Is Shingles A First Sign Of HIV?

Since the early 1980s, when HIV was first identified, the development of antiretroviral medication has shifted this virus from a slow and fatal diagnosis to a chronic but manageable illness. As a result, it is advisable to start highly active antiretroviral therapy (HAART) as soon as possible to reduce the risk of morbidity, mortality, and viral transmission to others. This treatment method also helps delay the onset of acquired immunodeficiency syndrome (AIDS).

Although there are several ways to find out the state of the immune system in relation to HIV infections, a large number of those with HIV are still receiving their diagnosis late into the course of the disease. 

In fact, studies show that only 54% of US adults aged between 18–64 ever report being tested for HIV. These studies further revealed that 21% of HIV infections in the US are undiagnosed. While there are many ways to notice a weakened immune system physically, experts have revealed that shingles could be the first sign of HIV.¹ ²

Shingles explained

Herpes zoster, another name for shingles, is a contagious condition characterized by a painful and uncomfortable rash. It is brought on by the same virus that causes chickenpox, varicella-zoster.

After recovering from chickenpox, varicella-zoster will remain inactive in the nerve tissue. It usually stays that way and never creates any complications. Varicella-zoster can, however, reactivate under certain conditions, such as those involving a compromised immune system, and manifest as shingles.

Although an outbreak typically emerges as a stripe or band on one side of the torso, it can develop anywhere on the body, including the groin and leg. A 2011 medical case report revealed that the face and trunk are the most typical places for a shingles outbreak. It is worth noting that although penile shingles outbreaks are uncommon, they are still potentially possible.³

Is there a connection between herpes zoster and shingles?

Studies show that those with HIV are more likely to get shingles and shingles-related complications than those without. This is because shingles affects those with a weakened immune system, including those with untreated HIV or stage 3 HIV. 

Generally, HIV attacks and kills CD4 cells of the immune system specifically. Consequently, a person is more likely to get shingles if they have lower CD4 cell counts and higher HIV levels in their blood. Reports show that shingles is more common in people who have detectable levels of HIV, as indicated by low CD4 levels and a high viral load.⁴

Recent studies show that people diagnosed with HIV and have low CD4 levels and a high HIV viral load have a higher chance of developing shingles. Likewise, 10–32% of people infected with HIV are likely to get immune reconstitution inflammatory syndrome (IRIS) shortly after beginning their antiretroviral treatment. This is because the immune system is becoming more powerful and is beginning to react to particular bacteria and viruses in the body.⁵ ⁶

Effective HIV treatment is the best strategy to strengthen the immune system. In the US, more than 30 HIV medications are available. These drugs decrease the virus's viral load within the blood to nearly zero, enabling the immune cells to strengthen and subsequently increase CD4 count. 

With proper care, an HIV-positive individual can live with the same level of comfort as someone without the virus, with a lower risk of contracting bacterial and viral diseases like shingles.

What are the common symptoms of shingles?

About 90% of people diagnosed with HIV experience skin changes and complications at some point in the setting of the virus. As mentioned earlier, shingles causes a painful and blistering rash on the skin. Before developing this visible rash, many people have an itching, burning, or tingling sensation in the infected region, which is usually one side of the body and face.⁷

Other common symptoms of shingles include:

• Fever

• Headache

• Fatigue

• Sensitivity to touch

• Stomach upset

Note that the shingles rash outbreak on the skin soon transforms into blisters with fluid, which will dry and scab over seven to ten days and should clear up after a maximum of four weeks. 

It is also vital to note that people with HIV are more likely to get complications related to shingles than those who are HIV-negative. We shall discuss this further in the section below.

Are there any complications associated with having shingles and HIV?

HIV and other long-term illnesses that impair immunity can exacerbate symptoms and complications associated with shingles. When an individual has herpes zoster and HIV, it means that their immune system is compromised. As a result, they are more likely to develop herpes zoster complications such as:

• A greater likelihood of skin infections

• Prolonged symptoms of shingles

• Extended pain that may last for years, a condition known as postherpetic neuralgia

• A greater chance of developing disseminated zoster, a chronic form of shingles where the rash covers a broader area of the body

• Persistent and chronic shingles infections

Note that herpes zoster can cause complications related to eye involvement in approximately 10–25% of herpes zoster patients, a condition called herpes zoster ophthalmicus (HZO). However, when compared to the general population, those with HIV have the highest risk of getting HZO. This is when the varicella-zoster virus (VZV) reactivates around the nerves in the eyes.⁸

How to treat a person with herpes zoster and HIV

People with shingles and HIV require special care. In some circumstances, hospitalization could be necessary. Usually, those with herpes zoster and HIV are treated using antiviral medications, such as:

• Valacyclovir

• Acyclovir

• Famciclovir

However, if an individual has acyclovir-resistant shingles, Foscarnet is given intravenously. Other common treatment methods for alleviating shingles symptoms in people with HIV include:

• Applying cold and moist compresses 

• Over-the-counter (OTC) medicines

• Topical skin treatments like creams and gels to reduce pain and itchiness

• Pain-relieving nerve blockers injected into the spine or nearby nerves by a doctor

• Supplemental painkillers

• Medicine for epilepsy or antidepressants

Note that corticosteroid eye drops may be used to alleviate irritation caused by shingles near the eyes. If you suspect that you have shingles, seek medical assistance right away. Individuals diagnosed with HIV should contact their doctor as soon as they start experiencing new symptoms of shingles.

Can people with HIV obtain the shingles vaccine?

It is advisable for people over the age of 50 to get the Shingrix vaccine, which has proved to be 90% effective in preventing long-term pain and shingles. The vaccine also maintains an efficiency above 85% for about four years.⁹ ¹⁰

Likewise, people with HIV with greater CD4 counts than 200 cells/mm3 can also get this vaccine to reduce their chance of getting shingles. However, whether the vaccine should be available to those with fewer CD4 counts than 200 cells/µL is still under assessment.

The lowdown

Shingles is common among people over 50 years and is characterized by an itchy and painful rash. This condition is a sign of a compromised immune system and has been linked as a possible early indicator of HIV. People with HIV, especially those with stage 3 HIV or those who are untreated or in the early stages of treatment, are more likely to get shingles and complications.