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Impact of Antiretroviral Therapy on the Risk of Herpes Zoster among Human Immunodeficiency Virus-Infected Individuals in Tanzania

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  • 1 Clinical Research Center, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts;
  • | 2 Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois;
  • | 3 Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts;
  • | 4 Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts;
  • | 5 Management and Development for Health, Dar es Salaam, Tanzania;
  • | 6 Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts;
  • | 7 Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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We examined the incidence of herpes zoster (HZ) before and after the initiation of antiretroviral therapy (ART), and risk factors for HZ among human immunodeficiency virus (HIV)-infected individuals in Tanzania. A cohort study was conducted among HIV-positive individuals enrolled in HIV care and treatment clinics in Dar es Salaam, Tanzania. A Cox proportional hazard model was used to examine the effect of ART on the risk of HZ after adjusting for sociodemographics and time-varying clinical and nutritional factors. Among 72,670 HIV-positive individuals, 2,312 incident cases of HZ (3.2%) occurred during the median follow-up of 15 months (interquartile range: 3–35). The incidence rate of HZ significantly declined from 48.9 (95% confidence interval [CI] = 46.7–51.0) per 1,000 person-years before ART to 3.7 (95% CI = 3.3–4.1) per 1,000 person-years after the initiation of ART (P < 0.001). The risk of HZ declined with longer duration on ART. Low CD4 cell count, older age, female sex, district of Dar es Salaam, and year of enrollment were independently associated with the risk of HZ in the multivariate analysis. Low body mass index and anemia were not associated with the risk of HZ. The risk of HZ substantially declined after ART initiation in this large cohort of HIV-infected individuals. Earlier initiation of ART could reduce the risk of HZ and other opportunistic infections among HIV-infected individuals in sub-Saharan Africa.

Author Notes

Address correspondence to Kosuke Kawai, Boston Children’s Hospital, 300 Longwood Ave., Boston, MA 02115-5724. E-mail: kosuke.kawai@childrens.harvard.edu

Financial support: This work was supported by the U.S. President’s Emergency Plan for AIDS relief (PEPFAR) through the Harvard School of Public Health and by the Ministry of Health and Social Welfare, Tanzania. K.K. was supported by Boston Children’s Hospital Aerosmith HIV Endowment Fund.

Authors’ addresses: Kosuke Kawai, Clinical Research Center, Boston Children’s Hospital, Harvard Medical School, Boston, MA, E-mail: kosuke.kawai@childrens.harvard.edu. Claudia A. Hawkins, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, E-mail: c-hawkins@northwestern.edu. Ellen Hertzmark, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, E-mail: stleh@channing.harvard.edu. Joel M. Francis and David Sando, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, and Management and Development for Health, Dar es Salaam, Tanzania, E-mails: joelmf@hsph.harvard.edu and dsando.tz@gmail.com. Aisa N. Muya, Management and Development for Health, Dar es Salaam, Tanzania, E-mail: aisamuya@gmail.com. Nzovu Ulenga, Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, and Management and Development for Health, Dar es Salaam, Tanzania, E-mail: nulenga@mdh-tz.org. Wafaie W. Fawzi, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, and Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, E-mail: mina@hsph.harvard.edu.

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