity, genetic susceptibility, exogenous boosting of immunity from varicella contacts, underlying cell-mediated immune disorders, mechanical trauma, psychological stress, and immunotoxin exposure. Our review highlights the lack of information about risk factors for zoster. We suggest areas of research that could lead to interventions to limit the incidence of zoster. Such research might also help to identify risk factors for age-related immune decline.
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Affiliation(s)
- Sara L Thomas
- Infectious Disease Epidemiology Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK.
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Gourishankar S, McDermid JC, Jhangri GS, Preiksaitis JK. Herpes zoster infection following solid organ transplantation: incidence, risk factors and outcomes in the current immunosuppressive era. Am J Transplant 2004; 4:108-15. [PMID: 14678041 DOI: 10.1046/j.1600-6143.2003.00287.x] [Citation(s) in RCA: 155] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Herpes zoster (HZ) infection is a frequent and serious complication of organ transplantation that has not been examined in the current era of immunosuppression. All solid organ transplants performed between 1994 and 1999 (n = 869) at our center were analyzed to determine the incidence, complications and risk factors for developing HZ. The overall incidence of HZ was 8.6% (liver 5.7%, renal 7.4%, lung 15.1% and heart 16.8%). The median time of onset was 9.0 months. We observed high rates of cutaneous scarring (18.7%) and post-herpetic neuralgia (42.7%). Independent organ-specific risk factors included: female gender and mycophenolate mofetil therapy (liver), and antiviral treatment other than prolonged cytomegalovirus (CMV) prophylaxis (renal and heart). For all organs combined, induction therapy and antiviral treatment other than prolonged CMV prophylaxis were independent predictors for the development of HZ. Herpes zoster is common and results in significant morbidity for solid organ transplant recipients. Risk factors include induction therapy and antiviral drug therapy other than CMV prophylaxis. The latter variable identifies a subpopulation that is likely at increased risk of latent herpesvirus reactivation. The high first-year post-transplant incidence rate suggests immunization pretransplant, even in varicella zoster virus immunoglobulin seropositive individuals, may be preventative.
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Affiliation(s)
- Sita Gourishankar
- Department of Medicine, Division of Nephrology & Transplantation Immunology, University of Alberta, Edmonton, Alberta, Canada.
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Abstract
Varicella-zoster virus (VZV), a member of the human herpesvirus family, causes childhood chickenpox (varicella), becomes latent in sensory ganglia, and reactivates years later in immunocompromised and elderly persons to produce shingles (herpes zoster). Early in the AIDS epidemic, zoster was noted in adults and children infected with HIV. Severe and debilitating zoster-associated dermatological, ophthalmic, and neurological complications may occur in patients infected with HIV. Antiviral therapy can modify the duration of zoster and alleviate its attendant complications. Varicella vaccine may boost the immunity and prevent virus reactivation. VZV immune globulin (VZIG) prevents or modifies clinical illness in persons who have been exposed to varicella or zoster.
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Affiliation(s)
- A Vafai
- Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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Domingo P, Torres OH, Ris J, Vazquez G. Herpes zoster as an immune reconstitution disease after initiation of combination antiretroviral therapy in patients with human immunodeficiency virus type-1 infection. Am J Med 2001; 110:605-9. [PMID: 11382367 DOI: 10.1016/s0002-9343(01)00703-3] [Citation(s) in RCA: 105] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Initiation of combination antiretroviral therapy may be followed by inflammatory reactions. We studied the epidemiology of herpes zoster infection among patients with human immunodeficiency virus (HIV) infection who were treated with combination antiretroviral therapy. SUBJECTS AND METHODS Of 316 patients who initiated combination antiretroviral therapy, 24 (8%) were treated for herpes zoster within 17 weeks of starting therapy. The characteristics of these cases were compared with those of a control group of 96 HIV-1-infected patients, who were matched by age, sex, plasma HIV-1 RNA concentration and CD4 cell counts, and length of follow-up. RESULTS The incidence of herpes zoster associated with combination antiretroviral therapy was 9 episodes per 100 patient-years. There were no significant differences between cases and controls in age, sex, years of HIV infection, history of herpes zoster, previous acquired immune deficiency syndrome, or baseline mean CD4 and CD8 cell counts before beginning combination antiretroviral therapy. However, patients who developed herpes zoster had a significantly greater mean (+/- SD) increase in the number of CD8 cells than did controls (347 +/- 269 vs. 54 +/- 331 cells/mL, P = 0.0006). In a multivariate analysis, the only factor that was associated with the development of herpes zoster was the increase in CD8 cells from before initiation of combination antiretroviral therapy to 1 month before development of herpes zoster (odds ratio 1.3 per percentage increase; 95% confidence interval: 1.1 to 1.5; P = 0.0002). CONCLUSION The initiation of combination antiretroviral therapy in HIV-1-infected patients was often associated with the development of herpes zoster, especially in those in whom the number of CD8 cells increased after therapy.
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Affiliation(s)
- P Domingo
- Department of Internal Medicine, Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
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Morgan D, Mahe C, Malamba S, Okongo M, Mayanja B, Whitworth J. Herpes zoster and HIV-1 infection in a rural Ugandan cohort. AIDS 2001; 15:223-9. [PMID: 11216931 DOI: 10.1097/00002030-200101260-00012] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare the rates and clinical features of herpes zoster in HIV-positive and HIV-negative individuals in a cohort in rural Uganda; to report the incidence of herpes zoster in the HIV-positive group in relation to seroconversion and CD4 cell counts and to determine whether it is indicative of a more rapid progression to death. DESIGN A prospective population-based cohort. METHODS The cohort comprised 107 prevalent and 144 incident (with documented dates of seroconversion) participants with HIV infection and 231 HIV-negative controls who were reviewed routinely every 3 months. RESULTS The mean rate of herpes zoster was 53.6/1000 person-years in HIV-positive and 4.4 in HIV-negative participants. The cumulative incidence of a first episode of herpes zoster was 7.6% at 2 years, 12.6% at 4 years and 24.0% at 6 years after seroconversion; the incidence rate was 35.6/1000 person-years. There was no evidence of a significant effect of age, gender, period from seroconversion or CD4 cell count on this incidence rate. Herpes zoster was an indicator of HIV-1 infection in this population but not an indicator of more rapid progression to death after adjusting for CD4 cell count and age. CONCLUSIONS The rates, including the cumulative incidence after seroconversion and the clinical presentation of herpes zoster, were similar to those reported from industrialized countries. Although an indicator of HIV-1 infection in this population, herpes zoster was unrelated to CD4 cell count or period from seroconversion and did not lead to a faster disease progression.
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Affiliation(s)
- D Morgan
- Medical Research Council Programme on AIDS/Uganda Virus Research Institute, Entebbe
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24
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Birner P, Gatterbauer B, Drobna D, Bernheimer H. Molecular mimicry in infectious encephalitis and neuritis: binding of antibodies against infectious agents on Western blots of human nervous tissue. J Infect 2000; 41:32-8. [PMID: 10942637 DOI: 10.1053/jinf.2000.0661] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To study the occurrence of cross-reactivities of antibodies against infectious agents with human nervous tissue. METHODS Binding of 25 antibodies against 17 neurotropic pathogens comprising Borrelia burgdorferi, Toxoplasma gondii, and various DNA and RNA viruses to Western blots of human cortex and myelin from central and peripheral nervous system was investigated. RESULTS Fourteen of the 25 antibodies tested showed binding to Western blots of human nervous tissue, suggesting the presence of shared epitopes. Binding of 11 antibodies against 10 pathogens to cortex and/or myelin correlated with the tissue targeted by neuropathological lesions. Three antibodies did not show such correlation; 11 antibodies did not bind at all. CONCLUSIONS Our results suggest that shared epitopes between infectious agents and human nervous tissues are more common than previously expected. Thus, molecular mimicry should be considered more frequently as a possible pathogenetic mechanism, among others, inducing tissue damage in encephalitis and neuritis caused by various pathogens.
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Affiliation(s)
- P Birner
- Institute of Neurology, University of Vienna, Austria
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Johnson RA. The immune compromised host in the twenty-first century: management of mucocutaneous infections. SEMINARS IN CUTANEOUS MEDICINE AND SURGERY 2000; 19:19-61. [PMID: 10834604 DOI: 10.1053/sd.2000.7371] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Infectious diseases encountered in dermatology have changed tremendously during the past few decades with the emergence of the immunocompromised host. This change is a result of the human immunodeficiency virus epidemic, use of immunomodulating drugs, bone marrow transplantation, increasing prevalence of diabetes mellitus, and an aging population. New pathogens have been discovered and new disorders have occurred. In the compromised host, infection can be more aggressive and widespread locally, be caused by opportunistic pathogens, and be disseminated hematogenously from or to the skin. The prevalence of nonmelanoma skin cancer has increased, and squamous cell carcinomas can be more aggressive with more rapid local growth as well as frequency of metastasis.
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Affiliation(s)
- R A Johnson
- Department of Dermatology, Beth Israel-Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
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Question 2. Med Mal Infect 1998. [DOI: 10.1016/s0399-077x(98)80093-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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