Varicella-Zoster Virus Infection

Prevention of Exposure
(1) HIV-infected children and adults who are susceptible to varicella-zoster virus (VZV) (i.e., those who have no history of chickenpox or shingles or are seronegative for VZV) should avoid exposure to persons with chickenpox or shingles (AII). Household contacts (especially children) of susceptible HIV-infected persons should be vaccinated against VZV if they have no history of chicken-pox and are seronegative for HIV, so that they will not transmit VZV to their susceptible HIV-infected contact (BIII).

Prevention of Disease
(2) Very little data regarding safety and efficacy of varicella vaccine in HIV-infected adults are available; and no recommendation for its use can be made for this population. See Pediatric Note for use of varicella vaccine in children.

(3) For the prophylaxis of chickenpox, HIV-infected children and adults who are susceptible to VZV (i.e., those who have no history of chickenpox or shingles or who have no detectable antibody against VZV) should be administered varicella zoster immune globulin (VZIG) as soon as possible but within 96 hours after close contact with a patient who has chickenpox or shingles (AIII). Data are lacking on the effectiveness of acyclovir for preventing chickenpox in susceptible HIV-infected children or adults, and no recommendation can be made.

(4) No preventive measures are currently available for shingles.

Prevention of Recurrence
(5) No drug has been proven to prevent recurrence of shingles in HIV-infected persons.

Notes

Pediatric Note
(6) HIV-infected children who are asymptomatic and not immunosuppressed (i.e. immunologic category 1, Table 6), should receive live attenuated varicella vaccine at 12-15 months of age or later (BII). Varicella vaccine should not be administered to other HIV-infected children because of the potential for disseminated viral infection (EIII).

Note Regarding Pregnancy
(7) VZIG is recommended for VZV-susceptible pregnant women within 96 hours after exposure to VZV (AIII). If oral acyclovir is used, VZV serology should be performed so that the drug can be discontinued if the patient is seropositive for VZV (BIII).

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