Epidemic zoster and AIDS.

10. van Ripper III C, Van Ripper SG, Lee Goff M, Laird M. The epizootiology and ecological significance of malaria in Hawaiian land birds. Ecological Monographs 1986;56:127-44. 11. Buisson GPE. Les îles Marquises et les Marquisiens. Annales d’Hygiène et de Médecine Coloniales 1903;6:535-59. 12. Halstead SB. Pathogenesis of Dengue: challenge to molecular biology. Science 1988;239:476-81. 13. Turner TB. Studies on the relationship between yaws and syphilis. American Journal of Hygiene 1937;25:477-506. 14. Garenne M, Aaby P. J Infect Dis 1990;161:1088. 15. Rollin L. Moeurs et coutumes des anciens Maoris des îles Marquises. Papeete: Stepolde, 1974. 16. Hanson A. Rapa, une île polynésienne hier et aujourd’hui. Paris: Publications de la Société des Océanistes, 1973. 17. Vallaux F. Mangareva et les Gambier. Papeete: Etablissement Territorial d’Achats Groupés, 1994. gested by reports from Africa (2). For over 150 years, it was believed that zoster occurred in local epidemics (3,4). By the 1950s, however, it was generally agreed that zoster represented reactivation of latent gangliar varicella virus either sporadically, or in response to immunosuppression or trauma. Epidemics of “endogenous” immunosuppression, such as those associated with epidemic HIV infection, might thus be expected to produce outbreaks of zoster, as seems to have occurred in Manipur and Vietnam. In the Indian outbreak traumatic zoster seemed unlikely: truncal and facial dermatomes predominated, rather than dermatomes corresponding to drug injection sites (usually the hands or legs). Recognition of zoster outbreaks may be important in developing countries where HIV diagnosis is limited, CD4 cell counts are unavailable, and diagnosis of AIDS is delayed. Zoster is not currently accepted as an AIDS-defining condition (5), and the extent to which it may reflect immune collapse or predict HIV disease progression is uncertain. Nevertheless, greater awareness of zoster as a sentinel indicator of community HIV transmission may be of help not only in clinical diagnosis, but also in public health efforts to recognize epidemic HIV occurrence.