Shingles in HIV: Outcome and discovery

Abstract

Background: Herpes zoster (HZ) is a frequent manifestation in people living with HIV (PLHIV), with a significantly higher incidence compared to the general population. It often presents as an early indicator of immunosuppression, making timely diagnosis and treatment crucial. Methods: This retrospective study, conducted from January 2015 to September 2024, analyzed 45 PLHIV diagnosed with HZ. Patients were recruited from the Infectious Diseases Department (for HIV-related HZ cases) and the Dermatology Department (for complicated HZ cases requiring hospitalization). Clinical and demographic data were collected, including ART status, HZ presentation, and treatment outcomes. Results: The mean patient age was 36.35 years, with a male predominance (M/F ratio: 8). Among the cohort, 12 patients had undiagnosed HIV, and HZ was the presenting symptom that led to HIV diagnosis. The thoracic metameric variant was the most common, with erythematous-vesicular, necrotic-hemorrhagic, and bullous forms observed. 21 patients were on antiretroviral therapy (ART), six of whom developed HZ shortly after ART initiation. Treatment involved oral or intravenous acyclovir, with hospitalization required for complicated or multi-metameric forms and high-risk patients. Outpatient management with close monitoring was provided for stable cases. Conclusions: HZ remains a significant opportunistic infection in PLHIV, often serving as a sentinel sign of undiagnosed HIV. Early HIV screening in patients presenting with HZ and timely initiation of antiviral therapy are essential for improved outcomes. Enhanced awareness and integrated HIV-HZ management strategies are crucial in clinical practice.