Cerebrospinal fluid findings in HIV patients with recent herpes zoster

Lars Hagberg, Magnus Gisslén
Affiliates: Not submitted

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Herpes zoster is a co-infection which may influence the central nervous system HIV infection.

Patients and methods
Sixteen HIV patients (9 females and 7 males, aged 31-57, mean 41 years, CD4 10-834, mean 310 cells/ml) with acute herpes zoster who were lumbar punctured within 90 days (mean 24 days, range 1-90) from herpes blizzard eruption were analyzed with cerebrospinal fluid (CSF) quantitative HIV PCR, cell count, albumine, neopterin as a marker of inflammation, and neurofilament (NFL) as a marker of neuronal damage between the years 1996-2014. The diagnose was confirmed with positive varicella zoster virus PCR from blizzards in 7 cases, and in 9 cases the diagnose was based on a typical clinical picture. Five patients were on HIV antiretroviral combination treatment (cART) and 11 were treatment naïve. Five patients had zoster engaging only the thorax, 2 axilla and thorax, 3 arm, 2 leg, and 3 had zoster in the head region. No patient suffered from post herpetic neuralgia, defined as disturbing pain more than 3 months.

Among the 11 patients who had no anti-HIV treatment there was a mean of 236000 CSF-HIV copies/ml (range 125-1000000) compared to a mean of 110000 HIV copies/ml (range 18500-302000) in blood, of whom 7/11 had higher viral load in CSF than in blood. Eight patients in this group had elevated CSF monocytic cell count above 5×106/ml (mean 33, range 0-245), 8/8 analyzed had elevated CSF neopterin concentration above the upper normal limit of 5.8 nmol/l (mean 25.1, range 8-88 nmol/l), and 5/8 had elevated CSF NFL concentrations.
Among patients on antiretroviral treatment 4/5 had detectable CSF virus >50 copies/ml (mean 574, range 0-1920 copies/ml) compared to 3/5 in blood (mean 126, range 0-481 copies/ml). One of these patients had elevated monocytic cell count above 5×106/ml, 3/4 analyzed had elevated CSF neopterin concentration (range 1.8-21) and 2/4 analyzed had elevated CSF NFL concentration.

We found signs of higher HIV viral load and inflammatory activity in HIV patients with recent zoster then we usually have found in previous studies of both asymptomatic naïve HIV patients and patients on cART. Results with matched controls will be presented at the meeting. The long term clinical impact is uncertain but zoster seems to boost the CNS HIV infection, at least temporarily. Interestingly, there were no post-herpes complications such as long term neuralgia.