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  • Title: Herpes zoster as an indicator of HIV infection in Africa.
    Author: Dehne KL, Dhlakama DG, Richter C, Mawadza M, McClean D, Huss R.
    Journal: Trop Doct; 1992 Apr; 22(2):68-70. PubMed ID: 1604717.
    Abstract:
    In areas where resources for health information are limited, the incidence of herpes zoster can usefully be monitored as an indicator of HIV infection. A sudden parallel rise of the number of symptomatic HIV cases and herpes zoster cases was observed in a northern district of Zimbabwe. Herpes zoster was made locally reportable. Three years later the incidence of herpes zoster and HIV in the hospital and of herpes zoster in the surrounding rural health centres was analysed. The herpes zoster attack rate and the HIV seropositivity rate of herpes zoster patients resembled those elsewhere in Africa. The distribution of cases of zoster was comparable with that of HIV infection. In 1987, Karoi district in northern Zimbabwe made herpes zoster a reportable disease because of an unusual increase in the number of cases in the district. Health workers at the hospital had seen an increase in the number of patients with HIV associated symptoms between June 1986 and March 1989. Herpes zoster cases rose from 0 to 100 between 1986 and 1987. HIV cases increased from 10 to 300 between 1986 and 1987. By 1988, these numbers increased to 500 and 450, respectively. 89% of herpes zoster cases at the hospital in 1988-89 were HIV positive. About 66% of these HIV positive cases had no sign or symptom of HIV infection other than herpes zoster. The percentage of confirmed HIV cases with a current or previous history of herpes zoster was 15% in 1987, 32% in 1988, and 17% in 1989. The decrease after 1988 was due to hospital staff telling health centers' staff that they no longer needed to refer all herpes zoster cases to the hospital since almost all young herpes zoster cases were HIV positive. Based on a herpes zoster attack rate of 15%, a positive predictive value of 90%, and the cumulative herpes zoster incidence for 1986-89 of 250/1200 inhabitants, the researchers calculated that there were about 1500 HIV positive cases or 12.5% of the total population living in the area. This would bring the number of HIV positive cases in the district to 3600 or 4 times the number who came to the hospital with HIV associated symptoms and were indeed HIV positive. Health workers can monitor expansion of the HIV epidemic in northern Zimbabwe based on the number of herpes zoster cases.
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