Herpes zoster ophthalmicus in patients with human immunodeficiency virus infection.
OBJECTIVE
To investigate the ocular complications of herpes zoster ophthalmicus in patients with human immunodeficiency virus (HIV) infection.


METHODS
This was a retrospective cohort study of 48 HIV-infected patients (48 eyes) treated at San Francisco General Hospital for herpes zoster ophthalmicus from December 1985 through March 1994.


RESULTS
All patients were initially treated with either intravenous or oral acyclovir. The median CD4 lymphocyte count at diagnosis was 48 per mm3 (range, 2 to 490 per mm3). Fifteen patients (31%) had mild or no ocular involvement. Seventeen patients (35%) had stromal keratitis, mostly mild, and two (4)% developed chronic infectious pseudodendritic keratitis. Twenty-four study patients (50%) had iritis, but only three (6%) had elevations in intraocular pressure. Two patients (4%) developed postherpetic neuralgia, and two others (4%) had zoster-associated central nervous system disease. Only two patients (4%) developed necrotizing retinitis, both in the form of the progressive outer retinal necrosis syndrome.


CONCLUSIONS
Excluding the patients with retinitis and central nervous system disease, the rate of sight-threatening complications in our series was lower than expected. Almost one third of study patients had no ocular complications or only mild surface epithelial disease. Although the relatively low incidence of sight-threatening disease in our study population may have been a consequence of aggressive management with acyclovir, chronic infectious pseudodendritic keratitis, retinitis, and central nervous system disease, complications of ophthalmic zoster whose pathogenesis is largely a consequence of active viral replication, were particularly devastating and difficult to manage.
Margolis
T P
TP
Francis I. Proctor Foundation, University of California, San Francisco, Medical Center 94122-0944, USA. tpms@itsa.ucsf.edu
Milner
M S
MS
Shama
A
A
Hodge
W
W
Seiff
S
S
D000212:Acyclovir / Q000627:therapeutic use; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D001927:Brain Diseases / Q000188:drug therapy / Q000821:virology; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology; D015331:Cohort Studies; D005128:Eye Diseases / Q000188:drug therapy / Q000209:etiology*; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000276:immunology; D006563:Herpes Zoster Ophthalmicus / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D006801:Humans; D007500:Iritis / Q000188:drug therapy / Q000821:virology; D007634:Keratitis / Q000188:drug therapy / Q000821:virology; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000188:drug therapy / Q000821:virology; D015882:Retinal Necrosis Syndrome, Acute / Q000188:drug therapy / Q000821:virology; D012189:Retrospective Studies
D000998:Antiviral Agents; D000212:Acyclovir