Herpes zoster in immunocompromised patients

Incidence, timing, and risk factors

Peter K. Wung, Janet T. Holbrook, Gary S. Hoffman, Andrea K. Tibbs, Ulrich Specks, Y. I. Min, Peter A. Merkel, Robert Spiera, John C. Davis, E. William St. Clair, Joseph McCune, Steven R Ytterberg, Nancy B. Allen, John H. Stone

Research output: Contribution to journalArticle

52 Citations (Scopus)

Abstract

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 <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 <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.

Original languageEnglish (US)
JournalAmerican Journal of Medicine
Volume118
Issue number12
DOIs
StatePublished - Dec 2005

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Herpes Zoster
Immunocompromised Host
Granulomatosis with Polyangiitis
Incidence
Confidence Intervals
Immunosuppression
Creatinine
Multivariate Analysis
Immune System Diseases
Serum
Therapeutics

Keywords

  • Herpes zoster
  • Immunosuppression
  • Incidence
  • Renal insufficiency
  • Wegener's granulomatosis

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Wung, P. K., Holbrook, J. T., Hoffman, G. S., Tibbs, A. K., Specks, U., Min, Y. I., ... Stone, J. H. (2005). Herpes zoster in immunocompromised patients: Incidence, timing, and risk factors. American Journal of Medicine, 118(12). https://doi.org/10.1016/j.amjmed.2005.06.012

Herpes zoster in immunocompromised patients : Incidence, timing, and risk factors. / Wung, Peter K.; Holbrook, Janet T.; Hoffman, Gary S.; Tibbs, Andrea K.; Specks, Ulrich; Min, Y. I.; Merkel, Peter A.; Spiera, Robert; Davis, John C.; St. Clair, E. William; McCune, Joseph; Ytterberg, Steven R; Allen, Nancy B.; Stone, John H.

In: American Journal of Medicine, Vol. 118, No. 12, 12.2005.

Research output: Contribution to journalArticle

Wung, PK, Holbrook, JT, Hoffman, GS, Tibbs, AK, Specks, U, Min, YI, Merkel, PA, Spiera, R, Davis, JC, St. Clair, EW, McCune, J, Ytterberg, SR, Allen, NB & Stone, JH 2005, 'Herpes zoster in immunocompromised patients: Incidence, timing, and risk factors', American Journal of Medicine, vol. 118, no. 12. https://doi.org/10.1016/j.amjmed.2005.06.012
Wung, Peter K. ; Holbrook, Janet T. ; Hoffman, Gary S. ; Tibbs, Andrea K. ; Specks, Ulrich ; Min, Y. I. ; Merkel, Peter A. ; Spiera, Robert ; Davis, John C. ; St. Clair, E. William ; McCune, Joseph ; Ytterberg, Steven R ; Allen, Nancy B. ; Stone, John H. / Herpes zoster in immunocompromised patients : Incidence, timing, and risk factors. In: American Journal of Medicine. 2005 ; Vol. 118, No. 12.
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AU - Holbrook, Janet T.

AU - Hoffman, Gary S.

AU - Tibbs, Andrea K.

AU - Specks, Ulrich

AU - Min, Y. I.

AU - Merkel, Peter A.

AU - Spiera, Robert

AU - Davis, John C.

AU - St. Clair, E. William

AU - McCune, Joseph

AU - Ytterberg, Steven R

AU - Allen, Nancy B.

AU - Stone, John H.

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N2 - 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 <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 <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.

AB - 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 <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 <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.

KW - Herpes zoster

KW - Immunosuppression

KW - Incidence

KW - Renal insufficiency

KW - Wegener's granulomatosis

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