HERPES-ZOSTER AS THE INITIAL PRESENTATION OF HUMAN-IMMUNODEFICIENCY-VIRUS TYPE-I INFECTION IN KENYA

We conducted a prospective observational study to determine the clinic al features, the degree of immunosuppression, and the prevalence of hu man immunodeficiency virus type 1 (HIV-I) infection associated with he rpes tester in Kenya, The study included 196 HIV-l-positive individual s and 34 HIV-l-negative individuals between the ages of 16 and 50 year s who presented to a referral clinic in Nairobi. Comparison of the cli nical characteristics in the two groups found that the duration of ill ness in the HIV-l-positive group was longer (32 vs. 22 days; P <.001) and that the HIV-l-positive group was more likely to have generalized lymphadenopathy (74% vs, 3%; OR: 12.2; 95% CI: 1.6, 91.7), severe pain (69% vs, 39%; OR: 3.6; 95% CI: 1.7, 7.6), bacterial superinfection (1 5% vs, 6%; OR: 5.7; 95% CI: 1.3, 25.0), and more than one affected der matome (38% vs, 18%; OR: 2.8; 95% CI: 1.1, 8.0). Dermatomal distributi on of the lesions was similar in the two groups, except for cranial le sions, which occurred exclusively in the HIV-l-positive group. The mea n CD4 T lymphocyte count at presentation was 333/mm(3) in the HIV-l-po sitive group and 777/mm(3) in the HIV-l-negative group (P <.001), Herp es tester is often recognized as the initial HIV-l-related illness in Kenya despite the fact that patients have moderate to severe depressio n of CD4 cell counts at presentation, Although the clinical features o f herpes tester may be more severe in HIV-l-positive individuals, reco very is generally complete and uncomplicated.