A systematic review of viral infections associated with oral involvement in cancer patients: A spotlight on Herpesviridea

Sharon Elad*, Yehuda Zadik, Ian Hewson, Allan Hovan, M. Elvira P. Correa, Richard Logan, Linda S. Elting, Fred K.L. Spijkervet, Michael T. Brennan

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

60 Scopus citations


Purpose: Our aim was to evaluate the literature for the prevalence of and interventions for oral viral infections and, based on scientific evidence, point to effective treatment protocols. Quality of life (QOL) and economic impact were assessed if available in the articles reviewed. Methods: Our search of the English literature focused on oral viral infections in cancer patients within the timeframe of 1989-2007. Review methods were standardized. Cohort studies were used to determine the weighted prevalence of oral viral infection in cancer patients. The quality of selected articles were assessed and scored with respect to sources of bias, representativeness, scale validity, and sample size. Interventional studies were utilized to determine management guidelines. Literature search included measures of QOL and economic variables. Results: Prevalence of oral herpes simplex virus (HSV) infection in neutropenic patients was higher than in patients treated with radiotherapy for head and neck cancer (49.8% vs. 0%, respectively). In patients treated with radiochemo-therapy for head and neck cancer, the prevalence of oral HSV infection increases up to 43.2% (CI, 0-100%). Prevalence of HSV infection was higher when oral ulcers existed. Information about other oral viral infections is sparse. There was a significant benefit of using acyclovir to prevent HSVoral infection (at 800 mg/day). Various dosing protocols of valacyclovir achieved prevention of HSV reactivation (500 or 1,000 mg/day). The prevalence of HSV reactivation was similar for acyclovir and valacyclovir. No information about impact on QOL and economic burden was available. Conclusions Acyclovir and valacyclovir are equally effective in preventing oral HSV infection. Neutropenic patients, who were primarily treated for hematological malignancies in the studies reviewed, are at a greater risk for viral infection.

Original languageAmerican English
Pages (from-to)993-1006
Number of pages14
JournalSupportive Care in Cancer
Issue number8
StatePublished - Aug 2010


  • Acyclovir
  • Cancer
  • Complication
  • HSV
  • Herpes
  • Infection
  • Oral
  • Valacyclovir
  • Viral


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