Incidence of Herpes Zoster infection (Shingles) among adults living with and without HIV in British Columbia, Canada: A population-based study

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dc.contributor.authorLima, Viviane Diasen
dc.contributor.authorHussain, Saarah Sofiaen
dc.contributor.authorYan, Jintongen
dc.contributor.authorCopp, Estheren
dc.contributor.authorHull, Marken
dc.contributor.authorBudu, Michaelen
dc.contributor.authorDuailibe, Felipeen
dc.contributor.authorTrigg, Jasonen
dc.contributor.authorLeung, Victoren
dc.contributor.authorPhillips, Peteren
dc.contributor.authorGuillemi, Silviaen
dc.contributor.authorHogg, Robert Sen
dc.contributor.authorMontaner, Julio S Gen
dc.contributor.funderCanadian Institutes of Health Researchen
dc.date.accessioned2026-09-16T13:55:58Z
dc.date.available2026-09-16T13:55:58Z
dc.date.issued2026-03-10en
dc.description.abstractBackground: Herpes zoster (HZ) incidence is elevated among immunocompromised populations, including people living with HIV (PLWH). We evaluated HZ incidence, associated risk factors, recurrence, and postvaccination HZ occurrence among PLWH compared with people living without HIV (PLWoH) in British Columbia, Canada. Methods: We conducted a retrospective, population-based matched cohort study using data from the Comparative Outcomes and Service Utilization Trends study (2000–2019). PLWH aged ≥19 years initiating antiretroviral therapy were propensity-score matched to PLWoH from the general population. Incident HZ was identified from administrative health records using a 12-month washout. Age-stratified time-to-event, competing-risk, and multivariable models were used to estimate incidence, risk factors, recurrence, and vaccination-associated outcomes. Results: Among 9053 PLWH and 9053 matched PLWoH, HZ incidence rates were higher among PLWH overall. Before vaccine availability, PLWH experienced substantially higher HZ hazards than PLWoH, particularly among participants aged <50 years. After 2009, HZ risk remained elevated among younger PLWH, while hazards were similar between groups among those aged ≥50 years. HZ recurrence was approximately twice as frequent among PLWH. Among PLWH, advanced immunosuppression, including low CD4 cell counts and unsuppressed viral load, and selected comorbidities were independently associated with higher HZ risk. Postvaccination HZ incidence was low in both populations, with no meaningful difference between PLWH and PLWoH; breakthrough events were uncommon. Conclusions: PLWH remain at increased risk of HZ and recurrence, especially if younger or immunosuppressed. Vaccination was associated with a lower HZ risk supporting expanded access to recombinant zoster vaccination for immunocompromised adults irrespective of age.en
dc.description.sponsorshipCanadian Institutes of Health Research|130419; Canadian Institutes of Health Research|143342; Canadian Institutes of Health Research|PJT-148595en
dc.description.statusPeer revieweden
dc.description.versionPublished Versionen
dc.format.mimetypeapplication/pdfen
dc.identifier.citationLima, V. D., Hussain, S. S., Yan, J., Copp, E., Hull, M., Budu, M., Duailibe, F., Trigg, J., Leung, V., Phillips, P. and Guillemi, S. (2026) 'Incidence of Herpes Zoster infection (Shingles) among adults living with and without HIV in British Columbia, Canada: A population-based study', Journal of Infectious Diseases, 234(1), pp. 69-80. https://doi.org/10.1093/infdis/jiag118en
dc.identifier.doi10.1093/infdis/jiag118en
dc.identifier.endpage80en
dc.identifier.issn0022-1899en
dc.identifier.issn1537-6613en
dc.identifier.issued1en
dc.identifier.journaltitleThe Journal of Infectious Diseasesen
dc.identifier.startpage69en
dc.identifier.urihttps://hdl.handle.net/10468/19264
dc.identifier.volume234en
dc.language.isoenen
dc.publisherOxford University Press (OUP)en
dc.rights© 2026, the Author(s). Published by Oxford University Press on behalf of Infectious Diseases Society of America. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. https://doi.org/10.1093/infdis/jiag118en
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/en
dc.subjectHerpes zoster (HZ)en
dc.subjectRecombinant zoster vaccinationen
dc.subjectImmunocompromised adultsen
dc.titleIncidence of Herpes Zoster infection (Shingles) among adults living with and without HIV in British Columbia, Canada: A population-based studyen
dc.typeArticle (peer-reviewed)en
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