Does shingles mean HIV? (+11 facts)

In this article, we will discuss if shingle is an indication of Human Immunodeficiency virus (HIV). We will also discuss possible clinical interventions that can be adopted for symptomatic treatment of shingles.

Does shingles mean HIV?

No, shingle does not always mean HIV. However, HIV patients are at high risk of developing shingles. HIV causes a depletion of CD4 T-lymphocytes by targeting the immune system.

CD4 lymphocytes help to fight infection by activating other immune cells like macrophages. Therefore, when the immunity drops, the patient becomes vulnerable to other infections, including shingles.

Shingles are caused by Herpes zoster virus. The virus can lie dormant in the nerves after chickenpox. The virus activates once your immunity drops due to HIV or other underlying conditions.

Therefore, reactivation of Herpes zoster virus may indicate the presence of untreated or Stage 3 HIV. However, shingles can also reactivate due to chemotherapy, long-term use of steroids, and 

Which factors cause HIV to trigger shingles?

Some of the factors that can trigger the occurrence of shingles while the patient is also HIV-positive include:

• Weakened immune system: HIV lowers the CD4 T-lymphocyte count. The risk of getting shingles increases if the CD4 count is less than 200 cells/mm3.

A weakened immune system may also happen due to other diseases, including leukaemia, lymphoma, multiple sclerosis, and celiac disease. Some medications can also weaken the immune system including chemotherapy.

Medicines given during organ transplant, or advanced psoriatic arthritis are more likely to weaken to immune system. This increases the risk of getting shingles, especially if the patient is also HIV-positive.

• Disease severity: Although shingles can occur at any lymphocyte count, patients with Stage 3 HIV are more prone to get shingles.

People with low white blood cell count and high viral load of HIV and shingles are more likely to get shingles. Clinical data suggest that around 16% of the patients develop varicella-zoster virus antibodies while being HIV-positive (1).

• Untreated HIV: Shingles are more likely to occur in HIV-positive patients if the disease has been recently diagnosed.

Sometimes the patient might not have been diagnosed with HIV yet. In such cases, shingles can be an early detection parameter of HIV as shingles point to a compromised immune system.

• Early stages of treatment: If the HIV-positive patient is in the early stages of treatment then he might get shingles due to a compromised immune system.

If the patient develops a rash while being HIV-positive and also had chickenpox in the past, then this indicates the early symptoms of developing shingles. Early diagnosis can prevent shingle-related complications.

• Age: Elderly patients have compromised immune systems and HIV can worsen it.

Therefore, patients who are 50 and above are more likely to develop shingles. However, anyone who had chickenpox in their childhood can develop shingles in the adult age. Nonetheless, such cases are rare.

What does the research suggest?

In one of the cohort studies, 183 out of 4353 HIV-positive patients developed shingles. It was more common in men (62%), with a mean age of 39 years. Almost 12% of the patients developed postherpetic neuralgia; a complication of shingles (2).

In another case report, middle-aged women developed shingles and then later diagnosed with HIV. Her CD4 count had already dropped to less than 200 cells/mcL due to late diagnosis (3).

What are the symptoms of shingles and HIV?

Shingles is a non-contagious disease. The symptoms of shingles might include:

• Itchy rash,
• tingling and burning sensation,
• Skin redness,
• Blister formation,
• Headache,
• Fever or chills, and
• Pain.

HIV is a contagious disease and spreads from one person to another. The symptoms might include:

• Swollen lymph nodes,
• Sore throat,
• Fever,
• Night sweats, 
• Weight loss,
• Cough and shortness of breath,
• Diarrhea and vomiting.

How to prevent shingles in patients with HIV?

There is no particular cure for shingles, however, the symptoms can be managed.

• Antiviral drug: These drugs, including Acyclovir and Famciclovir, can reduce the disease progression. 

It is noteworthy that antiviral drugs cannot prevent or cure shingles, but rather inhibit the division and spread of the virus in the body. Acyclovir (5 time a day) and Famiclovir (3 times a day) should be administered for seven days.

• Oral Analgesics: Pain medicine, including acetaminophen and ibuprofen, can reduce the pain associated with shingles.

Shingles can be a painful disease, especially when scratching causes bleeding. Acetaminophen can be used alone or in combination with ibuprofen or codeine to alleviate pain. Analgesics should be administered daily rather than as needed.

• Antiinflammatory drugs: These drugs, including prednisone, might be prescribed if shingles spread to the eyes. However, diclofenac cannot be used.
• Antihistamines: If the patient has severe itching, then antihistamine medication can be given.

Nonsedating antihistamines like cetirizine, loratadine, and fexofenadine are preferred over sedating antihistamines (diphenhydramine). The effect of nonsedating antihistamines lasts for 24 hours, however, diphenhydramine requires frequent dosing.

• Antibacterial drugs: These drugs might be prescribed if the patient develops a bacterial infection at the site of the rash.

However, it is important to know that antibiotics are not effective against the shingle-causing virus. They are only useful against infection caused by scratching or bleeding.

Therefore, if the patient has no sign of infection then antibiotics should not be prescribed as they might disturb the normal flora of the human body and also weaken immunity (4). 

How to prevent post-herpetic neuralgia associated with shingles?

• Anticonvulsants and tricyclic antidepressants: These medications are prescribed to the patient only if he has post-herpetic neuralgia. 

Anticonvulsant drugs like pregabalin and carbamazepine can ease the pain associated with shingles or postherpetic neuralgia. Similarly, tricyclic antidepressants like nortriptyline and amitriptyline can lessen the pain and depression caused by shingles. 

• Topical analgesics: Lidocaine and capsaicin cream may be used for a shingles-associated complication like postherpetic neuralgia.

These medications should not be applied on the broken skin. Lidocaine is a local anaesthetic that is used to numb the pain caused by shingles. Capsaicin creams help to relieve pain associated with nerve damage. 

What are other causes of shingle-like symptoms in HIV patients?

• HIV rash: It is the most common symptom in patients with HIV. The rash is characterized by a flat red area that may have small bumps on the surface.
• Skin lesions: Herpes virus I and II can cause skin lesions and is a common disease in a patient with HIV.

When I contacted chickepox, one of the most important instruction I got from my dermologist was to improve and boost my immunity. Although a non-cantagious disease, shingles can cause discomfort to the patient.

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