A patient with HIV (CD4 count 60 cells/μL) develops a painful vesicular rash over the T5-T7 dermatome on the right side. Cranial nerve involvement is NOT present. The MOST appropriate antiviral treatment is:

• A Topical acyclovir cream applied 5 times daily for 7 days
• B Oral valacyclovir 1 g three times daily for 7 days
• C Famciclovir 250 mg twice daily; no difference between oral and IV in HIV patients
• D IV acyclovir 10 mg/kg every 8 hours for 7–14 days due to immunocompromised status ✓

Explanation

Herpes zoster in significantly immunocompromised patients (HIV with CD4 <200 cells/μL) carries high risk of visceral dissemination and encephalitis; IV acyclovir (10 mg/kg every 8 hours, adjusted for renal function) for 7–14 days is the standard of care regardless of dermatomal limitation. Oral antivirals (valacyclovir, famciclovir) are appropriate for immunocompetent individuals. Topical acyclovir has no systemic bioavailability and is not appropriate for herpes zoster management.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.