HERPES-ZOSTER OPHTHALMICUS AND HIV-INFECTION IN NIGERIA

Eight patients, 3 men and 5 women, aged between 24 and 40 years who ha d herpes tester ophthalmicus (HZO) were seen in the Eye Department of the University of Nigeria Teaching Hospital, Enugu between 1994 and 19 97. One of the patients was already on treatment for active pulmonary tuberculosis at the time he was first seen. All had skin eruptions at different stages of development in the area of distribution of the fir st trigeminal nerve on the affected side of the face and head. Ocular examination revealed impaired vision in the affected eye (between 6/12 and hand movement) in all the patients. All had lid oedema while 5 ha d ptosis (3 partial and 2 complete). Various degrees of conjunctival i njection were observed in all patients while 6 of them had corneal ana esthesia and keratitis. Uveal inflammation, present in all the patient s varied from mild iritis in 4 individuals to severe iridocyclitis in the remaining 4. Pupils reacted to Light sluggishly in 2 patients whil e they were dilated and fixed in 3 others. None had any associated abn ormalities in the posterior segment. Six of the patients consented and were screened for human immunodeficiency virus (HIV) infection. Of th ese, 4, including the patient with pulmonary tuberculosis, tested sero positive while 2 were seronegative. All 8 were treated with topical ac yclovir. This was combined with oral acyclovir in one of the patients. Follow-up period was between 2 and 52 weeks. During this period skin eruptions and anterior segment signs improved in 5 patients while rema ining stable in 3 others; post-herpetic neuralgia persisted on the aff ected side in 4 patients. Patients who were HIV seropositive did not r ecover as quickly or to the same extent as the seronegative ones. It i s concluded that HZO infection may indicate underlying HIV infection i n young Africans as has been found in whites.