Burden of Herpes Zoster Among People with Human Immunodeficiency Virus in the United States

Background Recent United States data on incidence, healthcare resource utilization (HRU), and costs for herpes zoster (HZ) in adults with human immunodeficiency virus (HIV) are lacking. Methods This retrospective cohort study included insured adults during 2015–2022. HZ incidence rates were estimated among HZ-unvaccinated adults with HIV, HIV without other immunocompromising conditions (ICC) (HIV only), and 1,000,000 randomly selected adults with no ICC. Poisson regression was used to estimate adjusted incidence rate ratios (aIRRs) and 95% confidence intervals (CIs). All-cause HRU and costs were compared between propensity score-matched cohorts with HIV and HZ versus HIV without HZ during the first 1, 3, and 12 months after an episode of HZ. Results The incidence rates of HZ in the HIV (n = 53,700), HIV only (n = 41,544), and no ICC cohorts were 12.0, 10.3, and 5.6 per 1,000 person-years, respectively (HIV vs. no ICC: aIRR 2.05, 95% CI 1.92–2.19; HIV only vs. no ICC: aIRR 1.93, 95% CI 1.79–2.09). Mean all-cause per-patient costs were higher among adults with HIV and HZ during the first month (n = 1,078 and 4,312; cost difference $3,075, 95% CI $1,239–4,911) and the first 3 months (n = 994 and 3,976; $2,980, 95% CI $649–5,310) compared with adults with HIV without HZ. Conclusions People with HIV are at increased risk of HZ compared to adults without ICC, and the costs associated with HZ among people with HIV are considerable. These findings support the importance of HZ prevention for adults with HIV.