HERPES-ZOSTER AND THE STAGE AND PROGNOSIS OF HIV-1 INFECTION

Objectives: To examine the incidence of herpes tester in HIV-1 infecti on. To assess the prognostic significance of the occurrence of herpes tester and progression to AIDS or death. Design and methods: 146 homos exually active men with known times of HIV-1 seroconversion were ident ified through the Sydney AIDS Prospective Study and the clinic records of a private medical practice with large caseload of HIV infected hom osexual men. Medical records were reviewed for a history of herpes tes ter, CD4+ lymphocyte counts, and HIV-1 disease status. Cox's proportio nal hazards model was used to determine whether herpes tester predicte d progression to AIDS or death. Results: After a mean follow up of 54 months, 30 men (20%) had an episode of herpes tester and three of thes e men had one recurrence. The overall incidence of herpes tester was 4 4.4 episodes per 1000 person years (95% CI 30.0-63.5). Herpes tester w as not found to be a marker of deteriorating immune function as measur ed by CD4+ lymphocyte counts. CD4+ counts did not differ significantly between those with and without tester at 1 year (551 v 572 x 10(6)/l, p = 0.79), 2 years (451 v 557, p = 0.11), and 3 years (424 v 481, p = 0.50) following HIV-1 seroconversion. There was no statistically sign ificant difference in progression to AIDS (RR = 1.89, 95% CI 0.80-4.46 , p = 0.15) or death (RR = 0.90, 95% CI 0.31-2.65, p = 0.85) from HIV- 1 seroconversion in those who did and those who did not develop herpes zoster. Conclusion: The incidence of herpes tester was consistent wit h the findings of other studies. There was no association between the occurrence of herpes tester and progression of HIV-1 disease.