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

Publication ,  Journal Article
Wung, PK; Holbrook, JT; Hoffman, GS; Tibbs, AK; Specks, U; Min, Y-I; Merkel, PA; Spiera, R; Davis, JC; St Clair, EW; McCune, J; Ytterberg, SR ...
Published in: Am J Med
December 2005

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.

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Published In

Am J Med

DOI

EISSN

1555-7162

Publication Date

December 2005

Volume

118

Issue

12

Start / End Page

1416

Location

United States

Related Subject Headings

  • Time Factors
  • Risk Factors
  • Receptors, Tumor Necrosis Factor
  • Middle Aged
  • Male
  • Incidence
  • Immunosuppressive Agents
  • Immunoglobulin G
  • Immunocompromised Host
  • Humans
 

Citation

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Wung, P. K., Holbrook, J. T., Hoffman, G. S., Tibbs, A. K., Specks, U., Min, Y.-I., … WGET Research Group, . (2005). Herpes zoster in immunocompromised patients: incidence, timing, and risk factors. Am J Med, 118(12), 1416. https://doi.org/10.1016/j.amjmed.2005.06.012
Wung, Peter K., Janet T. Holbrook, Gary S. Hoffman, Andrea K. Tibbs, Ulrich Specks, Y. -. I. Min, Peter A. Merkel, et al. “Herpes zoster in immunocompromised patients: incidence, timing, and risk factors.Am J Med 118, no. 12 (December 2005): 1416. https://doi.org/10.1016/j.amjmed.2005.06.012.
Wung PK, Holbrook JT, Hoffman GS, Tibbs AK, Specks U, Min Y-I, et al. Herpes zoster in immunocompromised patients: incidence, timing, and risk factors. Am J Med. 2005 Dec;118(12):1416.
Wung, Peter K., et al. “Herpes zoster in immunocompromised patients: incidence, timing, and risk factors.Am J Med, vol. 118, no. 12, Dec. 2005, p. 1416. Pubmed, doi:10.1016/j.amjmed.2005.06.012.
Wung PK, Holbrook JT, Hoffman GS, Tibbs AK, Specks U, Min Y-I, Merkel PA, Spiera R, Davis JC, St Clair EW, McCune J, Ytterberg SR, Allen NB, Stone JH, WGET Research Group. Herpes zoster in immunocompromised patients: incidence, timing, and risk factors. Am J Med. 2005 Dec;118(12):1416.
Journal cover image

Published In

Am J Med

DOI

EISSN

1555-7162

Publication Date

December 2005

Volume

118

Issue

12

Start / End Page

1416

Location

United States

Related Subject Headings

  • Time Factors
  • Risk Factors
  • Receptors, Tumor Necrosis Factor
  • Middle Aged
  • Male
  • Incidence
  • Immunosuppressive Agents
  • Immunoglobulin G
  • Immunocompromised Host
  • Humans