Shingles and HIV: What You Should Know

Medically reviewed by Judith Marcin, MD on May 27, 2016Written by Ann Pietrangelo on May 27, 2016

Overview

The varicella-zoster virus is a type of herpes virus that causes chickenpox, or varicella, and shingles, or zoster. If you catch the virus, you’ll get chickenpox. You may get shingles decades later. Only people who’ve had chickenpox get shingles.

The risk of getting shingles increases as you age, especially after age 50. Part of the reason for this is that your immune system weakens as you age.

You have an even greater risk of developing shingles if HIV has compromised your immune system.

What are the symptoms of shingles?

The most obvious symptom of shingles is a rash that usually winds around one side of the back and chest.

Some people start to feel a tingling sensation or pain several days before the rash appears. It begins with a few red bumps. Over the course of three to five days, many more bumps form.

The bumps fill with fluid and turn into blisters, or lesions. The rash may sting, burn, or itch. For some, it can become very painful.

After a few days, the blisters begin to dry out and form a crust. The scabs usually start to fall off in about a week. The whole process can take from two to four weeks. After the scabs fall off, you may notice subtle color changes on your skin. Sometimes, the blisters leave scars.

Some people experience lingering pain after the rash clears up. This is a condition known as postherpetic neuralgia. In some cases, this can last several months.

Other symptoms may include fever, nausea, and diarrhea. You can also get shingles around the eye. This can be quite painful and can damage your vision.

If you have symptoms of shingles, see your doctor right away. Prompt treatment can cut down on your risk of serious complications.

What causes shingles?

After you recover from chickenpox, the virus remains inactive, or dormant, in your body. Your immune system works to keep it inactive. Years later, usually when you’re over age 50, the virus can become active again. The cause of this isn’t clear, but the result is shingles.

Having a weakened immune system can increase your chances of developing shingles at a younger age.

Shingles doesn’t spread from one person to another. The varicella-zoster virus is contagious, though. If you never had chickenpox and you’re exposed to active shingles blisters, you can get the virus and develop chickenpox. This exposes you to the risk of shingles later on. Shingles can recur multiple times.

What if you have never had chickenpox or the vaccine for it?

If you’ve never had chickenpox or the chickenpox vaccine, you can’t get shingles. But you’re at risk of contracting the virus that causes both. If you have HIV, you should take some precautions:

  • Try to avoid exposure to people with chickenpox or shingles.
  • Be especially careful to avoid direct contact with the rash.
  • Ask your doctor if you should get the vaccine.

The shingles vaccine contains a live virus. It’s safe for some people with HIV, but if your immune system is severely compromised, it may not be. Don’t get the vaccine if you haven’t checked with your doctor.

What are the complications of having shingles and HIV?

If you have HIV, you might get a more severe case of shingles. You’re also at increased risk of complications.

Longer illness

Skin lesions may last longer and are more likely to leave scars. Take care to keep your skin clean and avoid exposure to germs. Skin lesions are susceptible to bacterial infection.

Disseminated zoster

Most of the time, the shingles rash appears on the trunk of your body. In some people, the rash spreads out over a much larger area. This is called disseminated zoster. It’s much more likely to happen if you have a compromised immune system. Other symptoms of disseminated zoster may include a headache and light sensitivity. Severe cases may require hospitalization, especially if you have HIV.

Long-term pain

Postherpetic neuralgia can last for months or even years.

Recurrence

The risk of persistent, chronic shingles is higher in people with HIV.

If you have HIV and suspect you have shingles, see your doctor for prompt treatment.

How is shingles diagnosed?

Most of the time, a doctor can diagnose shingles by performing a physical exam. Your doctor may also want to examine your eyes to see if they’re affected.

It may be harder to diagnose shingles if the rash is spread out over a large portion of your body or has an unusual appearance. If that’s the case, they can take skin samples from a lesion and send them to a lab for cultures or microscopic analysis.

What are the treatment options for shingles?

Treatment for shingles is the same for people with HIV as it is for those without HIV. Treatment includes the following:

  • You should get started on an antiviral medication as quickly as possible to ease symptoms and potentially shorten the duration of the illness.
  • For pain, you can take an over-the-counter (OTC) pain reliever. If you’re in severe pain, your doctor can prescribe a stronger medication.
  • Try an OTC lotion to relieve itching, but avoid lotions that contain cortisone.
  • You can also apply a cool compress to your skin.
  • For shingles of the eye, your doctor may recommend eye drops that contain corticosteroids to treat inflammation.

If your lesions seem infected, contact your doctor right away.

What is the outlook?

For people with HIV, shingles can be more serious and it can take longer to recover. You may have scars on your skin or long-term pain. If you have shingles of the eye, it may damage your vision.

However, most people with HIV recover from shingles without serious long-term complications.

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