ABSTRACT
This article describes a prospective longitudinal study of varicella-zoster virus (VZV) infections in human immunodeficiency virus (HIV)-infected children, designed to determine their natural history of VZV infection and possible effects of VZV on the progression of HIV infection. Varicella was usually not a serious acute problem, and it did not seem to precede clinical deterioration. The rate of zoster was high: 70% in children with low levels of CD4+ lymphocytes at the time of development of varicella. It is predicted that immunization with live attenuated varicella vaccine is unlikely to be deleterious to HIV-infected children. Moreover, if they are immunized when they still have relatively normal levels of CD4+ lymphocytes, they may have a lower rate of reactivation of VZV than if they were allowed to develop natural varicella when their CD4+ cell counts have fallen to low levels as a result of progressive HIV infection.
Subject(s)
Chickenpox/complications , HIV Infections/complications , Herpes Zoster/complications , Antibodies, Viral/blood , Antibodies, Viral/immunology , CD4 Lymphocyte Count , CD8-Positive T-Lymphocytes/immunology , Case-Control Studies , Chickenpox/prevention & control , Chickenpox Vaccine/adverse effects , Chickenpox Vaccine/immunology , Child , Child, Preschool , Disease Progression , Female , HIV Infections/immunology , HIV Infections/virology , Herpes Zoster/immunology , Herpes Zoster/virology , Herpesvirus 3, Human/immunology , Humans , Male , New York , Prospective StudiesABSTRACT
Whether reexposure of varicella-immune persons to varicella-zoster virus would protect against or predispose to development of zoster was analyzed. The rate of zoster in 511 leukemic recipients of varicella vaccine who had 1 or > 1 dose of varicella vaccine and in those who did or did not have a household exposure to varicella was determined. A Kaplan-Meier life-table analysis revealed that the incidence of zoster was lower in those given > 1 dose of vaccine (P < .05). A Cox proportional hazards analysis showed that both household exposure to varicella and receipt of > 1 dose of vaccine were highly protective (P < .01) against zoster. Thus, the risk of zoster is decreased by reexposure to varicella-zoster virus, either by vaccination or by close exposure to varicella.