British Columbia study underscores the importance of the shingles vaccine for people with HIV
May 12, 2026
CATIE News
- Researchers in B.C. studied more than 18,000 adults over a period of 20 years
- Overall, the rate of shingles was higher among people with HIV than people without HIV
- Vaccination was highly effective at reducing the risk of shingles regardless of HIV status
Herpes zoster virus causes a disease called chickenpox in children. After an outbreak of this illness, the virus goes into latency, hiding in nerves in the spine. In adults in the general population (usually beginning in people over 50 and increasing with age) whose immune systems have been weakened by age or other circumstances, the virus can come out of hiding and cause an illness called shingles.
Symptoms of shingles can include severe nerve pain and skin lesions. An outbreak can last a week or two. The pain from shingles can persist for weeks, even after skin lesions have healed. What’s more, in people whose immune systems are weakened by HIV, symptoms of shingles can be more severe and can occur earlier on (in some cases, before the age of 50). The virus can affect the membranes that surround the brain and spinal cord, causing inflammation in these tissues. Some research suggests that shingles is linked to an increased risk of stroke, heart disease and possibly dementia.
A recent U.S. study found an increased risk for shingles in adults without HIV (or other immune-suppressive conditions such as cancer) aged 30 to 39 (compared to healthy people in their 50s) who had conditions such as asthma, chronic obstructive pulmonary disease (COPD), depression, type 2 diabetes, stress, and injury from serious accidents.
In British Columbia
A team of scientists at the BC Centre for Excellence in HIV/AIDS, the University of British Columbia, Simon Fraser University and Providence Health Care analyzed health-related information collected from more than 18,000 adults, half of whom had HIV. The researchers found that people with HIV had a higher risk of developing shingles. What’s more, the risk of experiencing a recurrence of shingles was double among people with HIV compared to people without HIV.
The scientists also found that the shingles vaccine was highly effective at conferring protection from this illness regardless of a person’s HIV status. The study’s findings support expanding access to people with immune suppression, including people with HIV.
Study details
The scientists extracted data from a dataset called COAST (Comparative Outcomes and Service Utilization Trends). This dataset contains de-identified health information on people with diagnosed HIV in B.C. It also contains a randomly selected sample of 10% of the general population of B.C.
The researchers analyzed data collected between January 2000 and December 2019. There were 9,503 people with HIV, all of whom had initiated HIV treatment (antiretroviral therapy; ART) at some point during the study. Data from each person with HIV was compared to a person without HIV of the same age and sex.
At the time they entered the study, 85% of people with HIV were assigned male at birth and their average age was 39. Most people with HIV were in the study for about 12 years.
Results
Before 2009, people with HIV had what the scientists called a “substantially higher” risk for developing their first episode of shingles compared to people without HIV. This was particularly the case in people with HIV who were aged 50 and older; their risk for developing a first episode of shingles was “nearly four times higher […] than in people without HIV,” according to the researchers. When the scientists analyzed data from people who were aged 19 to 49, they found that people with HIV had a risk of developing shingles that was six times higher than that of people without HIV.
After 2009, there was a program in B.C. that offered shingles vaccination. In analyzing data after 2009, scientists found that the rates of shingles between people with and without HIV narrowed. In people aged 50 and older, the risk of shingles among people with HIV was described by the scientists as “modestly higher” than that of people without HIV. However, among people aged 49 and younger, the risk among people with HIV remained nearly threefold greater than that of people without HIV.
Factors affecting the risk of a first-time episode of shingles
When the scientists analyzed the data for factors that increased the risk for shingles among people with HIV, they found the following:
People aged 50 and older
- having a diagnosis of shingles in the past
- having a severely weakened immune system (less than 50 CD4+ cells)
- having unsuppressed HIV
People aged 49 and younger
- having unsuppressed HIV
- having a severely weakened immune system (less than 50 CD4+ cells)
Factors affecting the risk of recurrence of shingles
Some participants developed recurring episodes of shingles during the study.
Factors affecting recurrence of shingles during the study period were distributed as follows:
People aged 50 and older
- having a diagnosis of shingles in the past (particularly in people who had two or more previous episodes)
- having a severely weakened immune system (less than 50 CD4+ cells)
- having unsuppressed HIV
- having transplanted tissue/organ (such people would have been receiving drugs to partially suppress their immune systems so that that the transplanted tissue/organ could survive)
People aged 49 and younger
- having a diagnosis of shingles in the past (particularly in people who had two or more previous episodes)
- having a severely weakened immune system (less than 50 CD4+ cells)
- having unsuppressed HIV
The scientists noted that people under the age of 49 who had HIV were more likely than people without HIV in the same age range to have inflammatory bowel diseases and depression and/or anxiety. Treatments for inflammatory bowel conditions reduce inflammation by partially weakening the immune system. It is possible that this may have contributed to the increased risk for shingles in this population of younger people in the present study.
Vaccination
It appeared that only people aged 50 and older received the shingles vaccine. In this population, the vaccine was highly effective, particularly in people with HIV.
Bear in mind
It is not surprising that people whose HIV was not suppressed had a higher risk of shingles. In part, this was driven by immune deficiency. Untreated HIV infection is also associated with increased inflammation and immunological dysfunction—factors that could help incite the shingles virus out of dormancy.
The scientists found that people with HIV who were vaccinated against shingles tended to have “better health status and engagement in HIV care, including higher CD4+ cell counts and viral suppression.”
They also found that some comorbidities may have contributed to an increased risk for shingles. In the present study, such comorbidities included:
- cardiovascular disease
- non-AIDS-defining cancers
- high blood pressure
- chronic liver disease
- mood and anxiety disorders
Other studies in the general population have found a link between these conditions and an increased risk for shingles. Part of the reason for this may be that the conditions listed are associated with increased inflammation, which can contribute to driving the virus that causes shingles out of latency.
Focus on vaccination
Provinces and territories in Canada have different criteria for making subsidized access to the shingles vaccine available. In Canada, each dose of the vaccine costs about $160 (two doses are required; each dose is given between two and six months apart). The B.C. scientists encourage health systems to make the vaccine more widely available, particularly for people aged 50 and older and for people with weakened immune systems.
Other benefits
The present B.C. study focused on shingles. Emerging studies from Canada and other countries suggest that the shingles vaccine is also associated with a reduced risk for the following conditions in people without HIV:
- dementia
- cardiovascular disease
- stroke
Thus, shingles vaccination has the potential to reduce the risk for several diseases. Studies are needed with people who have HIV to determine if the shingles vaccine can reduce the risk for developing other conditions.
In Alberta
Several years ago, researchers in Calgary, Alberta, did a study about the impact of shingles on people with HIV and the healthcare system. They found that this illness could result in complications that led to hospitalization. Furthermore, the researchers found that vaccinating people with HIV would likely not only reduce their risk for shingles and hospitalization but also reduce costs to health systems.
—Sean R. Hosein
Resources
Herpes zoster (shingles) vaccine: Canadian Immunization Guide – Government of Canada
Shingles vaccine – Government of Quebec
Shingles– BC Centre for Disease Control
Calgary researchers study the impact of shingles in people with HIV – CATIE News
BC Centre for Excellence in HIV/AIDS
REFERENCES:
- Lima VD, Hussain SS, Yan J, et al. Incidence of herpes zoster infection (shingles) among adults living with and without HIV in British Columbia, Canada: A population-based study. Journal of Infectious Diseases. 2026; in press.
- Whitley RJ. Chapter 198. Varicella-Zoster Virus infections. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J, eds. Harrison’s Principles of Internal Medicine. 22nd ed. New York: McGraw-Hill; 2025.
- Cohen RA, Oraichi D, Mwakingwe-Omari A, et al. Age-specific risk of herpes zoster in adults aged ≥18 years with comorbid conditions – a retrospective cohort study in the United States. Clinical Infectious Diseases. 2026; in press.
- Pomirchy M, Chung S, Bommer C, et al. Herpes zoster vaccination and incident dementia in Canada: an analysis of natural experiments. Lancet Neurology. 2026 Feb;25(2):170-180.
- Kawai K, Muhere CF, Lemos EV, et al. Viral infections and risk of cardiovascular disease: Systematic review and meta-analysis. Journal of the American Heart Association. 2025 Nov 4;14(21): e042670.
- Ogunjimi B, Warren-Gash C, Ouwendijk WJD, et al. Varicella zoster virus and the central nervous system. Nature Reviews Microbiology. 2026; in press.
- Rayens E, Sy LS, Qian L, et al. Recombinant zoster vaccine is associated with a reduced risk of dementia. Nature Communications. 2026 Feb 9;17(1):2056.
- Xie M, Eyting M, Bommer C, et al. The effect of shingles vaccination at different stages of the dementia disease course. Cell. 2025 Dec 11;188(25):7049-7064.e20.
- Polisky V, Littmann M, Triastcyn A, et al. Varicella-zoster virus reactivation and the risk of dementia. Nature Medicine. 2025 Dec;31(12):4172-4179.
- Heidecker B, Libby P, Vassiliou VS, et al. Vaccination as a new form of cardiovascular prevention: a European Society of Cardiology clinical consensus statement. European Heart Journal. 2025 Sep 22;46(36):3518-3531.
From Canadian AIDS Treatment Information Exchange (CATIE).
This content was originally published by CATIE, Canada’s source for HIV and hepatitis C information.
Source: CATIE:
https://www.catie.ca/catie-news/british-columbia-study-underscores-the-importance-of-the-shingles-vaccine-for-people
For more information visit CATIE's Information Network at www.catie.ca
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