HERPES-ZOSTER, IMMUNOLOGICAL DETERIORATION AND DISEASE PROGRESSION IN HIV-1 INFECTION

Objective: To study the incidence of herpes tester, the relationship between herpes tester and immunological markers, and the prognostic value of herpes tester for progression of HIV disease. Design and methods: A total of 966 homosexual participants in The Amsterdam Cohort Study were studied. Herpes tester was defined by its characteristic clinical presentation. Incidence was calculated using Poisson regression, cumulative incidence by the Kaplan-Meier product-limit method and the prognostic value was evaluated using Cox proportional hazards model. Results: The incidence of first episodes of herpes tester was 3.31 per 1000 person-years (PY) in HIV-seronegatives and 51.51 per 1000 PY in HIV-1-seropositive individuals. Recurrences only occurred in HIV-1-positive patients (25.6%). Cumulative incidences of first episodes increased linearly with the duration of follow-up. In HIV-1-seropositives the incidence was 31.2 per 1000 PY at CD4+ cells greater than or equal to 500 x 10(6)/l, 47.2 per 1000 PY [relative risk (RR), 1.51; 95% confidence interval (CI), 0.78-2.94] at CD4+ cells 200-499 x 10(6)/l and 97.5 per 1000 PY (RR, 3.13; 95% Cl, 1.54-6.32) at CD4+ cells < 200 x 10(6)/l. Besides CD4+ cell counts, CD3 monoclonal antibodies and phytohaemagglutinin-induced T-cell reactivity were independent predictors for herpes tester. The hazard ratio for AIDS after herpes tester was 1.6 (95% CI, 1.1-2.4) and for death 1.7 (95% CI, 1.1-2.5), but these were not independent from CD4+ cell counts. Conclusion: In HIV-1 infection the incidence of herpes tester increases with the decrease of CD4+ cell counts and T-cell reactivity, but herpes tester is not an independent predictor for disease progression.