Epstein-Barr Virus, Varicella Zoster Virus, and Human Herpes Viruses-6 and -8

Abstract

Epstein-Barr virus (EBV), varicella zoster virus (VZV), and human herpes viruses-6 (HHV-6) and -8 (HHV-8) present unique management challenges to clinicians who care for patients with cancer. Although latent infection by these organisms is either common (HHV-8, VZV) or essentially ubiquitous (EBV, HHV-6), clinical manifestations vary widely in frequency and severity. Syndromes caused by EBV, VZV, HHV-6, and HHV-8 span from highly contagious infections (e.g., varicella) to monoclonal malignant populations (e.g., endemic Burkitt's lymphoma). Within this broad spectrum are polyclonal cellular proliferations (e.g., Multicentric Castleman's disease) that obscure the traditional boundary between infection and cancer. Despite the availability of acyclovir and related compounds, these Herpes viruses continue to cause significant morbidity and mortality in patients with cancer. Newer therapies that modulate the host immune response, either by vaccination or the infusion of targeted lymphocytes, have generated significant interest and are already available in some centers.