RESEARCH - Shingles in immunocompromised patients: incidence, timing, and risk factors

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Am J Med. 2005 Dec;118(12):1416. Related Articles, Links

Herpes zoster in immunocompromised patients: incidence, timing, and risk

factors.

Wung PK, Holbrook JT, Hoffman GS, Tibbs AK, Specks U, Min YI, Merkel PA,

Spiera R, JC, St Clair EW, McCune J, Ytterberg SR, NB, Stone JH;

WGET Research Group.

s Hopkins University School of Medicine, s Hopkins University,

Baltimore, Md, USA.

PURPOSE: To evaluate the risk factors for herpes zoster as well as the

incidence and timing of this complication in patients who were treated with

immunosuppression because of active Wegener's granulomatosis. SUBJECTS AND

METHODS: We studied the 180 Wegener's granulomatosis patients in the

Wegener's Granulomatosis Etanercept Trial (WGET). Herpes zoster events

during WGET were documented prospectively. Follow-up questionnaires were

employed to describe the location, treatment, and complication(s) of herpes

zoster and its therapy. Univariate and multivariate analyses were performed

to evaluate risk factors, including history of herpes zoster, for the

occurrence of herpes zoster during the trial. All analyses were based on the

time to first occurrence of herpes zoster. RESULTS: Eighteen patients (10%

of the WGET cohort) suffered a total of 19 herpes zoster episodes over a

mean follow-up period of 27 months. The annual incidence of herpes zoster in

the WGET cohort was 45 cases/1000 patient-years (95% confidence interval

[CI]: 27, 70). The median time from enrollment to the occurrence of herpes

zoster in the subgroup of patients with that complication was 16.5 months

(+/- 9.4). Fifteen of the 19 herpes zoster events (79%) occurred between

months 6 and 36, many months after the period of most intensive

immunosuppression. In univariate analyses, history of serum creatinine > or

=1.5 mg/dL before enrollment was associated with a relative risk (RR) of 3.0

(95% CI: 1.1, 7.8) for herpes zoster during WGET (P=.03). In multivariate

analyses, serum creatinine > or =1.5 mg/dL was associated with an RR of 6.3

(95% CI: 2.0, 19.8; P=.002), and female sex with an RR of 4.6 (95% CI: 1.6,

13.2; P=.004). CONCLUSION: Renal dysfunction and female sex were

consistently strong risk factors for herpes zoster events in this

population. Contrary to expectation, most herpes zoster events did not occur

during periods of most intensive immunosuppression. These data may inform

studies of interventions designed to prevent herpes zoster in patients on

treatment for immune-mediated diseases.

PMID: 16378799

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dopt=Abstra\

ct & list_uids=16378799 & itool=iconabstr & query_hl=3 & itool=pubmed_DocSum

Not an MD

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Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org