Photogallery. Herpes zoster

Herpes zoster (HZ) is a disease of viral etiology. Its occurrence is directly related to the reactivation of the human herpesvirus type 3. At certain periods of life, 10 to 20% of the population are at risk of developing HZ. The probability of HZ increases significantly in immunocompromised individuals with conditions such as HIV infection, cancer, after bone marrow transplantation, as well as during long-term treatment with cytostatics and systemic glucocorticoids. Thus, in patients with HIV infection, HZ occurs 8 to 15 times more often than in the general population. The results of a study previously conducted by the author showed that 15.4% of patients with HZ aged 18-50 years in one of the Russian regions with a high level of HIV infection in the population were HIV-positive. In cases of immunodeficiency, including HIV-associated immunodeficiency, the course of HZ may have distinct characteristics.

The current photo gallery is dedicated to OH cases that developed against the background of HIV infection. In these cases, OH manifestations typically occur when the level of CD4⁺ T-lymphocytes in the blood falls below 400 cells/μl. With progressive immunosuppression in individuals not receiving antiretroviral therapy, relapses of the disease are possible. In some patients with low immune status, OH manifests as part of the immune reconstitution inflammatory syndrome. The severity and clinical manifestations of OH depend on the degree of immunodeficiency. In the context of HIV infection, multidermatomal lesions are often observed, involving two or more dermatomes in the pathological process. Compared to people without HIV, the rash period may be extended to 10 days or more. Atypical forms (hemorrhagic, ulcerative-necrotic, warty, disseminated, generalized) are recorded more frequently and may coexist. These rashes are distinguished by their intensity and greater depth of tissue damage. In HIV-infected individuals, when the rash is localized in the external auditory canal and the innervation zone of the first branch of the trigeminal nerve, there is a high probability of damage to the auditory and visual organs, respectively. One of the complications of OH is Ramsay Hunt syndrome, characterized by typical OH rashes in the auricular area, pain in the affected ear, and paresis or paralysis of the facial nerve.

The first episode of HZ in people living with HIV serves as the basis for establishing, according to the Russian clinical classification, stage 2B of HIV infection (acute HIV infection with secondary diseases) or stage 4A of secondary diseases, depending on the duration of HIV infection. Repeated or disseminated HZ corresponds to stage 4B of secondary diseases.

We offer a photo gallery of various clinical forms and localizations of HZ in patients with HIV infection. In the case descriptions, the location of the lesions is indicated in accordance with the innervation zones of the peripheral sensory nerves. All photographs presented in the article are from the author's archive.