Neurological complications of varicella-zoster virus infection in adults with human immunodeficiency virus infection

This multicentre retrospective study describes the clinical features and pr ognostic significance of Varicella-zoster virus (VZV)-associated neurologic al complications. The study was performed in patients with human immunodefi ciency virus (HIV) infection, hospitalized for VZV neurological complicatio ns, confirmed in every case by positive VZV polymerase chain reaction (PCR) in cerebrospinal fluid (CSF). Between 1990 and 1995, 34 HIV-infected patie nts were included in the study. At diagnosis, 59% had AIDS, with a median C D4 count of 11 x 10(9)/l. A past history of tester was noted in 35% of case s. A concomitant herpes tester rash and/or acute retinal necrosis were note d in 71% and 12% of patients, respectively, The predominant neurological ma nifestations were encephalitis (13), myelitis (8), radiculitis (7) and meni ngitis (6). The mean CSF white blood cell count was 126/mm(3) and the mean CSF protein concentration was 2.3 g/l. Interferon-alpha level was increased in 36% of patients. VZV was isolated from CSF cultures in 2/6 cases. Magne tic resonance imaging was abnormal, demonstrating encephalitis lesions. Aft er intravenous antiviral therapy, complete recovery was obtained in 18 case s (53%), serious sequelae were observed in 10 cases (29%) and 6 patients di ed (18%), Severe symptoms and a low CD4 cell count appeared to be associate d with death or sequelae. In conclusion, VZV should be considered as a poss ible cause of encephalitis, myelitis. radiculitis or meningitis in HIV-infe cted patients, especially in patients with a history of or concomitant herp es tester or acute retinal necrosis. VZV-PCR in the CSF may allow rapid dia gnosis and early specific antiviral treatment.