Why Shingles May Be a First Sign of HIV

Research indicates that shingles may actually be an early sign of human immunodeficiency virus (HIV). HIV is also associated with a more severe case of shingles, in addition to other complications like long-lasting pain. In this article, we'll discuss the connection between HIV and shingles.

A person gets an HIV blood test on their finger from a gloved healthcare provider

Alex Levine / Getty Images

What Is Shingles?

Shingles, also known as herpes zoster, is a condition that develops in people who have had chickenpox. After someone gets chickenpox, typically during childhood, the virus lies dormant in the nerves. Later on, the virus can reactivate and cause shingles.

Shingles may indicate a weakened immune system since the body can usually keep the virus from reactivating. Thus, the fact that it is triggered at all may be a sign of a weakened immune system response.

Sometimes shingles can also lead to herpes zoster ophthalmicus (HZO). This occurs when varicella-zoster is reactivated in the nerves in the eye area. Up to 25% of people with herpes zoster will develop HZO. However, people with HIV have the greatest risk of developing HZO compared with the general population.

Symptoms of Shingles

Shingles is marked by a painful, itchy rash that develops on one side of the face and body. It usually occurs in a single stripe. Prior to the development of the rash, many of the people who get shingles will have itching, pain, or tingling in the area where the rash will later appear.

Besides a rash, some other symptoms associated with shingles include:

  • Fever
  • Headache
  • Chills
  • Upset stomach

The shingles rash is made up of blisters that will most likely scab over within seven to 10 days, fully clearing up within two to four weeks.

What Is the Connection to HIV?

People with HIV have been found to have higher rates of shingles than the general population. They are also at risk of experiencing complications as a result of shingles.

HIV targets the immune system by depleting it of its CD4 T lymphocytes (CD4 cells). CD4 cells are lymphocytes, a type of white blood cell (WBC) that helps the body fight off infections.

While shingles can be triggered in adults with HIV at any CD4 count, the risk of infection is higher in people with lowered CD4 counts, as in less that 200 cells per cubic millimeter of blood (cells/mm3). Lowered CD4 counts are linked to untreated HIV and stage 3, or advanced, HIV. This is why shingles may indicate HIV since untreated HIV and stage 3 HIV are associated with a higher chance of developing shingles.

A person with a compromised immune system is more susceptible to getting shingles. This includes people with untreated HIV and stage 3 HIV. This may have to do with depleted levels of CD4 cells, meaning the body is more vulnerable to infection.

Risk of Complications

People with HIV are more at risk of shingles-related complications. These may include:

  • More severe, prolonged illness
  • Disseminated zoster (spread-out rash)
  • Postherpetic neuralgia (lasting pain after infection)
  • Recurrent cases of shingles
  • Encephalitis (extremely rare)

Certain factors will further increase your risk of developing complications from shingles if you have HIV. These include:

  • You're not receiving HIV treatment.
  • You're early into HIV treatment.
  • You have a stage 3 HIV infection.


People with HIV who get shingles typically need specific treatment. In some cases, hospitalization may be necessary. As far as specific therapies go, the following are recommended for people with HIV and shingles:

  • Acyclovir
  • Valacyclovir
  • Famciclovir

If someone has acyclovir-resistant shingles, Foscarnet administered intravenously (IV), through a vein, is effective.

When it comes to the varicella vaccine, it can be given to people who have HIV and CD4 cell counts of greater than 200 cells/µL, even though there is a theoretical risk of live virus vaccination in this population. Although it should be noted that a live vaccine to prevent the reactivation of the varicella-zoster virus is not recommended for immunocompromised patients, including people with HIV.

However, there is a new, recombinant non-live virus sub-unit herpes zoster vaccine known as Shingrix. This particular vaccine is recommended for all people living with HIV over the age of 50, with CD4 counts greater than 200 cells/mm3 without concern for reactivation from a live virus vaccine. Whether this vaccine should be used for those with CD4 less than 200 cells/µL is still under review.

When to See Your Doctor

To avoid complications, see your doctor immediately if you have HIV and suspect shingles.

Immune Reconstitution Inflammatory Syndrome (IRIS)

At times, shingles flares up after people with HIV start treatment. This is due to a mechanism called immune reconstitution inflammatory syndrome, or IRIS. IRIS is a state of a hyperinflammatory response, a complication as a result of antiretroviral therapy (ART), and usually happens within the first six months of treatment.

If someone develops shingles shortly after beginning treatment for HIV, this may show that the immune system is responding to treatment by targeting specific viruses and bacteria in the body. This is known as immune restoration syndrome. If you suspect shingles after starting ART, talk to your doctor immediately to lower your chances of developing shingles-related complications.

A Word From Verywell 

Shingles is a common condition marked by a painful, itchy rash, typically on the torso. Shingles points to a weakened immune system. It has also been linked as a potential early sign of HIV.

Those with HIV are more prone to developing shingles, as well as experiencing shingles-related complications. This is especially true for those with untreated HIV, in early treatment for HIV, and with stage 3 HIV. However, people without any particular immunocompromising condition can also get shingles. See your doctor immediately if you have HIV and suspect shingles to avoid complications. Quick, effective treatment is vital to controlling the course of shingles.

7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. Ubani U. Herpes-zoster virus ophthalmicus as presenting sign of HIV diseaseJournal of Optometry. 2011;4(4):117-121. doi:10.1016/S1888-4296(11)70052-8

  3. Centers for Disease Control and Prevention. Shingles (herpes zoster): Signs & symptoms.

  4. Blank LJ, Polydefkis MJ, Moore RD, Gebo KA. Herpes zoster among persons living with HIV in the current antiretroviral therapy eraJAIDS Journal of Acquired Immune Deficiency Syndromes. 2012;61(2):203-207. doi:10.1097/QAI.0b013e318266cd3c

  5. HIV.info.NIH.gov. HIV Treatment.

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  7. Centers for Disease Control and Prevention. What Everyone Should Know about the Shingles Vaccine (Shingrix).

By Molly Burford
Molly Burford is a mental health advocate and wellness book author with almost 10 years of experience in digital media.