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How serious is chicken pox with AIDS
Jul 20, 2011

Hi. My husband doesn't ever recall having chicken pox as a child and his mother also says he never had it. He has not been vaccinated for it either. Our daughter (age 7) and our son (age 16) have both just gotten a rash that is definitely chicken pox. Neither child has had it before and our 7 year old was vaccinated but our 16 year old was not. They are still contagious as none of the blisters have even crusted over yet. My questions are: 1) How serious is this for my husband who has AIDS? His CD4 is 316 and his viral load is 90. He is on Norvir, Presista, and Truvada and has been for 5 months. He has been exposed to the chicken pox through our children today. 2) If he does develop chicken pox, what is the treatment and what are the risks and things I need to watch for?

Also, he is currently fighting off double ear infections with a mild sore throat but his doctor doesn't seem too concerned about the ear infections at the moment. I don't know if this will make things worse with the chicken pox. The doctor says he's doing great and his numbers are impressive from where he started 5 months ago. In the beginning he had a CD4 of 45 and VL of 650,000 with PCP pneumonia so he's come a long way since then and is healthy with a good appetite etc now. We're just extremely worried about the chicken pox because we've looked it up online and didn't find anything too comforting about it and also read that it could be deadly in a patient with AIDS.

Thank you!

Response from Dr. Henry

Your husband needs to discuss situation with his HIV specialist. Checking for immunity to varicella zoster virus is recommended. I have pasted the recommendations from the US DHHS panel below:

Postexposure Prophylaxis For prophylaxis against chickenpox, HIV-infected children and adults who are susceptible to VZV should receive varicella-zoster immune globulin (VariZIG) as soon as possible (but within 96 hours) after close contact with a person who has active varicella or herpes zoster (AIII). As of June 2007, VariZIG can be obtained only under a treatment IND; contact FFF Enterprises, 800-843-7477. The duration of protection should last at least for 3 weeks. Patients receiving monthly high-dose immune globulin intravenous (IGIV) (>400 mg/kg) are likely to be protected and probably do not require VariZIG if the last dose of IGIV was administered <3 weeks before exposure. Risk for VZV transmission is higher from exposure to a patient with chickenpox than from exposure to localized herpes zoster. Among VZV-susceptible immunocompetent children, post-exposure varicella vaccination has been shown to reduce the risk for chickenpox developing in children and is more effective than pre-emptive therapy with acyclovir. Post-exposure varicella vaccination (for patients with CD4+ counts of >200 cells/μL) or short-term post-exposure administration of acyclovir may be considered for preventing chickenpox among susceptible HIV-infected adolescents or adults, but has not been studied in this population (CIII).

With decent CD4 counts (> 200) the issue of whether to use varicella immune globulin is usually less urgent so vaccination or use of an anti herpes drug might be considerations. KH

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