Herpes zoster, or shingles, is a reactivation of a previous herpes varicella-zoster virus infection. It can be one of the earliest manifestations of HIV. A longitudinal study showed an incidence of 29.4 cases per 1000 person-years among people seropositive for HIV vs 2.0 cases per 1000 person-years among control participants who were seronegative for HIV.3 Shingles risk and severity may be increased with increasing immunosuppression.4 Because shingles has a distinctive disease course and lesions, clinical diagnosis is usually accurate, but laboratory studies may be required for confirmation.5 Patients often first experience pain along one of the sensory nerves of the skin, followed by a painful rash several days later.6 The rash begins with grouped vesicles confined to 1 dermatome or spread over 2 adjacent dermatomes. The vesicles eventually crust over and then heal 3 to 4 weeks later, but may result in significant scarring. Pain sometimes persists after resolution of the vesiculation (ie, postherpetic neuralgia).
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