Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology
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Impairment of varicella zoster virus (VZV)-specific cell-mediated immunity, including impairment due to immunosenescence, is associated with an increased risk of developing herpes zoster (HZ), whereas levels of anti-VZV antibodies do not correlate with HZ risk. This crucial role of VZV-specific cell-mediated immunity suggests that boosting these responses by vaccination will be an effective strategy for reducing the burden of HZ. Other strategies focus on preventing the major complication of HZ--post-herpetic neuralgia. These strategies include pre-emptive treatment with drugs such as tricyclic antidepressants, anticonvulsants and analgesics.
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Herpes zoster (HZ; shingles)--a reactivation of the latent varicella zoster virus (VZV)--can cause significant morbidity. Its major complication is pain, particularly post-herpetic neuralgia (PHN). ⋯ New molecules in development that show improved activity against VZV are also covered, and new drug targets are outlined. The role of translational neuroscience in moving towards a goal of finding disease-modifying treatments will be examined.
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Herpes zoster (HZ) is a common condition that affects all age groups and both immunocompetent and immunocompromised individuals. However, it mainly impacts elderly and immunocompromised people and is associated with important and sometimes permanent detriment to quality of life and activities of daily living. ⋯ Despite increasing knowledge of the pathology causing PHN, the management modalities for acute HZ pain and PHN remain inadequate. Public, and probably physician, understanding of HZ and its complications is poor, potentially leading to low utilisation of HZ vaccination and delayed presentation for treatment.
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Oseltamivir is considered the drug of choice for patients with pandemic influenza for whom drug treatment is recommended because adamantanes seem to be ineffective against pandemic A/H1N1 influenza virus and zanamivir is contraindicated in people with underlying respiratory conditions and difficult to administer in younger children. ⋯ The emergence of oseltamivir-resistant strains is related to the administration of the drug, supporting the restriction of oseltamivir use to carefully defined high-risk groups. Infection due to pandemic virus with the H275Y mutation can be associated with a severe clinical course, supporting the systematic monitoring of antiviral susceptibility in pandemic influenza-positive high-risk patients whose influenza is not resolved by oseltamivir treatment. Zanamivir inhalation can be successfully used in patients with cystic fibrosis without causing adverse respiratory events, highlighting that the risks and benefits of this drug must be considered on a patient by patient basis.