Herpes Zoster Risk in Immunocompromised Adults in the United States: A Systematic Review

Abstract

Background The primary reported risk factors for herpes zoster (HZ) include increasing age and immunodeficiency, yet estimates of HZ risk by immunocompromising condition have not been well characterized. We undertook a systematic literature review to estimate the HZ risk in immunocompromised patients. Methods We systematically reviewed studies that examined the risk of HZ and associated complications in adult patients with hematopoietic cell transplants (HCT), cancer, human immunodeficiency virus (HIV), and solid organ transplant (SOT). We identified studies in PubMed, Embase, Medline, Cochrane, Scopus, and clinicaltrials.gov that presented original data from the United States and were published after 1992. We assessed the risk of bias with Cochrane or Grading of Recommendations Assessment, Development, and Evaluation methods. Results We identified and screened 3765 records and synthesized 34 studies with low or moderate risks of bias. Most studies that were included (32/34) reported at least 1 estimate of the HZ cumulative incidence (range, 0–41%). There were 12 studies that reported HZ incidences that varied widely within and between immunocompromised populations. Incidence estimates ranged from 9 to 92 HZ cases/1000 patient-years and were highest in HCT, followed by hematologic malignancies, SOT, and solid tumor malignancies, and were lowest in people living with HIV. Among 17 HCT studies, the absence of or use of antiviral prophylaxis at <1 year post-transplant was associated with a higher HZ incidence. Conclusions HZ was common among all immunocompromised populations studied, exceeding the expected HZ incidence among immunocompetent adults aged ≥60 years. Better evidence of the incidence of HZ complications and their severity in immunocompromised populations is needed to inform economic and HZ vaccine policies.

Disseminated Herpes Zoster During COVID-19

“… 7 On the one hand, it has been observed that the absolute number of lymphocytes decreased during SARS-CoV-2 infections in proportion to the severity of the disease. 8 This coincides with the significant drop in lymphocyte count at the time of the rash seen in this patient. On the other hand, it can be assumed that the lymphocyte recruitment generated by the infection and triggering the classical immune mechanisms 9 could reduce the effectiveness of acquired immunity against VZV.…”

Herpes zoster in HIV-1 infection: The role of CSF pleocytosis in secondary CSF escape and discordance

“…While it occurs in those without HIV-1 infection, herpes zoster ((HZ) is more common in PLWH in which it is more frequent in those with depressed blood CD4+ counts [39], but also occurs in untreated and treated PLWH at higher blood CD4+ T-cell counts than the more severe opportunistic infections defining an AIDS diagnosis [39,40]. Beginning with reactivation in the sensory ganglion, varicella-zoster virus (VZV) spreads along the associated peripheral nerve both centrifugally to the associated dermatome, resulting in the characteristic rash, and centrally to the nerve root, and variably into the root entry zone of the spinal cord or brain stem [41].…”

Generalized herpes zoster and cutaneous metastasis during chemotherapy for non‐small cell lung cancer: A case report

“…reported that among 1410 patients with lung cancer, 35 (2.5%) developed herpes zoster. The incidence of herpes zoster in solid tumors is lower than hematological cancer 1,12 . Moreover, generalized herpes zoster, where VZV disseminates hematogenously from dorsal root ganglia cells to distant parts of the body, is uncommon 4 .…”