CLINICAL MANIFESTATIONS OF VARICELLA-ZOSTER VIRUS-INFECTIONS IN HUMAN-IMMUNODEFICIENCY-VIRUS INFECTED CHILDREN

Objective.-To study the clinical course of varicella-zoster infection in children infected with human immunodeficiency virus type I. Design and Setting.-A clinical and laboratory study of human immunodeficiency virus-infected children was undertaken at Cedars-Sinai Medical Center , Los Angeles. Participants.-Twenty-seven human immunodeficiency virus -infected children aged 1 to 13 years who were treated between 1987 an d 1992. Twenty-one children had acquired the infection through blood t ransfusion, 18 during the neonatal period and three during their early years of life. Six infants had acquired the infection perinatally. Re sults.-Seventeen children have developed varicella, of whom 10 had an uncomplicated course and seven suffered from chronic, recurrent, or pe rsistent varicella. Uncomplicated or recurrent varicella was a relativ ely benign illness that did not require antiviral therapy except in on e child. In contrast, patients with persistent varicella required anti viral therapy as they were sicker and had a prolonged course. One had pneumonia, and another patient developed hyperkeratotic lesions that w ere refractory to therapy. They had lower CD4 counts (P<.01) and had a more advanced stage of the human immunodeficiency virus disease than the other children. Three patients who were receiving regular intraven ous immunoglobulin developed their initial attack of varicella despite the presence of the varicella-zoster antibody. Four patients, three o f whom had uncomplicated varicella, developed zoster involving one or two dermatomes. One patient developed zoster while receiving acyclovir therapy. Conclusions.-Children infected with human immunodeficiency v irus type 1 may suffer unusual manifestations of varicella-zoster infe ction. The incidence of zoster in these children is higher than in the general population and is close to that in patients with leukemia. Th e effectiveness of antiviral therapy in these patients was difficult t o evaluate.