Management of varicella-zoster infection in 39 HIV-infected patients

OBJECTIVES: The main goal of this study was to assess therapeutic strategie s in HIV-infected patients with varicella-zoster virus infection. PATIENTS AND METHODS: This retrospective study conducted between 1989 and 1 996 concerned 39 HIV-infected patients who bad reached the AIDS stage and h ad at least one episode of varicella-zoster infection. Epidemiological, cli nical and therapeutic data were recorded. Chi-squared test was used for com parisons. RESULTS: A total of 78 episodes of varicelia-zoster infection occurred incl uding 39 primary episodes and 39 recurrences. Aciclovir (ACV) 200 mg per os was given in 27 cases as first intention therapy (mean dose 4000 mg/day fo r a mean 10 days), ACV 800 mg per os in 10 cases (mean dose 4000 mg per day for a mean 10 days), and intravenous ACV in 23 cases (mean dose 30 mg/kg/d ay for a mean 7 days). Foscarnet was used 5 times, 90 - 100 mg per day for 8 to 21 days. We did not observe any difference in efficacy between the thr ee ACV formulations, probably because of the small number of patients in th e series and the retrospective nature of the study. All of the failures of the oral treatments occurred in patients with CD4 counts below 100/mm(3). CONCLUSION: Aciclovir (800 mg) can be given in HIV-infected patients who de velop non-complicated varicella-zoster virus infection, Intravenous acidovi r should be reserved for severe disseminated and/or neurological forms and for highly immunodepressed patients (for example those with a CD4 count bel ow 200/mm(3)). These findings should be confirmed by prospective studies. ( C) 1999, Masson, Paris.