Varicella zoster virus-associated neurological disease in HIV-infected patients

Varicella tester virus (VZV) is an uncommon but well recognized cause of ne urological disease in HIV-infected patients. Analysis of cerebrospinal flui d (CSF) using the polymerase chain reaction (PCR) in HIV-infected patients presenting with neurological disease has increasingly allowed diagnosis of VZV-associated pathology. We report clinical, radiological and virological data from 15 consecutive patients with VZV-associated neurological disease. Clinical presentation was varied, including meningo-encephalitis in 9 and isolated cranial nerve palsies in 6. VZV deoxyribonucleic acid (DNA) was de tected by PCR in CSF of 11/ 15; pleocytosis was present in only 6/15, raise d protein in 11/15. Magnetic resonance imaging (MRI) appearances were focal signal abnormalities in 8, meningeal enhancement in 2 and normal in 2. Wit h specific anti-VZV therapy 10 patients recovered fully. The predictive val ue of PCR on CSF for diagnosis of VZV-associated neurological disease shoul d take into account the patient's clinical presentation, concurrent infecti ons and response to anti-VZV therapy.