677. Natural History of Herpes Zoster and Zoster-Related Pain: An Observational, Prospective Study in the Era of Antivirals
Session: Abstracts: Virology
Friday, October 22, 2010
Background: Herpes zoster (HZ) and zoster-related pain may have an important impact on quality of life (QoL). This study aims to describe the natural history of HZ presenting at general practice in the era of antiviral treatment, and impact of HZ and zoster-related pain on daily life as perceived by the patient.

Methods: This longitudinal, prospective, multicenter observational study followed for 12 months subjects aged ≥50 years with acute HZ consulting a general practitioner in France. Zoster-related pain and its impact on health related QoL were assessed at regular intervals over 12 months by telephone interview of patients using comprehensive, validated questionnaires. The general practitioner was contacted by telephone at 3, 6 and 12 months, and details of persistent zoster-related pain, clinical pathway and any treatment prescribed were obtained.

Results: Of 1358 patients included, 1032 completed follow-up (mean age 67.7 years; 62% female). The average time between appearance of rash and diagnosis of HZ was 2.6 days. The start of antivirals was considered to be the day of diagnosis (day 0). Most patients (94.1%) received antiviral drugs, 77% within 72 hours of rash onset. The prevalence of zoster-related pain at day 0, and 3, 6, and 12 months was 79.6%, 11.6%, 8.5%, and 6.6%, respectively. Prevalence of zoster-related pain was inversely correlated with delay of diagnosis: on day 15, 50.6% of patients had pain if diagnosis was done ≤1 day after rash onset, 33.3% if > 3 days; at 6 months, 11.6% had pain if diagnosis ≤1 day, 7.5% if > 3 days. Patients with persistent pain had lower scores on the physical and mental component summaries of the SF-12 (QoL score) and the ZBPI interference on activities of daily living score than those without pain.

Conclusion: Even with prompt diagnosis and antivirals, many patients will still experience persistent pain, which may markedly impact QoL. Consultation early in the disease course may predict severity and persistent pain.


Subject Category: J. Medical practice management

Speakers:
Jacques Gaillat , CHR Annecy, Annecy, France
Olivier Chassany , Hôpital Saint-Louis, Paris, France
Sohela El Kebir , REGISTRAT-MAPI, Lyon, France
Thomas Hanslik , Hôpital Ambroise Paré, Boulogne Billancourt, France
Odile Launay, MD, PhD , CIC de Vaccinologie Cochin-Pasteur, Université Paris Descartes, Paris, France
Claude Mann , Hôpital Saint-Eloi, Montpellier, France
Christian Rabaud , CHU de Nancy – Hôpitaux de Brabois, Nancy, France
Olivier Rogeaux , CH de Chambéry, Chambéry, France
Christophe Strady, MD-PHD , CHU Reims, Reims, France
Didier Bouhassira , Hôpital Ambroise Paré, Boulogne Billancourt, France

Disclosures:

J. Gaillat, None

O. Chassany, None

S. El Kebir, None

T. Hanslik, None

O. Launay, None

C. Mann, None

C. Rabaud, None

O. Rogeaux, None

C. Strady, None

D. Bouhassira, None

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