Another placebo-controlled RCT with acyclovir, published after this meta-analysis, also did not demonstrate a statistically significant effect on pain reduction after 1 month. Pain relief was seen at most a few days earlier. From the separate studies, however, it appeared that the effect of acyclovir on the duration of acute pain did reach statistical significance in a few instances. Because the various studies used measurement methods that could not be compared, no overall effect on the duration of acute pain could be established. 10 A subanalysis (4 studies 11 – 14 comprising 692 patients) showed that acyclovir (800 mg 5 times daily for 7–10 days) had no statistically significant effect on acute pain after 1 month (pooled odds ratio 0.83, 95% confidence interval 0.58 to 1.21). Most of the placebo-controlled RCTs of antiviral therapy were summarized in a meta-analysis. The aim of this article is to review the evidence regarding treatment of immunocompetent HZ patients, focusing on short-term as well as on long-term (prevention of PHN) effects. 9 Although PHN can disappear after a few months, it can also develop into a lasting persistent pain syndrome.Ī recent double-blind placebo-controlled trial showed that vaccination of immunocompetent persons 60 years of age and older with an investigational live attenuated zoster vaccine markedly decreased HZ morbidity and PHN incidence. 7, 8 A large prospective study identified 4 independent predictors of PHN: older age, severe acute pain, severe rash, and a shorter duration of rash before consultation. 5, 6 Sometimes, however, a period of 3 months is applied. Postherpetic neuralgia is usually defined as pain in the involved dermatome that is still present 1 month after rash onset.
The main complications of HZ include postherpetic neuralgia (PHN) and ophthalmic problems, the latter in cases of ophthalmic HZ. As it has not yet been proven that HZ is provoked by any serious underlying pathologic condition (eg, malignancy), 4 a search for possible risk factors is not warranted in otherwise healthy patients in whom HZ develops. Immunocompromised patients are also at increased risk of developing HZ. 1 – 3 As reactivation of the virus is linked to an age-related diminished virus-specific and cell-mediated immunity, HZ develops mainly in elderly people. The reported incidence varies from 2.2 to 3.
Herpes zoster (HZ), also known as shingles, is the secondary manifestation of an earlier infection with the varicellazoster virus in one or more dermatomes.
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