|Year : 1997 | Volume
| Issue : 2 | Page : 101-104
Herpes zoster in patients with HIV infection
AL Das, SK Sayal, CM Gupta, M Chatterjee
A L Das
Source of Support: None, Conflict of Interest: None
Five hundred twenty seven HIV seropositive male cases were observed for herpes zoster for a period of five years. Overall incidence of herpes zoster in HIV infection was found to be 11.8%. Herpes zoster was presenting symptom in 50% cases. It developed in first year of follow up in 38.8% cases, in second and third year of follow up in 4.8% cases each and in fourth year in 1.6% case. Majority of cases (89%) were in age group of 20 - 40 years. Thoracic dermatome (68%) was commonest to get involved followed by cervical (14.5%), trigeminal (9.7%) and lumbosacral (8%). Among other associations of HIV seropositive herpes zoster cases 24.2% cases had tuberculosis and 4.8% cases had hepatitis B virus infection. The skin lesions of herpes zoster in majority of cases were bullous, haemorrhagic and necrotic.
Keywords: HIV infection, Herpes zoster
|How to cite this article:|
Das A L, Sayal S K, Gupta C M, Chatterjee M. Herpes zoster in patients with HIV infection. Indian J Dermatol Venereol Leprol 1997;63:101-4
|How to cite this URL:|
Das A L, Sayal S K, Gupta C M, Chatterjee M. Herpes zoster in patients with HIV infection. Indian J Dermatol Venereol Leprol [serial online] 1997 [cited 2019 Oct 19];63:101-4. Available from: http://www.ijdvl.com/text.asp?1997/63/2/101/4529
| Introduction|| |
Herpes zoster results from reactivation of latent varicella zoster (VZ) virus and it was for the first time suggested by Garlan in 1973. This concept of reactivation of a latent virus was further confirmed by Weller et al. The reasons for latency and subsequent reactivation to produce herpes zoster are far from clear. A depressed immune system may play an important role in reactivation of VZ virus. Its association with impaired cell modiated immunity due to various causes is well known. In last few years its association with HIV infection has been reported by several workers. The development of herpes zoster has been reported to be a possible early clinical sign for development of AIDS in high risk individual by some workers. A five year follow up study of herpes zoster in HIV infected patients is presented in this study.
| Materials and Methods|| |
The study was conducted on 527 male patients of HIV infection admitted at Command Hospital, Southern Command, Pune from Jan 91 to Dec 96. In addition to recording of detailed history, each patient underwent detailed general physical and systemic examinations. A thorough dermatological examination was also done in all cases. The diagnosis of herpes zoster was made clinically on the basis of characteristic presentation of vesicles in dermatomal or disseminated pattern. Competitive ELISA was used for screening and Western Blot test was used for confirmation of HIV infection in all patients. A set of laboratory investigations consisting of routine haemogram, urinalysis, liver function tests, HBsAg and VDRL test were done in all cases. Relevant investigations pertaining to associated disorders were also done. All HIV seropositive patients were followed at six monthly intervals and each time thorough clinical examination and relevant investigations were done.
[Table - 1] shows year-wise incidence of HIV infection and herpes zoster. The overall incidence of herpes zoster in HIV infection was found to be 11.8% (62/527). There is an increasing trend in incidence of herpes zoster in HIV infection over the years 1991 to 1996. Age-wise distribution [Table - 2] shows 34 (54.8%) cases in 20-30 years age and 21 (33.9%) in 31 to 40 years age group. The youngest was 19 years and oldest was 54 years of age. Relationship of onset of herpes zoster with duration of HIV infection is shown in [Table - 3]. Herpes zoster was present at the time of diagnosis of HIV infection in 31 (50%) cases. It developed in first year of follow up of HIV infection in 24 (38.8%) cases and in 3 (4.8%) cases each in second and third year of follow up, while only one case was seen in fourth year of follow up of HIV infection. [Table - 4] shows dermatomal involvement pattern in HIV seropositive herpes zoster cases Thoracic dermatomes were involved in 42 (67.8%) cases. Disseminated herpes zoster was seen in 10 (16.1%) cases only. Twenty (32.2%) cases had severe localised pain with bullous haemorrhagic type of lesions which took more than 4 weeks to heal. No recurrance of herpes zoster was observed in any case. Among other findings persistant generalised lymphadenopathy (PGL) was present in 15/62 (24.2%), pulmonary tuberculosis in 5 (8%) cases and hepatitis B virus infection in 3 (4.8%) cases.
| Discussion|| |
The association of herpes zoster and HIV infection is well recognised. It may even be first sign of immunosuppression. It has been taken as one of the important dermatological marker of HIV infection. Cutaneous lesions in majority of cases have typical course, however some patients have disseminated infection with more destructive and necrotic lesions. Systemic complications especially meningitis and encephalitis may occur some time with disseminated or recurrent eruptions.
The incidence of herpes zoster in HIV infection has been reported to be 11% by Colebenders et al, 16% by Marshell et al, 26.7% by Buchbinder et al and 8.4% by Hira. Our study shows incidence of herpes zoster to be 11.8% in HIV infected patients. The incidence of herpes zoster in HIV seronegative patients has been reported to be 1% and 2% by Colebenders et aland Hira, respectively. Results of our study showing high incidence of herpes zoster in HIV infection is in general agreement with results of other workers.
The relationship of herpes zoster with duration of HIV infection is not clear. Some workers have described it as early manifestation and even significant predictor of more rapid progression to AIDS, while others have not found this association to be significant. In our study herpes zoster was presenting disease for HIV infection in 50% cases, while 38.8% cases developed herpes zoster in first year of HIV infection. This supports the view by some workers that the risk of herpes zoster is not associated with duration of HIV infection. None of our case had recurrence of herpes zoster as reported by some workers. [4, 5] The recurrence of herpes zoster in HIV infection may be indicative of more advanced stage of HIV infection. The dermatomal involvement pattern did not show much of difference from established pattern. However the lesions in about 32% cases were bullous, confluent and necrotic type with severe localised pain. Also it took longer time to heal with scarring. The disseminated lesions were seen in more than 10% cases.
To conclude, our study shows a high incidence of herpes zoster in HIV infection and majority of cases occurred within first year of HIV infection. The skin lesions of herpes zoster in large number of cases were of aggressive type and took long time to heal. Dissemination of lesions was also noticed in large number of cases. A study of 10-15 years of follow up will be more conclusive in determining relationship of herpes zoster and HIV infection.
| Acknowledgement|| |
The authors are grateful to Col P N Arora, former Senior Adviser (Derm and Ven), Command Hospital (SC), Pune for his help in the preparation of the article.
| References|| |
|1.||Garlan F. Varicella following exposure to herpes zoster. N Engl J Med 1943;228:336-7. |
|2.||Wellar TH, Wetton HM, Bell EJ. The etiological agent of varicella and herpes zoster: isolation, propagation and cultural characterstics in vitro. J Exp Med 1958; 108:843-68. |
|3.||Wellar TH. Vericella and herpes zoster: changing concepts of the natural history, control and importance of a not so benign virus. N Engl J Med 1983, 309:1362-68. |
|4.||Marshell JG, Richard DM, Richard EC, et al. Herpes zoster and human immune deficiency virus infection. J Infec Dis 1993; 168:1264-8. |
|5.||Buchinder SP, Katz MH, Hessel NA, et al. Herpes zoster and human immunodeficiency virus infection. J Infec Dis 1992;166:1153-6. |
|6.||Hira S K. Clinical profile of HIV 1/2 infection in Mumbai. Proceedings of the National Conference on HIV/AIDS Medicine. 1996 Nov 23-24 Pune, India. |
|7.||Friedman Kien AE, Lafleur FL, Gandler E, et al. Herpes zoster:a possible early clinical sign for development of AIDS in high risk individual. J Am Acad Dermatol 1986; 14:1023-8. |
|8.||Highet AS Kurtz J. Viral infections. In :Champion RH, Burton JL, Ebling FJG, editors, Textbook of dermatology. 5th ed, Oxford. Blackwell Scientific Publication, 1992:925. |
|9.||Colebunders R, Mann JM, Francis H, et al. Herpes zoster in African patients: a clinical predicator of human immunodeficiency virus infection. J infect Dis 1988; 157:314-8. [PUBMED] |
|10.||Melbye M, Grossman RJ, Goedert JJ, et al. AIDS after herpes zoster, lancet 1987;316:156-7. |
|11.||Moss AR, Bacchett P, Osmond D, et al. Seropositivity for HIV and development of AIDS or AIDS related condition. Three years follow up of San Francisco Hospital Cohort. Br Med J 1988;296:745-50. |
[Table - 1], [Table - 2], [Table - 3], [Table - 4]