ASSOCIATION OF HERPES-ZOSTER OPHTHALMICUS WITH ACQUIRED-IMMUNODEFICIENCY-SYNDROME AND ACUTE RETINAL NECROSIS

We conducted a review to investigate the prevalence of human immunodef iciency virus (HIV), or acquired immunodeficiency syndrome (AIDS), in patients with herpes zoster ophthalmicus, as well as the incidence of acute retinal necrosis after herpes zoster ophthalmicus. All charts of patients seen at our institution between 1987 and 1992 with a primary diagnosis of herpes zoster ophthalmicus were reviewed. Of 112 patient s with herpes zoster ophthalmicus, 29 (26%) had HIV or AIDS. All these patients were younger than 50 years at the time of diagnosis. Five of 29 (17%) immunocompromised patients had acute retinal necrosis after herpes zoster ophthalmicus. No acute retinal necrosis was identified i n the nonimmunocompromised patients after herpes zoster ophthalmicus. We recommend that all patients younger than 50 years who have herpes z oster ophthalmicus at initial examination be tested for HIV. Additiona lly, HIV-infected patients should be monitored closely after herpes zo ster ophthalmicus for development of acute retinal necrosis. Long-term oral prophylactic as well as initial high-dose intravenous acyclovir may be appropriate in HIV-infected individuals with herpes zoster.