People living with HIV who have had prior zoster vaccination have a significantly reduced risk of all-cause mortality and major adverse cardiovascular events (MACE), according to new research presented at IDWeek 2025.
Ali Dehghani, DO, of Case Western Reserve University School of Medicine in Cleveland, Ohio, and his colleague compared vaccinated and unvaccinated people living with HIV to assess patient deaths; MACE, such as stroke, myocardial infarction, and pulmonary embolism; dementia, and psychiatric morbidity, such as anxiety, depression, and schizophrenia.
Previous research suggests that people with HIV experience higher risk of adverse cardiovascular and neurodegenerative outcomes because of persistent immune activation.
Because herpes zoster is common in this population and may contribute to increased cardiovascular and neurodegenerative risks, the researchers compared outcomes by vaccination status.
The retrospective matched cohort study included 3146 people with HIV—half were vaccinated and half were unvaccinated. Participants were a median age of 58.4 years, mostly men (69%), and 41% were White. They were followed from 90 days to 7 years post-index, and matched 1:1 on demographics, antiretroviral therapy (ART) regimen, cardiometabolic and psychiatric history, statin and antihypertensive use, and prior vaccine exposures. All participants were on ART.
At IDWeek 2025, Dehghani discussed the study’s findings during a poster session. He highlighted that zoster vaccination significantly lowered hazards of all-cause mortality (hazard ratio [HR] 0.534; 95% CI, 0.380-0.749; P<0.001). Furthermore, vaccinated participants experienced higher MACE-free survival (HR 0.614; 95% CI, 0.481-0.783; P<0.001). Although dementia risk was lower in vaccinated individuals, the finding wasn’t statistically significant, according to the researchers (HR 0.559; 95% CI, 0.237-1.32; P=0.1783).
Secondary outcomes—psychiatric morbidity and Parkinsonism—did not show significant differences in either cohort.
These findings support a potential protective effect of zoster vaccination against long-term mortality and cardiovascular events in people living with HIV.
Reference
Dehghani A, et al. Presented at: IDWeek 2025. 402
