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

Updated: Jun 12, 2019
  • Author: Robert A Copeland, Jr, 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. The virus travels down the involved nerve, causing pain followed by a vesicular rash in the dermatome.

Herpes zoster can involve any dermatome, but particularly T3 to L3 and cranial nerve V (most commonly the ophthalmic division, V1). Herpes zoster of the ophthalmic division of the trigeminal nerve, with or without ocular involvement, is referred to as HZO.

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, unlike that of many of the other opportunistic infections seen in HIV disease, 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 of a herpes zoster event. [1]

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