Persistent Chickenpox in Advanced HIV Disease
Definition and Diagnosis
- Advanced HIV disease is defined by the 1993 CDC AIDS criteria, which includes opportunistic infections and severe immunosuppression, according to the Centers for Disease Control and Prevention (CDC) 1, 2
- Patients with symptomatic HIV infection, including thrush or unexplained fever, are considered to have advanced disease requiring treatment, as recommended by the CDC 1, 2
Treatment and Management
- High-dose IV acyclovir (10 mg/kg every 8 hours) remains the treatment of choice for severely compromised hosts, as suggested by the CDC and other guideline societies, although the specific recommendation is from Praxis Medical Insights 3
- Foscarnet 40 mg/kg IV every 8 hours is required for acyclovir-resistant cases, as recommended by the CDC and other guideline societies, although the specific recommendation is from Praxis Medical Insights 3
- Cidofovir may be used as an alternative for resistant VZV infection, according to the CDC 4
- Antiretroviral therapy should not be discontinued during acute opportunistic infections unless drug toxicity or interactions necessitate it, as recommended by the CDC 1, 2
Prevention
- VZIG should be administered within 96 hours to VZV-susceptible HIV-infected patients after exposure to chickenpox or shingles, as recommended by the CDC 4, 5
- If VZIG is unavailable or >96 hours post-exposure, a 7-day course of oral acyclovir beginning 7-10 days after exposure is recommended, although the specific recommendation is from Praxis Medical Insights 3
- Live varicella vaccine is contraindicated in HIV-infected adults and children due to risk of disseminated viral infection, as recommended by the CDC 4