Varicella zoster infection
Varicella zoster virus (VZV) infection is commonly seen early in the course of HIV infection.
This dermatomal eruption may be particularly bullous, hemorrhagic, necrotic, and painful in HIV-infected persons. The duration of blisters and crusts is usually 2 or 3 weeks.
Dissemination of VZV in HIV infection is uncommon. The clinical manifestations of disseminated VZV infection include typical blisters with or without an associated dermatomal eruption.
Treatment
Oral acyclovir. If the patient has a reasonably intact immune system and does not have clinical features of disseminated or visceral infection, and if lesions are not near the eye (trigeminal nerve), then oral acyclovir is adequate. A dosage of 800 mg orally 5 times daily for 5 days is recommended.
Famciclovir ( Famvir), 500 mg, and valacyclovir ( Valtrex), 1000 mg, may be given only three times daily but the dosage must be adjusted in renal impairment.
Intravenous acyclovir (10 mg/kg 3 times daily) is indicated when the immunosuppression is significant (CD4 <200), when disseminated or visceral lesions are present, and when VZV affects the ophthalmic branch of the trigeminal nerve (eyelid or tip of the nose). Intravenous treatment should continue until the lesions are well crusted (usually about 7 days), after which full doses of oral acyclovir may complete 10 to 14 days of therapy.
Wet compresses (2 or 3 times daily) will help remove necrotic debris. Silver sulfadiazine (Silvadene) or bacitracin keeps the scabs soft and may also prevent secondary infection. Capsaicin cream ( Zostrix) may reduce the pain of both acute and chronic zoster. It may be applied to the lesions 5 times daily until the pain is controlled. order cheap levitra