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Herpes Zoster -- Treatment Length & Vaccination
Jun 29, 2012

Dear Sir

I am 57 years,diagnosed HIV+ five years ago with CD4 105 and VL over half million. Current regime is Kivexa+Prezista+Norvir. Three weeks ago got my latest three-month test results : CD4 654(30%) and VL Undetectable.

A few days ago was diagnosed Herpes Zoster and given Acyclovir 800mg five times a day for seven days and have the following queries :

1) Medical guidelines inform that immunocompromised patients may need longer treatment, though it is not clear by that whether it is meant patients with CD4 below normal range or all HIV+ patients irespective of CD4 level. Should length depend on whether lesions have crusted or should I set out to take acyclovir for a longer period , say 10 days, irespective of outcome ?

2) Further, given this attack of Herpes Zoster, is it suitable to get vaccinated now or later ( when ? ) with the primary VZV vaccine ?. Given the normal CD4 count, could I also get the stronger Zoster vaccine ( Zostavax ) at some point to prevent recurrence ?

Your consultancy service in this medical forum is highly appreciated.

Trevor

Response from Dr. McGowan

Trevor,

I am sorry about the shingles, hope you heal up quickly.

There is no evidence that treating beyond when the lesions are crusted over would add any benefit. It is true that peolpe with immune system problems can have more severe disease with herpes zoster, and may be prone to widespread (disseminated) lesions, but the end of treatment goal is the same. I think with your CD4 count now over 500, you would not be one of those at high risk.

There was a study presented earlier this year (Benson et al, 19th CROI, abstract 96, http://www.retroconference.org/2012b/Abstracts/44084.htm) that showed the zoster vaccine was safe in people with HIV with CD4 coount above 200. It also appears to be effective in stimulating the immune system to generate protective antibodies. Accoding to the study design, it would be advisable to wait at least 1 year after your zoster episode to receive the vaccination.

Best, Joe



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