Aciclovir and valaciclovir in the prevention and treatment of herpes simplex virus in patients being treated for cancer

Evidence Summaries

Level of Evidence = A

Aciclovir and valaciclovir are efficacious in the prevention and treatment of herpes simplex virus infections in patients being treated for cancer.

A Cochrane review 1 included 17 studies. Only one of the trials included patients with solid tumours the remainder recruiting patients with haematological malignancies. Four trials evaluated preventative interventions for HSV lesions, three trials for viral isolates, and eight trials evaluated both outcome measures. A single trial reported on the cost of prophylaxis for HSV. Two trials evaluating treatment reported on time to healing, duration of viral shedding and relief of pain. No trials reported on duration of hospital stay, amount of analgesia or patient quality of life.

In placebo controlled trials, aciclovir was found to be effective for the prevention of HSV infections as measured by oral lesions or viral isolates (RR = 0.16, 95% CI 0.08 to 0.31, 9 trials; RR = 0.17, 95% CI 0.07 to 0.37, 9 trials). There is no evidence that valaciclovir is more efficacious than aciclovir, or that higher doses of valaciclovir are more effective than lower doses. Aciclovir was also found to be effective for the treatment of HSV in terms of duration of viral shedding (median of 2.5 days versus 17.0 days, P = 0.0002; 2 days compared to more than 9, P = 0.0008), time to first decrease in pain (median 3 days compared to 16, P = 0.04), complete resolution of pain (9.9 days compared to 13.6 days, P = 0.01; median of 6 days compared to 16, P = 0.05), 50% healing (median of 6 days compared to 11, P = 0.01) and total healing (median 13.9 days compared to 20.7 days, P = 0.08; median of 8 days compared to 21, P = 0.0).

References

1. Glenny AM, Fernandez Mauleffinch LM, Pavitt S, Walsh T. Interventions for the prevention and treatment of herpes simplex virus in patients being treated for cancer. Cochrane Database Syst Rev 2009 Jan 21;(1):CD006706.  [PMID:19160295]


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