Natural history of herpes zoster in the era of AIDS

Seventy-four consecutive patients with herpes zoster (HZ) in Mumbai were recruited into the study to determine its natural history. Thirty-five (47.3%) with HZ were infected with HIV-1/2. HZ+HIV+ and HZ+HIV- were demographically similar but HZ+HIV+ were clinically different; the latter were characterised by multidermatomal involvement of thoracic dermatomes below T6 or that of trigeminal nerve, recurrent episodes, bullous lesions and 17/35 had associated illnesses such as severe weight loss, recurrent fever, chronic cough, active tuberculosis and oral candidiasis. Significant differences in the course of healing, incidence of secondary bacterial infection and scaring emerged between the two groups after day-10. HZ+HIV+ individuals had vesicles and ulcers persisting for significantly longer time with frequent sequelae of post inflammatory pigmentation and post herpetic neuralgia. In areas where resources are limited for health information, such clinical differences between HZ+HIV+ and HZ+HIV- will serve to identify individuals with HIV infection in dermatologic clinic. These findings will also be helpful for early diagnosis of HIV infection, associated opportunistic infections and prevent their secondary transmission through appropriate interventions.