Frequent recurrence and persistence varicella-zoster virus infections in children infected with human immunodeficiency virus type 1 of L. von Seidlein, MD, S. G. Gillette, RN, Y. Bryson, MD, T. Frederick, PhD, L. Mascola, MD, J. Church, MD, P. Brunell, MD, Aù Kovacs, MD, A. Deveikis, MD, and M. Keller, MD From the Departments of Pediatrics, University of California at Los Angeles, Childrens Hos- pital LosAngeles, Cedars SinaiHospitalof LosAngeles, and LosAngeles County Hospitaland Universityof Southern California; the Department of Health Servicesof LosAngeles County, LosAngeles, California; the Department of Pediatrics, Millers Children Hospital, Long Beach, California; and the Department of Pediatrics, Harbor-University of California at LosAngeles Medical Center, Torrance, California Objective:To examine complications and treatment of varicella-zoster virus (VZV) infections in children infected with human immunodeficiency virus type I (HIV- I). Methods: Cases of VZV infection were identified retrospectively by reports to the department of health services and review of medical charts. The CD4 ÷ ceU counts were correlated with severity and frequency of VZV episodes. Results: We identified 117 episodes of VZV infection in 73 HIV-1-infected children between Aug. 21, 1986, and Dec. I, 1993. The most common complications were recurrence and persistence; 38 children (53%) had 69 recurrent episodes of VZV infection. The majority of cNldren (61%) had zoster during the first recurrent epi- sode, and 32% had a disseminated eruption typical of varicella. There was a strong association between an increasing number of episodes of VZV infection and Iow CD4 ÷ cell count (p = 0.0008). In a subgroup followed for at least 2 years after their primary varicella episode, 10 of 22 children had a recurrence. Persistence of VZV infection was documented in 10 of 73 children, whereas other complications were rare. Thirty-three children (45%) were hospitalized and received acyclovir intra- venously. Conclusion: Primary, recurrent, and persistent VZV infections area frequent cause of morbidity and hospitalization for HIV-1-infected children. Studies of improved preventive and therapeutic agents are urgently needed in this population. (J PE- DIATR1996;128:52-7) Varicella is usually a self-limited disease in immunocompe- tent children. With the emergence of human immunodefi- Presented in part at the 34th Interscience Conference on Antimi- crobial Agents and Chemotherapy, October 1994, Orlando, Fla. Submitted for publication May 16, 1995; accepted Aug. 15, 1995. Reprintrequests: Margaret A.Keller,MD, Departmentof Pediatrics, Harbor-UCLA Medical Center, Box 468, Building J4, 1000 West Carson St., PO Box 2910, Torrance, CA 90509-2910. Copyright © 1996 by Mosby-Year Book, Inc. 0022-3476/96/$5.00 + 0 9/20/68595 ciency virus infections in children, a large number of immu- nodeficient children are susceptible to VZV infections. Complications of VZV infections in HIV-infected children I HIV HIV-1 VZV Human immunodeficiency virus Human immunodeficiency virus type 1 VariceUa-zoster virus were reported as early as 1988,1 including recurrence, per- sistence, dissemination, and bacterial infections. 28 We identified 73 HIV-infected children with episodes of 52