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Human herpesvirus-6 is associated with cytomegalovirus reactivation in liver transplant recipients
1Department of Medicine, Division of Infectious Diseases and Multi-Organ Transplantation, Toronto General Hospital-University Health Network, Toronto, Ontario M5G 2C4, Canada. Atul.Humar@uhn.on.ca
Abstract:
Human herpesvirus-6 (HHV-6) may be a risk factor for cytomegalovirus (CMV) disease in posttransplant patients, possibly through a direct interaction or through a general immunomodulatory effect. To examine this possibility, 88 liver transplant recipients were monitored with serial HHV-6 polymerase chain reaction (PCR), CMV antigenemia, and CMV plasma viral load. HHV-6 infection was defined by a positive PCR of peripheral blood lymphocytes. Forty-eight (54.4%) of 88 patients had at least 1 positive HHV-6 PCR. CMV recurrence was significantly more common in patients with HHV-6 infection (38/48 patients [79. 2%]), compared with recurrence in those without HHV-6 infection (18/40 patients [45%]; P=.001). Peak CMV viral load was 24, 147+/-6799 copies/mL in patients with HHV-6 infection versus 8391+/-4598 copies/mL in patients without HHV-6 infection (P=.001). Symptomatic CMV disease was more common in patients with HHV-6 infection than it was in those without infection (15/48 patients [31. 3%] vs. 4/10 patients [10.0%]; P=.013). In a multivariate analysis including other risk factors for CMV, HHV-6 infection remained an independent risk factor for CMV disease (P=.013; odds ratio, 7.26; 95% confidence interval, 1.52-34.72). HHV-6 is associated with CMV infection and disease, thus supporting an interaction between these viruses.
Insights
Human herpesvirus-6 (HHV-6) infection is linked to a higher risk of cytomegalovirus (CMV) disease in liver transplant patients. This association suggests a significant interaction between these common post-transplant viral infections.
Area of Science:
- Virology
- Immunology
- Transplant Medicine
Background:
- Human herpesvirus-6 (HHV-6) and cytomegalovirus (CMV) are common viral infections in post-transplant patients.
- HHV-6 may influence CMV disease risk through direct interaction or immunomodulation.
Purpose of the Study:
- To investigate the association between HHV-6 infection and CMV disease in liver transplant recipients.
- To determine if HHV-6 is an independent risk factor for CMV infection and disease post-transplantation.
Main Methods:
- Prospective monitoring of 88 liver transplant recipients.
- Serial polymerase chain reaction (PCR) for HHV-6 detection in peripheral blood lymphocytes.
- Monitoring of CMV antigenemia and plasma viral load.
Main Results:
- HHV-6 infection was detected in 54.4% of patients.
- CMV recurrence was significantly higher in patients with HHV-6 (79.2%) versus without (45%).
- HHV-6 positive patients had higher peak CMV viral loads and increased symptomatic CMV disease.
Conclusions:
- HHV-6 infection is significantly associated with CMV infection and disease in liver transplant recipients.
- HHV-6 is an independent risk factor for CMV disease post-transplantation.
- Findings support an interaction between HHV-6 and CMV in this patient population.