What is herpes zoster ophthalmicus (HZO) in HIV infection?

Updated: Jul 21, 2021
  • Author: Luca Rosignoli, MD; Chief Editor: Andrew A Dahl, MD, FACS  more...
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Herpes zoster is a painful vesiculobullous dermatitis that results from the localized reactivation of varicella-zoster virus (VZV) infection. Over 90% of the general population develops serologic evidence of a VZV infection by adolescence and the prevalence of VZV infection is ~100% by 60 years old. [1]  VZV reactivation manifests as a painful rash following a dermatomal distribution.

Herpes zoster ophthalmicus affects the first division of the trigeminal nerve. Adnexal manifestations include vesicular involvement of eyelid margin and follicular conjunctivitis. Predisposing factors for herpes zoster include aging, immunosuppression, trauma, irradiation, surgery, or debilitating systemic disease. In the general population, the most common predisposing factor for herpes zoster is age over 60 years; by age 80 years, as many as 50% of adults who are seropositive with VZV will develop zoster, of which HZO represents a small fraction. HZO affects about 5-15% of patients who are infected with HIV.

The incidence of herpes zoster in HIV-positive patients is greater than in the non-infected population, and has apparently not decreased with the advent of highly active antiretroviral therapy (HAART). In one study, patients on HAART and those with CD4+ cell counts between 50 and 200/µL seemed to be at the highest risk for a herpes zoster event. [2]

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