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03.11.2014

Herpes zoster antiviral drugs, homeopathic definition - Review

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Significant scarring may result from cutaneous herpes zoster and this is most problematic with facial involvement. In most circumstances, the diagnosis of cutaneous herpes zoster is made on clinical grounds. The following treatment recommended for varicella and zoster are based on the 2009 document Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adolescents and Adults[4].
In general, HIV-infected patients with uncomplicated varicella infection can be treated with oral antiviral therapy. The recommendations regarding the use of the varicella vaccine (Varivax) and zoster vaccine (Zostavax) are discussed in the in Case 4 (Appropriate Vaccinations) in the section Initial Evaluation.
These extensive zoster lesions on the buttock and posterior leg have crusted and show no sign of secondary bacterial infection.
Given the widespread prevalence of varicella-zoster virus (VZV) infection in adults, most HIV-infected adults are at risk of developing VZV reactivation and herpes zoster.
The factors governing the maintenance of latency or the progression to viral replication remain poorly understood, but the increased incidence of zoster among immunocompromised persons suggests that cell-mediated immunity probably plays a critical role. Reactivation of herpes zoster in the trigeminal ganglia may lead to the development of herpes zoster ophthalmicus, a condition that includes a number of inflammatory manifestations in the eye, such as conjunctivitis, episcleritis, keratitis, and iritis. All patients with an acute episode of varicella or zoster should promptly receive antiviral treatment[4].
The recommended antiviral treatment options (Figure 8) for localized dermatomal zoster in HIV-infected persons consist of valacyclovir (Valtrex), famciclovir (Famvir), or acyclovir (Zovirax)[4].


In general, resistance should be suspected in patients who have lesions that do not improve with 10 days after starting antiviral therapy. In the rare instance when an HIV-infected person who is non-immune to VZV has significant exposure to a patient with active varicella or zoster, varicella zoster immune globulin (VZIG) should be administered within 96 hours of exposure (preferably within 48 hours). The incidence of zoster among HIV-infected adults is more than 15-fold higher than age-matched VZV-infected immunocompetent persons, with nearly 30 cases per year observed for every 1,000 HIV-infected adults[2]. Patients with herpes zoster often present with dysesthesias of the skin several days prior to the onset of cutaneous lesions.
Post-herpetic neuralgia (defined as pain that persists longer than 30 days after the onset of the rash) is a significant problem associated with herpes zoster infection, but, after adjusting for age, the risk of post-herpetic neuralgia does not differ significantly among HIV-infected persons compared with immunocompetent persons[7]. The direct fluorescent antibody (FA) assessment of a cellular rich sample from the base of the lesion offers the most sensitive, specific, and rapid diagnosis for herpes zoster.
Note these antiviral medications are administered at doses higher than those commonly used for the treatment of uncomplicated herpes simplex virus infections. The diagnosis of herpes zoster should prompt the clinician to consider HIV testing, particularly in persons with known HIV risk factors, those younger than 50 years of age, or those who develop multi-dermatomal herpes zoster. Post-herpetic neuralgia manifests as chronic (more than 30 days after the onset of lesions) severe skin pain along the distribution of the initial zoster outbreak[8].
In the absence of antiviral therapy for VZV, dissemination may extend to the central nervous system. In these cases of complicated varicella, if the patient responds well to intravenous acyclovir, they can typically switch to oral antiviral therapy to finish their treatment course[4].


In most antiviral studies, therapy was initiated within 3 days of the onset of rash, but one study in immunocompromised patients suggested substantial benefit from administering antiviral drugs even after 72 hours had elapsed[13].
Based on this report, as well as in vitro data, foscarnet is the recommended drug of choice for acyclovir-resistant VZV[4]. In February 2006, Gangene Corporation, the Canadian manufacturer of an investigation VZIG product (VariZIG), made this product available under an investigational drug application expanded access protocol. In addition, the incidence of zoster increases within the first 4 months after initiating highly active antiretroviral therapy (mean 5 weeks), probably related to immune reconstitution[6].
Although herpes zoster can occur anywhere on the body, the skin of the thorax is the most frequently involved region.
Bacterial superinfection of vesicles can also complicate cutaneous herpes zoster (Figure 6). Accordingly, the use of corticosteroids as part of the treatment for herpes zoster in HIV-infected persons is not recommended[4].
Although other infections, such as herpes simplex virus and smallpox, may cause similar appearing vesicular lesions, the characteristic dermatomal distribution of herpes zoster helps to distinguish herpes zoster from these other disorders.
Treating acute zoster-associated neuropathic pain or post-herpetic neuralgia is an important component of the management of patients with VZV infection.



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Comments to “Herpes zoster antiviral drugs”

  1. NEITRINO:
    Genital In any respect you wait.
  2. 665:
    Lessen the time it would take to heal.
  3. Arzu_18:
    And pills to the patients to keep its energy so that same virus that.