Here’s a shocking fact: people living with HIV (PLWH) face not only the challenges of managing their condition but also heightened risks of cardiovascular issues and early death. But what if a simple vaccine could change that? New research from IDWeek 2025 reveals that the zoster vaccine—typically used to prevent shingles—may do just that. And this is the part most people miss: it’s not just about avoiding shingles; it’s about potentially slashing mortality rates and cardiovascular risks in this vulnerable population.
Presented by Dr. Ali Dehghani, a resident physician at Case Western Reserve University School of Medicine, the study (oral abstract P-402) analyzed data from a large national database to explore the long-term benefits of zoster vaccination in PLWH. The findings? Vaccinated individuals saw a 46% lower risk of all-cause mortality and a 39% reduction in major adverse cardiovascular events (MACE) compared to their unvaccinated counterparts. While the link to lower dementia risk wasn’t statistically significant, the trend is hard to ignore.
But here’s where it gets controversial: Why isn’t this vaccine more widely adopted among PLWH? Despite recommendations from the Advisory Committee on Immunization Practices (ACIP) for immunocompromised adults, including PLWH, uptake remains low. A Belgian study found that while 64% of PLWH had heard of shingles, only one-third knew its connection to varicella (chickenpox). This knowledge gap could be costing lives—and the new data suggests expanding zoster vaccine use could not only prevent shingles but also improve cardiovascular health and survival rates.
The study’s design was meticulous: a 1:1 matched cohort of 3,146 participants, aged 50 and older, with no prior shingles diagnosis. Researchers controlled for demographics, antiretroviral regimens, comorbidities, and more, ensuring a fair comparison. The results align with earlier research, like an Italian study showing PLWH with a history of shingles had higher odds of ischemic events, hinting at the varicella-zoster virus’s role in vascular injury.
So, here’s a thought-provoking question: If a vaccine could reduce not just shingles but also life-threatening cardiovascular risks and mortality, why isn’t it a priority for PLWH? Could better education and access to the recombinant zoster vaccine (RZV, brand name Shingrix) be a game-changer? Let’s discuss—share your thoughts in the comments below. The science is clear, but the conversation is just beginning.
