<prompt> Which may be the first indication of clinical immunodeficiency in HIV infected patients?VitiligoHairy LeukoplakiaLupus vulagrisHerpes Zoster  <response>: Reactivation syndrome of varicella-zoster virus indicates a modest decline in immune function and may be the first indication of clinical immunodeficiency. Reactivation of herpes zoster shingles is seen in 10-20 of patients with HIV infection. Valacyclovir, acyclovir, or famciclovir is the TOC. Foscarnet may be of value in patients with acyclovir-resistant virus. 