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Zoster Vaccination in People Living with HIV Is
Associated with Reduced Mortality and Cardiovascular Risk:
A Real-World Matched Cohort Study Zoster Infection &
Vaccination as Determinants of Vascular and Cognitive Outcomes in PLWH
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IDWeek Oct 19-22 Atlanta
ABSTRACT
Background: People living with HIV (PLWH) face elevated risk of adverse cardiovascular and neurodegenerative outcomes due to persistent immune activation. Herpes zoster (HZ), common in PLWH, may further potentiate these risks. We assessed whether prior zoster vaccination reduces major adverse cardiovascular events (MACE)-a composite of sudden cardiac death, stroke, myocardial infarction, and pulmonary embolism, as well as dementia, all-cause mortality, and psychiatric morbidity (anxiety, depression and schizophrenia) in PLWH without prior HZ. Propensity Score Distribution Before and After Matching (Zoster Vaccinated vs. Unvaccinated PLWH).
Prior to matching, there was substantial imbalance between cohorts, with vaccinated individuals having lower baseline propensity scores. After matching on demographics, ART regimen, comorbidities, psychiatric history, and vaccine exposures, the distributions aligned closely, indicating adequate covariate balance.
Methods: We conducted a retrospective matched cohort study using the TriNetXAnalytics Network. Adults aged ≥50 years with HIV and no prior HZ diagnosis were stratified by zoster vaccination status. Exclusions included prior MACE, dementia, CNS infections, ESRD, or recent immunosuppressive therapy. Vaccinated individuals were matched 1:1 to unvaccinated controls on demographics, ART regimen, cardiometabolic and psychiatric history, statin and antihypertensive use, and prior vaccine exposures. Primary outcomes were MACE, dementia, and all-cause mortality; secondary outcomes included psychiatric morbidity, and Parkinsonism. Hazard ratios (HRs) and Kaplan-Meier analyses were used to assess outcome differences, with p < 0.05 considered statistically significant.
Results: A total of 3,146 PLWH (50% vaccinated and 50% unvaccinated) were followed from 90 days to 7 years post-index (median follow up: 2.89 years in the vaccinated vs 2.78 years in the unvaccinated group). After matching, the mean age was 58.4 years; 69% were male and 41% were white and 100% were on ART. Zoster vaccination was associated with significantly lower hazards of all-cause mortality (HR 0.534, 95% CI: 0.380-0.749; p=0.0002), MACE (HR 0.614, 95% CI: 0.481-0.783; p=0.0001). Dementia risk trended lower in vaccinated individuals (HR 0.559, 95% CI: 0.237-1.32; p=0.1783) but was not statistically significant. No significant differences were observed in psychiatric morbidity (HR 0.904, 95% CI: 0.793-1.03; p=0.1297) or Parkinsonism (HR 0.507, 95% CI: 0.173-1.483; p=0.2060).
Conclusion:
Zoster vaccination in PLWH was associated with significantly reduced risks of all-cause mortality and MACE. Dementia risk trended lower but was not statistically significant.
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