Treatment of Disseminated Herpes Zoster Infections

Abstract

Of all the infectious complications which plague the immunosuppressed patient, viral infections are the least amenable to drug therapy. Disseminated herpes zoster infections are relatively uncommon in immunosuppressed patients, but affect as many as 25 percent of patients with Hodgkin's disease. Herpes zoster infections are caused by the varicella-zoster virus (VZV), a DNA containing virus which is the etiological agent of both chickenpox and shingles. Vidarabine (ara-A) is a synthetic nucleoside which inhibits viral induced DNA-dependent DNA polymerase, and therefore viral replication. While vidarabine is remarkably nontoxic at a daily dose of 10 mg/kg, there is at present little evidence that early therapy of disseminated herpes zoster prevents visceral disease, further dissemination, or affects the incidence of postherpetic neuralgia. Initial studies employing human leukocyte interferon show promise, but large scale trials have been hampered by limited supplies of interferon.