Prevention and treatment of VZV infections in patients with HIV.
Varicella zoster virus (VZV) infections in human immunodeficiency virus (HIV)-infected patients are known to have a different disease spectrum from that seen in other types of patients. Varicella in children with HIV infection is likely to be more serious than in otherwise healthy children and routine antiviral therapy is recommended. There is evidence that the development of varicella in HIV-infected children is not associated with progression to AIDS, suggesting that it may be safe to immunize HIV-infected children with live attenuated varicella vaccine. There are no published data on varicella in HIV-infected adults, however, probably because most adults have already experienced varicella prior to HIV infection. Zoster in HIV-infected children differs somewhat from that in HIV-infected adults. In particular, HIV-infected children who develop varicella in the setting of severe immunodeficiency are at an especially high risk to develop zoster. Given the low rate of toxicity of aciclovir as well as its ease of administration and its efficacy in hastening the healing of VZV infections, prompt treatment with this antiviral agent is recommended for both HIV-infected children and adults. Foscarnet should be used for zoster that is strongly suspected or proven to be caused by aciclovir-resistant VZV. Patients with HIV for whom there is no evidence of significant immunosuppression and who have not had varicella should be immunized with live attenuated varicella vaccine as a preventative measure for both varicella and zoster. It is hoped that immunization of VZV seropositive HIV-infected patients will decrease the incidence of zoster. Studies to determine this are under way.
Gershon
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AA
Department of Pediatrics, Columbia University College of Physicians and Surgeons, 650West 168th Street, New York, NY, USA. aag1@columbia.edu
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy* / Q000276:immunology / Q000517:prevention & control* / Q000821:virology; D000212:Acyclovir / Q000008:administration & dosage / Q000627:therapeutic use*; D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002644:Chickenpox / Q000188:drug therapy* / Q000276:immunology / Q000517:prevention & control*; D019433:Chickenpox Vaccine / Q000008:administration & dosage; D002648:Child; D017245:Foscarnet / Q000627:therapeutic use; D014645:Herpesvirus 3, Human / Q000276:immunology; D006801:Humans; D011446:Prospective Studies; D012307:Risk Factors
D000998:Antiviral Agents; D019433:Chickenpox Vaccine; D017245:Foscarnet; D000212:Acyclovir