Even though herpes zoster (HZ) occurs at a higher age-specific rate in older patients with HIV, vaccination rates have remained low, according to a recent study.

The study in AIDS Research and Human Retroviruses analyzed how much interventions could help raise the rates. Past research has suggested that the risk of shingles in HIV patients is three times the general population.

University of Colorado, Medicine–led researchers designed a quality improvement study to assess herpes zoster vaccine (HZV) usage among HIV-positive patients and then assessed the effect of additional reminders/prompts. They also looked at barriers to HZV among older HIV patients.

Another recent study published in Clinical Infectious Diseases verified that the live attenuated zoster vaccine was safe and effective in HIV patients. “Two doses of ZV in HIV-infected adults suppressed on ART with CD4+ counts ≥200 cells/µL were generally safe and immunogenic,” concluded that research, which involved 395 participants.

The process was conducted in two parts at six institutions with varying payment structures. For Part 1 of the intervention, HIV patients eligible for HZV at the University of Colorado were identified, and providers were notified of patient eligibility. For Part 2, in addition to provider notification, an order for HZV was placed in the patient's chart prior to a clinic appointment.

Study authors note that HZV vaccination rates ranged from 1.5% to 42.4% at the six sites, and, prior to the intervention, 21.3% of eligible University of Colorado patients had received HZV.

The Part 1 intervention resulted in an additional 8.3% receiving HZV, while another 17.8% got vaccinated with Part 2 efforts. By the end of the intervention, researchers report that 53.2% of eligible patients had received HZV through routine clinical care or the additional efforts.

The most common reason for refusing the vaccine was insurance coverage concerns, according to the report, which adds that minor adverse reactions occurred in 26.7% patients and did not require medical care.

“HZV coverage was low at a majority of sites,” study authors conclude. “Clinical reminders with links to vaccination orders or pre-placed vaccination orders led to improved HZV coverage in our clinic, but published guidelines for use of HZV in [people living with HIV] and improvement in logistic or insurance barriers to HZV receipt are paramount to improved HZV coverage.”