Comparative clinical profile of herpes zoster in immunocompromised and immunocompetent patients: insights from a tertiary care center

Abstract Background: Herpes zoster (shingles) results from reactivating the latent varicella-zoster virus in sensory nerve ganglia. While incidence increases with age due to declining immunity, immunosuppression from human immunodeficiency virus (HIV) infection has led to a rising occurrence of shingles in younger populations. Objectives: This study compared the clinical profile of herpes zoster in immunocompromised and immunocompetent patients in a tertiary care setting in eastern India. Materials and Methods: Detailed clinical and demographic information was collected from all eligible patients. Each patient underwent a comprehensive examination to identify the affected dermatome(s) and assess disease severity, including vesiculation, crusting, pain, keloid formation, and systemic symptoms. HIV testing was conducted after obtaining informed consent. Patients were monitored weekly until full resolution of symptoms was achieved. Results: The thoracic dermatome was the most frequently involved, followed by the trigeminal, in both HIV-positive and HIV-negative groups. Multiple dermatome involvement was observed in 48.15% of HIV-positive patients but in none of the HIV-negative cases. Systemic symptoms were present in 22 (81.48%) HIV-positive patients, a significantly higher proportion compared with the HIV-negative group ( P = 0.0476). The duration for cessation of new vesicle formation and complete healing of lesions was notably longer in HIV-positive individuals than in HIV-negative ones. Conclusion: Herpes zoster shows distinct clinical differences in HIV-positive compared with HIV-negative individuals. The HIV-positive group exhibited prolonged lesion progression and healing. Since herpes zoster is classified as clinical stage 2 of HIV infection, its occurrence should prompt careful evaluation and management in HIV-positive patients.