Influence of Ganciclovir Prophylaxis on Citomegalovirus, Human Herpesvirus 6, and Human Herpesvirus 7 Viremia in Renal Transplant Recipients

Galarraga, M.; Gómez, E.; Oña, Marı́a de; Rodríguez, Azucena; Laurés, A Suárez; Boga, José Antonio; Melón, Santiago

doi:10.1016/j.transproceed.2005.03.123

Cited by 33 publications

(14 citation statements)

References 11 publications

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“…These findings are consistent with in vitro data suggesting that HHV‐6 and HHV‐7 replication are inhibited by foscarnet and ganciclovir but not by acyclovir [Agut et al, 1991; Black et al, 1997]. Of note, Brennan et al [2000] and Galarraga et al [2005] reported that ganciclovir prophylaxis for HCMV did not affect HHV‐6 or HHV‐7 viremia. Regarding HHV‐6, this finding differs from data obtained by Razonable et al [2005] in a study that focused on 263 solid‐organ transplant recipients (kidney, kidney–pancreas, lung, or heart).…”

Section: Discussionsupporting

confidence: 85%

“…Interestingly, HHV‐6 detection was more frequent in end‐stage renal disease patients than in healthy subjects, probably reflecting a state of immunosuppression due to dialysis. Confirming the results of previous studies, HHV‐6 detection was more frequent in patients after grafting than in healthy subjects, and HHV‐6 was reactivated in 68% of the transplant recipients during the 6‐month period following transplantation [DesJardin et al, 1998; Galarraga et al, 2005]. The behavior of HHV‐7 was paradoxical because the rate of detection was similar between healthy subjects and kidney recipients, whereas the viral loads were higher in healthy subjects.…”

Section: Discussionsupporting

confidence: 85%

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Confirmation of the low clinical effect of human herpesvirus‐6 and ‐7 infections after renal transplantation

Caïola¹,

Karras

Flandre

et al. 2012

Journal of Medical Virology

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Human herpesvirus-6 and -7 (HHV-6 and HHV-7) may lead to pathological manifestations in renal transplant recipients. The aim of this study was to investigate beta-herpesvirus infections in 50 adult kidney transplant recipients after transplantation to examine the effect, interactions, and pathogenic consequences of infection and the effect of immunosuppressive regimens and Human cytomegalovirus (HCMV) prophylaxis with VACV. Beta-herpesviruses loads in the blood of 50 adult kidney transplant recipients over a 6-month period after transplantation and 198 blood donors were determined using polymerase chain reaction. The rate of HHV-6 detection in peripheral mononuclear cells (PBMCs) was higher in patients with end-stage renal disease and during the posttransplantation follow-up than in healthy subjects (33% and 68% vs. 12%, respectively). The detection rate of HHV-7 in PBMCs was similar between patients, both before grafting and during the follow-up for transplant recipients (69% and 88%, respectively), and healthy subjects (78%), and correlated with the number of lymphocytes. HCMV in plasma was detected only in patients during the post-transplant period (24%). VACV prophylaxis had no negative effect on the replication of HHV-6 or HHV-7, and univariate analyses demonstrated associations between HHV-6 infection and acute graft rejection [Odds ratio (OR) ¼ 2.94, 95% confidence interval (CI), 1.05-8.2, P ¼ 0.04], and between HHV-7 infection and cholestasis [OR ¼ 2.61 (95% CI, 1.08-6.3), P ¼ 0.03]. Immunosuppressive regimens had no effect on beta-herpesviruses infections. This study revealed the differing behavior of HCMV, HHV-6, and HHV-7 in kidney transplant recipients, and confirmed the association of HHV-6 with graft rejection.J. Med. Virol. 84:450-456, 2012. KEY WORDS: human herpesvirus-6; human herpesvirus-7; human cytomegalovirus; viral load; renal transplantation; graft rejection; antiviral prophylaxis; immunosuppressive regimen INTRODUCTIONHuman herpesvirus-6 and -7 (HHV-6 and HHV-7) are related to the human cytomegalovirus (HCMV) [Lawrence et al., 1990]. After primary infection, which Abbreviations: HCMV, human cytomegalovirus; HHV-6, human herpesvirus-6; HHV-7, human herpesvirus-7; CNS, central nervous system; EqCop, number of viral genomic equivalent copies; PBMCs, peripheral blood mononuclear cells; VACV, valacyclovir. is primarily asymptomatic or associated with febrile illnesses including exanthema subitum, HHV-6 and HHV-7 remain latent in a majority of adults [Yamanishi et al., 1988;Hidaka et al., 1994]. In some cases, primary infection with HHV-6 may lead to serious illnesses, particularly meningoencephalitis and hepatitis [Asano et al., 1990;Yoshikawa and Asano, 2000]. HHV-6 reactivation may lead to pathological complications, particularly in immunocompromised individuals, whereas HHV-7 exhibits no opportunistic behavior [Boutolleau et al., 2003]. Thus, in solid-organ transplant recipients, the reactivation of HHV-6 is frequent and usually asymptomatic. However, clinical complications may occur, inclu...

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Section: Discussionsupporting

confidence: 85%

Section: Discussionsupporting

confidence: 85%

Confirmation of the low clinical effect of human herpesvirus‐6 and ‐7 infections after renal transplantation

Caïola¹,

Karras

Flandre

et al. 2012

Journal of Medical Virology

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“…In 2 studies of HHV‐6 prophylaxis in allogeneic stem cell transplant recipients, one retrospective analysis found a benefit from ganciclovir over placebo, and a second small prospective trial found that ganciclovir was superior to acyclovir 10, 11. Among renal transplant recipients, CMV prophylaxis with ganciclovir was associated with delayed appearance and shorter duration of detectable HHV‐6 DNA, but it had no effect on the overall incidence during the first 3 months post‐transplantation 12. It is likely that the choice of acyclovir for CMV prophylaxis in our patient increased the risk for HHV‐6 disease.…”

Section: Discussionmentioning

confidence: 99%

A report of human herpesvirus 6-associated encephalitis in a solid organ transplant recipient and a review of previously published cases

et al. 2009

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Human herpesvirus 6 (HHV-6) is a common pathogen among children, classically presenting as fever and rash that resolve without specific therapy (exanthem subitum or roseola infantum). Also identified as a pathogen in hematopoietic cell transplant and solid organ transplant (SOT) recipients, it has been recognized as a cause of limbic encephalitis, characterized by confusion and amnesia, with magnetic resonance imaging findings of T2 hyperintensity of the amygdala and hippocampus. We report a case of limbic encephalitis associated with HHV-6 infection in a liver transplant recipient, and we review previously reported cases of HHV-6 encephalitis in SOT recipients.

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“…The use of prophylactic ganciclovir in HCT and SOT patients can reduce HHV-6B reactivation [40,64] and may reduce associated morbidity in high-risk patients [65,66], but large scale adoption is limited by ganciclovir-induced myelosuppression. The use of low dose foscarnet for 10 days post-engraftment to prevent HHV-6B reactivation was recently explored in a retrospective cohort study of 118 allogeneic HCT recipients (unrelated or cord blood donors) [67 •• ].…”

Section: Treatmentmentioning

confidence: 99%

Roseoloviruses in transplant recipients: clinical consequences and prospects for treatment and prevention trials

Hill

Zerr

2014

Current Opinion in Virology

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Roseoloviruses frequently reactivate in transplant recipients. We review the impact of Roseoloviruses in transplant recipients and highlight research priorities. Human herpesvirus 6A (HHV-6A) and HHV-6B were recently classified as distinct species with important differences. Both viruses can result in inherited chromosomally integrated HHV-6, which may cause complications after transplant. HHV-6B is the primary species associated with disease and appears to have pleiotropic effects on the central nervous system. Small preemptive and prophylactic studies have not shown a statistically significant impact on HHV-6 disease. Although Roseoloviruses are associated with diverse complications in transplant patients, studies providing strong evidence for a causal role are lacking. Trials focusing on prevention and treatment will be important to inform the significance of Roseolovirus reactivation.

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Influence of Ganciclovir Prophylaxis on Citomegalovirus, Human Herpesvirus 6, and Human Herpesvirus 7 Viremia in Renal Transplant Recipients

Cited by 33 publications

References 11 publications

Confirmation of the low clinical effect of human herpesvirus‐6 and ‐7 infections after renal transplantation

Confirmation of the low clinical effect of human herpesvirus‐6 and ‐7 infections after renal transplantation

A report of human herpesvirus 6-associated encephalitis in a solid organ transplant recipient and a review of previously published cases

Roseoloviruses in transplant recipients: clinical consequences and prospects for treatment and prevention trials

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