Herpes zoster as an immune restoration disease in AIDS patients during therapy including protease inhibitors

Abstract

A prospective study to evaluate the incidence of herpes zoster (HZ) as an immune restoration disease in patients with AIDS during highly active antiretroviral therapy (HAART) was conducted in a series of 115 patients diagnosed with AIDS initiated on HAART between 1 January 2000 and 31 July 2001. Of these, a single dermatomal HZ episode occurred in 14 (12%) patients within one and 15 months of HAART (median eight months). The HZ patients were similar to the non-HZ patients in age, sex, and HIV transmission risk factor, but had a more advanced disease. Compared with the baseline values, the viral loads significantly (P<0.01) decreased, while the mean CD4+ T-cell counts increased by almost four-fold (P<0.01) in both groups at the time of the HZ episode (or equivalent in non-HZ), but remained below 400/mL in the HZ patients. HZ during HAART is an immunopathological consequence of the improvement of the host immuneresponse, correlating with the beginning of immune restoration.

Immune reconstitution inflammatory syndrome in patients starting antiretroviral therapy for HIV infection: a systematic review and meta-analysis

“…Seventeen cohorts (31%) were in unselected patient groups that included patients with and without AIDS and studied any type of IRD. 22232631–38 The remaining studies were in patients with previously diagnosed conditions and examined their paradoxical worsening after starting ART: tuberculosis (16 studies, 30%), 1819242539–47 cryptococcal meningitis (6 studies, 11%), 122048–50 cytomegalovirus (CMV) retinitis (10 studies, 19%), 2151–58 herpes zoster (1 study, 2%), 59 Kaposi’s sarcoma (2 studies, 4%) 1760 and progressive multifocal leucencephalopathy (2 studies, 4%). Twenty studies (37%) used one of the definitions listed in Table 1, fourteen (26%) used another definition and in twenty studies (37%) the definition was unclear.…”

Immune Restoration Diseases Reflect Diverse Immunopathological Mechanisms

“…Cohort studies of adults and children indicated that the incidence of VZV disease ranged from 5 to 12%, with most cases occurring in the first 16 weeks of therapy (Table 2). A low CD4 T-cell count was a risk factor in children (140) but not in adults (40,42,90). VZV disease after commencement of ART usually presents as shingles affecting a single dermatome but may present as multidermatomal shingles, Ramsay-Hunt syndrome (M. A. French, personal observations), or myelitis (20,29).…”

Superficial Thrombophlebitis: A New Clinical Manifestation of the Immune Reconstitution Inflammatory Syndrome in a Patient With HIV Infection

“…The occurrence of recurrent varicella-zoster viral infections in patients beginning with HAART has been reported as IRIS in several series of the literature. 12,[18][19][20][21][22][23][24][25][26][27][28] Usually, the patients have uncomplicated dermatomal lesions of herpes zoster, although rarely transverse myelitis 29 and keratitis 30 have been reported in isolated cases.…”