Clinical manifestation of HSV-1, HSV-2 or VHZ/HHV-3 in cervical cancer patients after treatment

Treatment of cervical cancer is associated with stress and cellular immune suppression. Our aim was to figure out relationships between reactivation of alpha-herpes virus infection based on clinical manifestation of HSV-1, HSV-2 or VHZ/HHV-3 after receiving anticancer treatment and peripheral blood lymphocyte count in cervical cancer patients. 64 cervical cancer patients (age 24-53) with clinical manifestation of alpha-herpes viruses were included in retrospective analysis. All patients had received anticancer treatment and were followed-up 24 months after the end of the treatment. Patients had pretreatment, one month after treatment and every three month follow-up blood counts (TNL and CD4+ cells) at the year 1st after the treatment and every six month at the year 2nd after the therapy. Baseline TNL were classified as normal (≥1200 cells/mm3) or abnormal (<1200 cells/mm3) as well as CD4+ cells ≥400 cells/mm3 or <400 cells/mm3 respectively. After the initiation of anticancer treatment, the CTCAE Version 5.0 was used to classify the severity of lymphopenia. 36 out of 64 patients had HSV-1 clinical manifestation during the time of observation, most of HSV-1 manifestation was self-limited and resolved within 7-10 days. 16 patients developed clinical signs of HSV-2 reactivation and 12 patients demonstrated herpes zoster clinical features. 60 patients had normal TNL and CD4+ cells before anticancer therapy. Lymphopenia was observed in 52 patients during the follow-up (grade I-II in 35 patients and grade III-IV in 17 patients). Severe lymphopenia was associated with concomitant chemo- and radiation therapy or external beam radiation followed by intracavitary brachytherapy and clinical manifestation of VZ/HHV-3 infection. Reactivation of various herpes viruses can be induced by local trauma or systemic stress during the anticancer therapy. Clinical manifestation of alpha- herpes viruses is associated with lymphopenia- decreased TNL as well as CD4+ cells in our patients.