Human polyomaviruses, BK virus (BKV) and JC virus (JCV), are world widely distributed in human population. After primary infection, BKV and JCV establish latency in kidneys and upper part of urinary tract. In seropositive healthy individuals asymptomatic reactivation of both viruses occurs in in 0.5-20%. On the other hand, reactivation of these viruses in imunosuppressed patients, primarily in patients with T cell immunodeficiency, can lead to development of polyomavirus-associated diseases. Some of these diseases such as progressive multifocal leukoencephalopathy (PML), polyomavirusinduced nephropathy (PVN), hemorrhagic cystitis (HC) are life-threatening diseases with high mortality and morbidity rate.However, they do not affect all immunosuppressed patients, suggesting that other factors, such as genetic variability of BKV and JCV, can contribute to their occurrence.Immunosuppression leads to increased levels of replication of both viruses. Increased levels of replication are associated with higher incidence of mutations in the VP1 gene. Mutations, especially those located in outer loops, may lead to changed tropism and generation of more aggressive variants of BKV and JCV. This review is focused on clinical significance of BK and JC virus infection in immunosuppressed patients, especially in HIV-infected, and sequence changes in the VP1 gene that can contribute to selection of more virulent variants of BKV and JCV via adaptive evolution.
Key words: BKV, JCV, HIV, mutations, VP1
SažetakHumani poliomavirusi, BK virus (BKV) i JC virus (JCV), su široko raspostranjeni u humanoj populaciji. Posle primarne infekcije, BKV i JCV uspostavljaju latenciju u bubrezima i u gornjim partijama urinarnog trakta. Sporadična asimptomatska reaktivacija oba virusa se dešava kod 0.5-20% imunokompetetnih seropozitivnih osoba. S druge strane, reaktivacija kod imunosuprimiranih pacijenata, pre svega kod onih sa T ćelijskom imunodeficijencijom, može dovesti od nastanka poliomavirus-udruženih oboljenja. Neka od ovih oboljenja poput progresivne multifoklane leukoencefalopatije (PML), poliomavirus-udružene nefropatije (PVN), hemoragijskog cistitisa (HC) su životno ugrožavajuća sa visokim stepenom mortaliteta i morbiditeta.Međutim, ova oboljenja ne nastaju kod svih imunosuprimiranih osoba, ukazujući da i neki drugi faktori, poput genetičke varijabilnosti BKV i JCV mogu doprineti njihovom nastanku.Imunosupresija dovodi do povećanja nivoa virusne replikacije. Povećan nivo replikacije je povezan sa češćom pojavom mutacija u VP1 genu i ove mutacije, posebno one locirane u spoljašnjim domenima, mogu dovesi do izmene tropizma i stvaranju novih agresivnijih varijanti BKV i JCV. Akcenat u ovom revijskom radu je stavljen na klinički značaj BK i JC virusne infekcije kod imunosuprimiranih pacijenta, s posebnim osvrtom na HIV-inficirane pacijente, i na mutacije u okviru VP1 gena koje mogu doprineti evolutivnoj selekciji virulentnijih varijanti BKV i JCV.