A systematic review of viral infections associated with oral involvement in cancer patients: a spotlight on Herpesviridea.
OBJECTIVE
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 radiochemotherapy 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 HSV oral 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.
Elad
Sharon
S
Department of Oral Medicine, Hebrew University, Hadassah School of Dental Medicine, Jerusalem, Israel. sharon.elad@ekmd.huji.ac.il
Zadik
Yehuda
Y
Hewson
Ian
I
Hovan
Allan
A
Correa
M Elvira P
ME
Logan
Richard
R
Elting
Linda S
LS
Spijkervet
Fred K L
FK
Brennan
Michael T
MT
D000998:Antiviral Agents / Q000627:therapeutic use*; D006561:Herpes Simplex / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology; D006566:Herpesviridae Infections / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology; D006801:Humans; D009059:Mouth Diseases / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology; D009369:Neoplasms / Q000628:therapy*; D009503:Neutropenia / Q000209:etiology; D017410:Practice Guidelines as Topic; D011788:Quality of Life; D012307:Risk Factors; D014777:Virus Diseases / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology
D000998:Antiviral Agents