Varicella Zoster Virus (VZV)

Diagnosis and treatment. For prevention, see Immunizations in persons with HIV

Diagnosis:
Identification of VZV-DNA by nucleic acid amplification techniques (NAT) in skin lesions is useful to confirm clinical diagnosis and enables differentiation of VZV vs. HSV-1 vs. HSV-2 when lesion distribution is not typical.
Identification of VZV-DNA in CSF, aqueous humor or tissue biopsy is recommended for diagnosis of infection of specific sites. Tissue antigen detection may be used when NAT is not available.

Notes on treatment:
monitor renal function and adjust drug dose in renal impairment. See also Anti-infective/ART interaction table

	Drug / Dose	Comments
Primary Varicella infection (Chickenpox) and Herpes Zoster (Shingles): Not disseminated	valaciclovir 1000 mg tid po	Chickenpox: 5-7 days Shingles: 7-10 days
OR famciclovir 500 mg tid po
OR aciclovir 800 mg x 5/day po
Herpes Zoster: Disseminated	aciclovir 10 mg/kg tid iv	10-14 days (or until lesion resolution)
Encephalitis (including vasculitis), retinitis or infection of other sites	aciclovir 10-15 mg/kg tid iv	14-21 days If retinitis, consult ophthalmologist
Foscarnet can be considered as a therapeutic option in case of resistance or toxicity with the other treatments listed

Drug / Dose

Comments

Primary Varicella infection (Chickenpox)
and
Herpes Zoster (Shingles):
Not disseminated

valaciclovir
1000 mg tid po

Chickenpox: 5-7 days
Shingles: 7-10 days

OR
famciclovir
500 mg tid po

OR
aciclovir
800 mg x 5/day po

Herpes Zoster:
Disseminated

aciclovir
10 mg/kg tid iv

10-14 days (or until lesion resolution)

Encephalitis (including vasculitis), retinitis or infection of other sites

aciclovir
10-15 mg/kg tid iv

14-21 days
If retinitis, consult ophthalmologist

Foscarnet can be considered as a therapeutic option in case of resistance or toxicity with the other treatments listed