Shingles (Herpes Zoster) & HIV

Shingles is a painful rash that commonly occurs in older people. It is also known as herpes zoster. Shingles is caused by the varicella-zoster virus (VZV). This is the same virus that causes chickenpox. Some estimates suggest that over 90 percent of adults in the United States have been exposed to VZV.1

After you recover from chickenpox, VZV stays in your body. It hides out in your nerves. For some people, VZV may never come back. For others, it may comeback one or more times as they get older. When VZV gets reactivated in the body, it causes shingles.

How is shingles transmitted?

Shingles itself is not transmitted from person-to-person. However, 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 those with weakened immune systems.2

Who is at risk?

Shingles often affects older people. It is most commonly affects people who are 50 to 60 years old or older. The risk of shingles increases with age and with weakened immune system status. VZV may also reactivate during times of stress or infection.

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People who may have weakened or malfunctioning immune systems include people living with HIV, those with autoimmune conditions, cancer, organ transplants, and people on drugs that suppress the immune system.

How is shingles related to HIV?

Because of this, people with HIV tend to have higher rates of shingles or of getting shingles multiple times. This is especially true for those with high viral loads and lower CD4 counts. Some people may also get shingles soon after they start antiretroviral therapy (ART) as their immune system is changing and responding to the drugs.

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 with HIV.1,2

Signs and symptoms

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

Rashes

Within 2 weeks after this first discomfort, 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 two. The pain can range from mild to severe. Most doctors can determine if a rash is due to shingles because of the specific location it affects. However, in some people with very weakened immune systems, the rash may be more widespread.

Post-herpetic neuralgia

Occasionally, the pain related to shingles can remain even after the rash fades. This is called post-herpetic neuralgia. This type of pain 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 symptoms.1,2

Treatment and prevention

Unfortunately, there is no cure for shingles at this time. Some antiviral medications may be used to help reduce the severity and length of an outbreak. The faster these medications can be started, the more likely they’ll have an impact. Other common symptom-relieving treatments like soothing baths, over-the-counter pain relievers, and lotions may be helpful.2

The best way to fight shingles is to prevent it from reactivating. While we cannot change our exposure to the virus in the first place, we can get vaccinated.

Talk to your doctor about vaccination options

There are vaccines available to prevent the reactivation of shingles. These are often recommended for people over the age of 50 years old. However, depending on the status of their immune system and their CD4 count, some shingles vaccines may not be beneficial in people with HIV. Your doctor can help determine which vaccine is right for you based on your immune system’s status.2,3

Maintain immune system health

It also may be helpful to stay adherent to your ART to help keep your immune system as strong as possible and prevent shingles.1 If you know someone who has shingles or chickenpox, it is best to avoid contact with that person as much as possible. This is especially important for people with weakened immune systems who are unsure if they have had chickenpox in the past or are unsure if they have been vaccinated for chickenpox.

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