# Aciclovir prophylaxis against herpes simplex and shingles during cancer treatment

Source: https://onco.cc/protocols/herpes-simplex-and-zoster-antiviral-prophylaxis/  
OnCo record `herpes-simplex-and-zoster-antiviral-prophylaxis` (Protocol). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

The viruses behind cold sores and shingles stay in the body for life and can flare when cancer treatment weakens the immune system. People having intensive leukaemia treatment, a stem cell transplant, or myeloma drugs such as bortezomib are usually given an antiviral tablet, aciclovir or valaciclovir, to prevent this. Most people having ordinary chemotherapy for a solid tumour do not need it.

## Summary

ASCO/IDSA (2018) recommend nucleoside analogue prophylaxis such as aciclovir for HSV-seropositive patients having allogeneic stem cell transplant or leukaemia induction. AGIHO (2022, adults) recommends oral aciclovir 400 mg twice or four times daily against oral HSV disease (AIIr), valaciclovir as an alternative (BI), and intravenous aciclovir 250 mg/m2 three times daily if oral medication is not tolerated (AIIr). Against VZV, oral aciclovir from 400 mg once daily to 400 mg three times daily (AII). Indications: acute leukaemia on intensive chemotherapy, from induction through neutropenia (BIIr); ALL throughout treatment (BI); acute promyelocytic leukaemia on arsenic trioxide, during treatment and 6 months after (BIIr); any proteasome inhibitor-based myeloma regimen, bortezomib strongly (AII); idelalisib (BIII); selected lymphoma and CLL by individual risk. Not generally indicated for VZV in solid tumours (DIII), where 5-year cumulative zoster incidence is about 5%; consider it with long-term corticosteroids (CIIu), continued up to 6 months after steroids stop. Serology is optional because about 90% of adults are HSV-1 and VZV seropositive, so universal prophylaxis is equally appropriate. Recombinant (non-live) zoster vaccine is recommended, with aciclovir still added in high-risk groups until comparative data exist; live zoster vaccine is contraindicated. All three nucleoside analogues need dose adjustment in renal impairment. Brivudin is contraindicated with fluoropyrimidines.

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: acyclovir prophylaxis; aciclovir prophylaxis; valaciclovir prophylaxis; HSV prophylaxis; VZV prophylaxis; shingles prevention bortezomib; herpes zoster prophylaxis
- Tags: protocol; antiviral-prophylaxis; infection-prevention

## Connected records

- terms: [Infection prophylaxis in lymphoma: PJP, herpes, fungal risk and vaccination](https://onco.cc/terms/lymphoma-tx-pjp-and-infection-prophylaxis/)
- cancers: [Acute lymphoblastic leukaemia](https://onco.cc/cancers/all-leukemia/), [Acute myeloid leukaemia](https://onco.cc/cancers/aml/), [Chronic lymphocytic leukaemia](https://onco.cc/cancers/cll/), [Multiple myeloma](https://onco.cc/cancers/multiple-myeloma/)
- fronts: [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- technologies: [Allogeneic stem cell transplantation](https://onco.cc/technologies/allogeneic-hsct/), [Autologous stem cell transplant (high-dose therapy)](https://onco.cc/technologies/autologous-stem-cell-transplant/)
- drugs: [Bortezomib](https://onco.cc/drugs/bortezomib/), [Idelalisib](https://onco.cc/drugs/idelalisib/)
- institutions: [American Society of Clinical Oncology (ASCO)](https://onco.cc/institutions/asco/)

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