The zoster vaccine increases the number of VZV specific CD4+ T cells [14] and older adults have an increase in IFN after a second dose of vaccine [15]
The zoster vaccine increases the number of VZV specific CD4+ T cells [14] and older adults have an increase in IFN after a second dose of vaccine [15]. controls (64.5%; p = 0.025). Cases had comparable mean VZV antibody levels prior to zoster diagnosis compared to controls [2.25 0.85 vs. 2.44 0.96 index value/optical density (OD) ratio; p = 0.151] with no difference in the change in antibody levels over time (0.08 0.71 vs. 0.01 0.94 index value/OD per year; p = 0.276). == Conclusion == Quantitative VZV antibody levels are stable in HIV-infected persons and do not predict zoster reactivation. Low CD4 count and lack of ART use appear to be better predictors of future zoster diagnosis. Keywords:HIV, Varicella zoster computer virus, Military == Background == Contamination with varicella zoster computer virus (VZV) can cause relapse of disease in those with impaired cell mediated immunity (CMI) known as herpes zoster (HZ) and is seen more frequently in those with HIV infection compared to HIV-uninfected individuals [1]. Overall incidence has decreased with increased use of antiretroviral therapy (ART), but rates MRX30 still remain high in the HIV-infected populace compared to the general populace (628650 per 100,000 person years [1,2] vs. 150300 per 100,000-person-years [3,4] respectively). Complications of HZ include bacterial superinfection, post-herpetic neuralgia (PHN), and ocular complications, among others [4]. PHN is usually a longterm neuropathic pain syndrome that is difficult to treat and it is estimated to affect 1020% of those with HZ with risk increasing with age [5]. Cell mediated immunity appears to play a role in preventing HZ, as waning CD4 count is usually associated with development of HZ [1,4]. Conversely, effective ART results in immune reconstitution and CD4 gains which reduce the risk of VZV reactivation [6,7]. Even though the association between reduced CMI and VZV reactivation has been well established, it remains difficult to predict disease, as it can occur at any CD4 count, and the risk of HZ remains high in the HIV-infected populace even in the ART era Leucovorin Calcium [1]. B cell dysfunction has also been observed in those with HIV [8,9] and can lead to altered antibody response [10]. Clinicians currently use VZV antibody status to determine prior exposure to VZV and help guideline vaccine decisions while Varicella vaccine clinical trials have used antibody levels to determine efficacy [11]. It is unclear if these antibody levels wane over time, and what role Leucovorin Calcium HIV infection plays in longitudinal quantitative VZV antibody levels. == Objectives == We retrospectively evaluated VZV antibody titers in HIV-infected persons with and without HZ in order to determine if VZV antibody levels can be used to predict HZ. == Study design == The US Military HIV Natural History Study (NHS) is usually a prospective observational study of HIV-infected military members and beneficiaries. Enrolled participants are 18 years of age with documented HIV contamination and complete informed consent in this IRB approved study. NHS participants have clinical visits approximately every 612 months at select military treatment facilities. The NHS database was queried for participants with (cases) or without (controls) a HZ diagnosis after HIV diagnosis. In order to assess the change in serum VZV antibody titers over time, only participants with a HZ diagnosis greater than or equal to 5 years after HIV diagnosis were included. Participants were required to have a serum Leucovorin Calcium sample 30180 days prior to HZ diagnosis in addition to a sample at least 3 years prior to documented HZ contamination. A total of 100 cases and 200 controls meeting inclusion criteria and serum sample availability were selected for analysis. Control participants who did not develop HZ were matched by age, race, gender, and CD4 count number at time of HIV diagnosis. Participants with unfavorable VZV antibody or receipt of varicella or zoster vaccines were excluded. Two repository plasma specimens were evaluated using a Leucovorin Calcium quantitative anti-VZV ELISA assay (Zeus Scientific, Somerville, NJ). VZV antibody levels are represented for each sample by a calibration cut-off value which is usually expressed as index value/OD ratio. Specimen time-points for controls were matched to corresponding cases. Differences in quantitative VZV levels were analyzed by the Wilcoxon MannWhitney.