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Herpes zoster risk in immunocompromised adults in the United States: A systematic review
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    Clin Infect Dis. 71(7):e125-e134
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    Clin Infect Dis
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    Background: The primary reported risk factors for herpes zoster (HZ) are increasing age and immunodeficiency yet estimates of HZ risk by immunocompromising condition have not been well characterized. We undertook a systematic review of the literature to estimate HZ risk in five categories of immunocompromised patients. Methods: We systematically reviewed studies examining risk of HZ and its complications in adult patients with hematopoietic cell transplants (HCT), cancer (hematologic and solid tumor), HIV, and solid organ transplant (SOT; kidney and other). We identified studies in Pubmed, Embase, Cochrane, Scopus, and that presented original data from studies in the United States published after 1992 (1996 for HIV). We assessed risk of bias with Cochrane or GRADE methods. Results: We identified and screened 3,765 records and synthesized 34 studies with low or moderate risk of bias. The majority of studies included (32/34) reported at least one estimate of HZ cumulative incidence (range=0%–41%). Twelve studies reported HZ incidence, which varied widely within and between immunocompromised populations. Incidence estimates ranged between 9 and 92 HZ cases/1,000 patient-years and were highest in HCT, followed by hematologic malignancies, SOT, solid tumor malignancies, and lowest in HIV patients. Among 17 studies of HCT patients, absent or <1 year of post-transplant antiviral prophylaxis were associated with higher HZ cumulative incidence. Conclusions: HZ is common among all immunocompromised populations studied— exceeding expected HZ incidence among immunocompetent adults ≥60 years. Better evidence of incidence of HZ complications and severity in immunocompromised populations are needed to inform economic and HZ vaccine policy analyses.
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