Fact Sheet Number 514
- WHAT IS SHINGLES?
- SHINGLES AND HIV
- HOW IS SHINGLES TRANSMITTED?
- HOW IS SHINGLES TREATED?
- CAN SHINGLES BE PREVENTED?
- THE BOTTOM LINE
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PrintShingles is a very painful disease caused by the same herpes virus
that causes chicken pox (varicella zoster virus). Like other
herpes viruses, the varicella-zoster virus has an initial infectious
stage, (chicken pox) followed by a dormant stage. Then, with
no warning, the virus becomes active again.
This reactivation of the virus is most likely to occur in people
with a weakened immune system. This includes people with HIV
disease, and anyone over 50 years old.
Herpes zoster lives in nerve tissue. Outbreaks of shingles
start with itching, numbness, tingling or severe pain in a belt
like pattern on the chest, back, or around the nose and eyes.
In rare cases, herpes can infect the facial or eye nerves. This
can cause outbreaks around the mouth, on the face, neck, and scalp,
in and around the ear, or at the tip of the nose.
Shingles outbreaks are almost always on just one side of the
body. Within a few days, a rash appears on the skin area related
to the inflamed nerve. Small blisters form and fill with fluid.
Later they break open and develop crusty scabs.
If the blisters are scratched, someone with shingles might
develop a skin infection. This could require treatment with antibiotics
and might cause scars.
In most cases, the rash goes away within a few weeks, but in
some cases, severe pain can last for months or even years. This
condition is called “post herpetic neuralgia.”
SHINGLES AND HIV
Shingles is not one of the infections that leads to a diagnosis
of AIDS.
A recent study of people with HIV found the highest rates of
shingles in:
- gay or bisexual men
- those younger than age 29
- people with less than 500 T-cells
- whites rather than blacks or Hispanics
Shingles can occur in people with HIV shortly after they start
taking strong antiviral medications. These cases of shingles
are believed to be a sign of a recovering immune system.
TRANSMITTED?
Shingles can only occur after someone has had chickenpox.
If someone who has already had chickenpox comes into contact with
the fluid from shingles blisters, they will not “catch”
shingles. However, people who have not had chickenpox could become
infected with herpes zoster and develop chickenpox. They should
avoid contact with the shingles rash or with any materials that
may have touched the shingles rash or blisters.
TREATED?
The standard treatment for shingles is the drug acyclovir, which
can be given orally (in pill form) or intravenously in more severe
cases.
Recently, two new drugs have been approved for the treatment
of shingles: famciclovir and valacyclovir. Both famciclovir and
valacyclovir are taken three times each day, compared to five
times for acyclovir. All of these drugs work best when they are
started within the first three days after the shingles pain begins.
Doctors often prescribe various pain medications for people
with shingles. Because the pain of shingles can be so intense,
some researchers have looked for other ways to block the pain.
When the herpes zoster virus inflames nerves, they pump out a
chemical messenger called glutamate. Glutamate then lands on receptors
on nearby cells, which transmit pain signals to the brain.
Shingles triggers such a flood of glutamate that some cells
stop functioning while others become hypersensitive. This probably
explains why shingles patients can feel great pain even when skin
is touched only lightly.
There are drugs that can block the receptor sites where glutamate
lands, and researchers are studying whether these drugs will help
relieve shingles pain.
In 1999, the FDA approved a patch form of the anesthetic lidocaine.
The patch, called Lidoderm, provides pain relief for some people
with shingles. Because lidoderm is applied to the skin, it has
less risk of side effects than pain medications taken in pill
form.
PREVENTED?
Currently, there is no way to predict an outbreak of shingles,
and there is no medication approved to prevent it.
However, researchers have shown that giving older people a
stronger form of the chicken pox vaccine used for children can
boost the type of immunity believed necessary to hold the virus
in check. The researchers hope to show that this increased immunity
will result in a lower risk of shingles in later life.
Shingles is an unpredictable, very painful disease. It is caused
by a re-activation of the virus that causes chicken pox. Although
not directly linked to HIV, shingles seems to occur more frequently
in people with AIDS.
Although shingles may disappear within a couple of weeks, severe
pain may continue for several months.
There is no known way to prevent outbreaks of shingles.
The disease has been treated with acyclovir, taken five times
daily, or given intravenously in severe cases. Two newer drugs,
famciclovir and galaciclovir, seem to be more effective against
the pain of shingles and need to be taken only three times each
day.
It can be very difficult to deal with the pain of shingles.
A newer treatment is an anesthetic patch that can be applied directly
to the skin.
Revised August 7, 2002
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