IDWeek 2025: Zoster vaccination in people with HIV linked to lower mortality and cardiovascular risk

Zoster vaccination was associated with significantly reduced risks for all-cause mortality and major adverse cardiovascular events (MACE) among people living with HIV (PLWH), according to data from a real-world matched cohort presented at IDWeek 2025, in Atlanta.

The study (oral abstract P-402), presented by Ali Dehghani, DO, a PGY-2 resident physician at Case Western Reserve University School of Medicine, in Cleveland, used a large national database to examine whether prior zoster vaccination could influence long-term systemic outcomes in this high-risk population. “People living with HIV face elevated risk of adverse cardiovascular and neurodegenerative outcomes due to persistent immune activation,” Dr. Dehghani and colleagues wrote. “Herpes zoster, common in this population, may further potentiate these risks.”

1:1 Vaccinated to Unvaccinated 

Using the TriNetX Analytics Network, the investigators conducted a retrospective matched-cohort study of adults aged 50 years and older with HIV and no prior herpes zoster diagnosis. Participants were matched 1:1 for demographics, antiretroviral regimen, comorbidities, psychiatric history, and prior vaccine exposures. Individuals with prior MACE, dementia, central nervous system infections, end-stage renal disease, or recent immunosuppressive therapy were excluded.

The final cohort included 3,146 participants: half vaccinated and half unvaccinated. Median follow-up was about 2.9 years among vaccinated patients and 2.8 years for the unvaccinated controls. After matching, the mean age was 58 years; 69% identified as male, 41% white, and all were receiving antiretroviral therapy.

Lower Risks When Vaccinated

Compared with unvaccinated controls, those who had received the recombinant zoster vaccine experienced a 46% lower risk for all-cause mortality (hazard ratio [HR], 0.534; 95% CI, 0.380-0.749; P=0.0002) and a 39% lower risk for MACE (HR, 0.614; 95% CI, 0.481-0.783; P=0.0001). A nonsignificant trend toward lower dementia risk was observed (HR, 0.559; 95% CI, 0.237-1.32; P=0.18). No differences were found for psychiatric morbidity or parkinsonism.

“Zoster vaccination in PLWH was associated with significantly reduced risks of all-cause mortality and MACE,” the authors concluded. “Dementia risk trended lower but was not statistically significant.”

Understanding Infection Risks

These results are consistent with other evidence that varicella-zoster virus reactivation may contribute to vascular injury in PLWH. In a recent retrospective Italian cohort study, PLWH with a history of herpes zoster had markedly higher odds of ischemic events, even after multivariate adjustment (Viruses 2023;15[11]:2217).

The Advisory Committee on Immunization Practices recommends two doses of recombinant zoster vaccine (RZV; Shingrix, GlaxoSmithKline) for adults aged 19 years and older who are or will be immunocompromised, including PLWH.

Yet uptake remains limited. A recent study conducted among PLWH in Belgium, for example, found low awareness of herpes zoster, its complications, and its link with varicella; while 64% of the 327 patients surveyed reported being aware of herpes zoster, only one-third knew of the link between herpes zoster and varicella infection (Prev Med Rep 2025;56:103143). The new findings suggest that expanding RZV use in PLWH could not only reduce shingles incidence but potentially improve cardiovascular and survival outcomes.

The sources reported no relevant financial disclosures.

By Gina Shaw

SEE ALSO:

• Healio: Shingles vaccine has broader benefits for people with HIV