Shingles (Herpes Zoster) & HIV

Shingles is a painful rash that commonly occurs in older people. It is also known as herpes zoster. The varicella-zoster virus (VZV) causes shingles. VZV is the same virus that causes chickenpox. Shingles is a common viral infection that affects about 1 out of every 3 people in the United States.^1,2

After you recover from chickenpox, VZV stays in your body. It remains inactive (dormant) in your nerves. For some people, VZV may never come back. For others, it may come back as they get older. When VZV gets reactivated in the body, it causes shingles.¹

How is shingles transmitted?

Shingles itself is not transmitted from person to person. But someone who has never had VZV can get chickenpox from someone else with shingles. Because of this, people with shingles are advised to stay away from others who have never had chickenpox or have never been vaccinated for chickenpox. It is also recommended that people with shingles avoid contact with people whose immune systems are weakened.¹

Who is at risk for shingles?

Shingles often affects older people. It most commonly affects people who are at least 50 years old. The risk of shingles increases with age and if you have a weakened immune system. People whose immune systems may be weakened or malfunctioning include those:^1,3

• With HIV, autoimmune conditions, or cancer
• Who have had organ transplants
• On certain medicines that suppress the immune system

How is shingles linked to HIV?

Because people with HIV have a compromised immune system, they tend to have higher rates of shingles. They may also get shingles multiple times. This is especially true for those with high viral loads and lower CD4 counts (numbers of white blood cells that fight infection).^4,5

Some people may also get shingles soon after they start antiretroviral therapy (ART). This may be due to their immune system changing and responding to the drugs.^4,5

Shingles is common in people living with HIV

The good news is that the rate of shingles may be declining with the increased, long-term use of ART to treat HIV. As the immune systems of people living with HIV get stronger due to treatment, the risk of shingles decreases. Shingles is still more common in people living with HIV than those without HIV. But the gap may be closing. However, there is still an increased risk of shingles-related complications when you have HIV.^4,5

Signs and symptoms

The first sign of shingles may be burning, tingling, pain, itching, or numbness in 1 area of the body. This may be on 1 half of the face or 1 side of the back. VZV hides in the nerves. When it is reactivated, it travels along nerve pathways. This leads to symptoms in a very specific location where a nerve runs (such as 1 small line across half of the chest).^1,6

Rashes

Within 2 weeks after the first symptom, a blistering rash may appear in the same area. This rash often forms a single stripe that is painful and lasts around another week or 2. The pain can range from mild to severe. Most doctors can tell if a rash is due to shingles because of the specific location it affects. But some people have immune systems that are very weakened. For these people, the rash may appear over a wider area.^1,6

Post-herpetic neuralgia

Occasionally, the pain related to shingles can remain even after the rash fades. This is called post-herpetic neuralgia (PHN). PHN can last for weeks, months, or even years after the original rash. Very rarely, shingles may progress and affect the lungs, brain, eyes, or ears, causing more serious symptoms.^1,7

Shingles treatment and prevention

While there is no cure for shingles, it can be treated. Antiviral drugs are used to help reduce the severity and length of an outbreak. The faster these drugs can be started, the more likely they will have an impact. Other common treatments to relieve shingles pain include:⁸

• Soothing baths
• Over-the-counter pain relievers
• Lotions

The best way to fight shingles is to prevent it by getting the shingles vaccine. This vaccine is called Shingrix® (recombinant zoster vaccine). Shingrix is approved by the US Food and Drug Administration (FDA). It is over 90 percent effective at preventing shingles. The vaccine is available in most doctors’ offices and pharmacies.⁹

Shingrix is not meant to treat an active case of shingles, only to help prevent it. The Shingrix vaccine is recommended for adults who:⁹

• Are at least 50 years old
• Have previously had chickenpox, the chickenpox vaccine, or shingles
• Received the prior shingles vaccine, Zostavax® (zoster vaccine live)
• Have a health condition that weakens their immune system, like HIV
• Do not remember ever having chickenpox

While extremely effective at helping prevent shingles, the shingles vaccine cannot prevent all cases of shingles. But it can help shorten the length and severity of the illness. The vaccine can also reduce the risk for PHN. Studies show that Shingrix is safe, though you may have temporary side effects from getting the shots.⁹

Talk to your doctor about getting vaccinated

Given that the risk of shingles is high in people with HIV, it is recommended to get the Shingrix vaccine. Depending on your immune status and your CD4 count, your doctor may advise waiting to get the vaccine. If you have questions about side effects from Shingrix, talk to your doctor.^3,5

Maintain immune system health

For people with HIV, it is vital to keep up with ART to keep your immune system as strong as possible and prevent shingles. If you know someone who has shingles or chickenpox, it is best to avoid contact with that person as much as possible. Talk with your doctor about ways you can protect yourself from shingles in the future.^3-5