VARICELLA-ZOSTER VIRUS (VZV) DNA IN CEREBROSPINAL-FLUID OF PATIENTS INFECTED WITH HUMAN-IMMUNODEFICIENCY-VIRUS - VZV DISEASE OF THE CENTRAL-NERVOUS-SYSTEM OR SUBCLINICAL REACTIVATION OF VZV INFECTION

To identify varicella-zoster virus (VZV) infections of the nervous sys tem in patients infected with human immunodeficiency virus (HN), polym erase chain reaction (PCR) analysis of cerebrospinal fluid (CSF) sampl es from 514 consecutive HIV-infected patients with neurological diseas e was performed to detect VZV DNA. VZV DNA was detected in CSF of 13 ( 2.5%) of 514 patients. Four of 13 patients had VZV encephalitis or men ingoencephalomyelitis. These four patients received intravenous acyclo vir therapy; CSF became negative for VZV DNA and clinical conditions i mproved far two, whereas CSF remained positive for VZV DNA and clinica l conditions worsened until death for two. In nine of 13 patients, the neurological symptoms were likely caused by other simultaneous HIV-re lated complications in the central nervous system, After intravenous t herapy with high doses of acyclovir or foscarnet, VZV was cleared from CSF in eight of nine patients, VZV DNA can be detected in CSF of HIV- infected patients in association with either manifestations of neurolo gical VZV disease or subclinical reactivation of VZV infection. Antivi ral treatment may be effective in suppressing VZV replication in the n ervous system.