IDSA Recommendations for Preventing and Treating Varicella Zoster Virus (VZV) Infections in HIV-AIDS

Pre-Exposure Prevention of VZV Primary Infection

Indications:

 • Adult and adolescent patients with CD4 count ≥200 cells/mm3 without documentation of vaccination, health-care provider diagnosis or verification of a history of varicella or herpes zoster, laboratory confirmation of disease, or persons who are seronegative for VZV

Vaccination:

 • Primary varicella vaccination (Varivax™), 2 doses (0.5 mL SQ) administered 3 months apart

 • If vaccination results in disease because of vaccine virus, treatment with acyclovir is recommended.

 • VZV-susceptible household contacts of susceptible HIV-infected persons should be vaccinated to prevent potential transmission of VZV to their HIV-infected contacts.

 • If post-exposure VariZIG has been administered, wait at least 5 months before varicella vaccination.

 • If post-exposure acyclovir has been administered, wait at least 3 days before varicella vaccine

Treatment of Varicella Infections

Primary Varicella Infection (Chickenpox)

Uncomplicated Cases - Preferred Therapy:

 • Valacyclovir 1 g PO TID (AII), or

 • Famciclovir 500 mg PO TID (AII)

Alternative Therapy: Acyclovir 800 mg PO 5 times daily (BII)

Duration: 5–7 days 



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