Varicella zoster as a manifestation of immune restoration disease in HIV-infected children

J Allergy Clin Immunol. 2004 Apr;113(4):742-6. doi: 10.1016/j.jaci.2004.01.768.


Background: Exacerbation of opportunistic infections in HIV-infected patients shortly after initiation of highly active antiretroviral therapy (HAART) has been named immune restoration disease (IRD). Thus far, IRD has not been reported in children.

Objective: We describe the clinical and immune characteristics of IRD in HIV-infected children treated with HAART.

Methods: A historical cohort study was conducted in a tertiary HIV center in perinatally HIV-infected children who were started on a first stable HAART between January 1996 and July 2002. The incidence of opportunistic infections, newly AIDS-defining events or death after initiation of HAART, and virologic and immunologic information was evaluated at baseline and every 3 months post-HAART.

Results: Sixty-one perinatally HIV-infected children were started and maintained on HAART for >6 months. Seven episodes of IRD occurred. All were cutaneous herpes zoster (HZ). Children who developed HZ had significantly lower baseline CD4+ and CD8+ T-cell numbers compared with children who did not. HZ occurred only in children (7 of 34 subjects) with virological and immunological success to HAART. In children with a previous history of varicella infection, the risk of developing HZ after HAART was higher in those without a protective level of varicella-specific IgG (50%, or 5 of 10 subjects) compared with those with seroprotection (10%, or 2 of 20).

Conclusion: Herpes zoster is a common manifestation of IRD in HIV-infected children after the initiation of HAART. Risks for developing HZ include no protective varicella-specific antibody despite previous varicella infection, severe immunodeficiency at baseline, and vigorous immunologic and virologic responses to HAART.

MeSH terms

  • Antiretroviral Therapy, Highly Active*
  • Child
  • Child, Preschool
  • Cohort Studies
  • Female
  • HIV Infections / complications*
  • HIV Infections / drug therapy*
  • Herpes Zoster / etiology*
  • Herpes Zoster / virology
  • Herpesvirus 3, Human / physiology
  • Humans
  • Male
  • Opportunistic Infections / etiology*
  • Retrospective Studies
  • Risk Factors
  • Treatment Outcome
  • Virus Activation