研究背景：愛滋病毒與帶狀疱疹間的關係密不可分，目前已知的是愛滋病毒感染者感染帶狀疱疹的機率較高，且有反覆發生情形，而帶狀疱疹感染可視為愛滋病毒感染者發病的風險因子，但對於促進疾病進程及死亡並無直接關係。1996年HAART藥物問世後，對於愛滋病毒感染者的免疫功能有防護作用，並降低伺機性感染及愛滋病死亡率，使愛滋病成為慢性病的一環，但HAART藥物對於降低帶狀疱疹的影響沒有一致性的結果。
研究目的：本研究以健保資料庫的2000-2010年愛滋病特殊需求檔資料分析15歲以上愛滋病毒感染者服用HAART藥物前後感染帶狀疱疹的機率，探討愛滋病毒感染者服用HAART藥物後對帶狀疱疹發生率的影響，以及相關影響因素。
研究方法：採回溯性世代研究法，擷取全民健保抽樣資料，內容含括承保資料檔(ID)、健保門診處方及治療明細檔（CD）、門診處方醫令明細檔(OO)、住院醫療費用清單明細檔(DD)、住院醫療費用醫令清單明細檔(DO)進行分析，分析2000-2010年愛滋病毒感染者有無併發帶狀疱疹之發生率，以2000年美國人口為標準化人口，運用標準化年齡、年度計算感染愛滋病毒後伺機感染帶狀疱疹者之發生率，而後以Cox proportional hazard描述影響患者感染帶狀疱疹後感染愛滋病毒的相關因素。
結果：
2000-2010年愛滋病毒感染者併發帶狀疱疹發生率為5.07人/100人年。不同年齡層的愛滋病毒感染者，其帶狀疱疹發生率隨著診斷時間增加。以多變項迴歸分析愛滋病毒感染者發生帶狀疱疹感染之相關因素為：感染帶狀疱疹病史(AHR: 6.72, 95% CI: 5.16-8.76, p-value: < 0.001)、服用HARRT藥物(AHR: 0.65, 95% CI: 0.54-0.78, p-value: < 0.001)。存活分析發現愛滋病毒感染者診斷後之前四年，有使用HAART療法其併發帶狀疱疹發生率顯著高於未使用HAART療法者 (HR: 1.79, 95% CI: 1.48-2.16, p<0.0001)。而四年之後，反而使用HAART療法其併發帶狀疱疹發生率顯著低於未使用HAART療法者(HR: 0.60, 95% CI: 0.47-0.78, p<0.0001)。進一步針對9334位愛滋病毒感染者服用HAART藥物，結果發現HAART服藥遵從性>=85%相較服藥不規律者其併發帶狀疱疹風險顯著降低(HR: 0.40, 95% CI: 0.19-0.85 , p<0.001)。
結論：
本研究的結果發現愛滋病毒感染者診斷後之前四年，使用HAART療法其併發帶狀疱疹發生率顯著高於未使用HAART療法者，可能原因為HAART療法誘發免疫重建發炎症候群，導致帶狀疱疹發生率增加；在四年之後，使用HAART療法其併發帶狀疱疹發生率顯著低於未使用HAART療法者，長期使用HAART療法，隨著遵從性增加，帶狀疱疹併發風險更為下降，因此建議透過個案管理模式加強服藥遵從性的推廣及重要性。本研究確立了愛滋病毒感染者與帶狀疱疹併發風險之相關因子，可列為臨床醫療人員列為帶狀疱疹併發之預防。

The impact of HAART on the incidence of HZ infection is not well understood. This study investigated the incidence of HZ infection and its associated risk factors among patients with HIV infection. This study investigated the incidence of HZ infection among patients with HIV infection patients receiving HAART and identified the association among HZ, HAART, and HIV among patients with HIV infection. The NHIRD identified 15,112 patients with HIV infection. The incidence rates were standardized according to age based on the 2000 WHO standard population. Cox proportional hazards models were used to assess the effect of HAART on the incidence of HZ infection among patients with HIV infection. The average incidence of the first episode of HZ after the diagnosis of HIV infection was estimated at 5.07 people/100 person-years. Multivariate Cox proportional hazards model showed that history of HZ infection and administration of HAART were the factors associated with HZ. Life-table method was used to divide the duration of HIV from diagnosis into two phases, namely, ≤4 years and >4 years. Initiation of HAART within 4 years of HIV diagnosis was associated with an increased risk of HZ and after 4 years of HIV diagnosis was associated with a decreased risk of HZ infection. Among HIV-infected patients on HAART, with ≥85% adherence was showed significantly lower risk of developing HZ. We suggested emphasizing the importance of early treatment and HAART adherence.

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