HHV-6A and HHV-6B in Solid Organ Transplantation

Lautenschlager, Irmeli; Razonable, Raymund R.

doi:10.1016/b978-0-444-62703-2.00012-4

Cited by 5 publications

(14 citation statements)

References 99 publications

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“…According to our results, the HHV‐6 DNAemia typically started 2 weeks after transplantation, both in patients with a primary infection and HHV‐6 reactivation, and lasted several weeks or months. In other studies, the incidence of HHV‐6 reactivation peaked at 2‐8 weeks after transplantation, when the level of immunosuppressive medication was at its most intense . Delayed viral activation has also been reported, similar to our study, where the latest primary HHV‐6 infection was observed 2 years after transplantation .…”

Section: Discussionsupporting

confidence: 90%

“…However, Fawaz et al. reported symptoms in 28% of pediatric patients with liver transplants who had verified HHV‐6 infections . In our study, the frequency of symptoms was 35% and fever and diarrhea were the most common symptoms.…”

Section: Discussioncontrasting

confidence: 46%

“…We found it difficult to diagnose leukopenia due to an HHV‐6 infection because of the myelosuppressive medication that patients received, namely azathioprine or mycophenolate mofetil, trimethoprim/sulfamethoxazole, and/or valganciclovir. Also, when the alanine aminotransferase levels were elevated, we found it difficult to distinguish an HHV‐6 infection from other possible causes, such as drug effects, bile flow problems, and mild rejections …”

Section: Discussionmentioning

confidence: 96%

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Human herpes virus 6 infection in pediatric organ transplant patients

Ylinen

Lehtinen

Jahnukainen

et al. 2017

Pediatric Transplantation

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Transplant patients need lifelong immunosuppressive medication, but this reduces their defense mechanisms, making them prone to viral infections and reactivations. We aimed to clarify the prevalence and clinical manifestations of the human herpes virus 6 (HHV-6) infection in children after pediatric solid organ transplants. Clinical findings and viral loads were compared between primary HHV-6 infections and reactivations. The study comprised 47 kidney, 25 liver, and 12 heart transplant patients who underwent surgery from 2009 to 2014. HHV-6 antibodies were analyzed before surgery, and HHV-6 DNAemia tests were regularly carried out after the transplant using a real-time quantitative polymerase chain reaction method. We found the primary HHV-6 infection in 19 of 22 (86%) seronegative patients, and it was more common in patients under 3 years of age (79%) than over 3 (38%, P=.0002). Post-transplant HHV-6 DNAemia affected 48 of 84 (57%) patients and was significantly higher in primary infections than reactivations (P=.001), and 17 of 48 (35%) patients had symptoms when it was detected at a median of 2 weeks post-transplant. The HHV-6 infection was common after solid organ transplants, especially under 3 years of age, and it typically started 2 weeks after surgery. Testing for HHV-6 DNAemia is recommended shortly after transplantation, especially in patients with fever, diarrhea, rash, seizures, or abnormal liver enzyme tests.

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Section: Discussionsupporting

confidence: 90%

Section: Discussioncontrasting

confidence: 46%

Section: Discussionmentioning

confidence: 96%

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Human herpes virus 6 infection in pediatric organ transplant patients

Ylinen

Lehtinen

Jahnukainen

et al. 2017

Pediatric Transplantation

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“…Accordingly, the International Herpesvirus Management Forum and the American Society of Transplantation do not recommend antiviral prophylaxis for HHV-6 infection but promote the initiation of antiviral therapy in case of HHV-6 encephalitis. Intravenous ganciclovir and foscarnet are proposed as first-line drugs (164,223,224). However, no other recommendation has been approved internationally for the therapy of active HHV-6 infections while numerous questions are pending.…”

Section: Indications and Management Of Clinical Hhv-6 Treatmentsmentioning

confidence: 99%

“…Thus, reducing the dose of immunosuppressive drugs is a valuable approach to consider when this option is available (11,223). The general strategy of antiviral therapy against HHV-6 may be inspired by the current practices of anti-HCMV treatment, thus leading to a choice between prophylactic, preemptive, and curative approaches (Fig.…”

Section: Indications and Management Of Clinical Hhv-6 Treatmentsmentioning

confidence: 99%

Laboratory and Clinical Aspects of Human Herpesvirus 6 Infections

2015

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SUMMARY Human herpesvirus 6 (HHV-6) is a widespread betaherpesvirus which is genetically related to human cytomegalovirus (HCMV) and now encompasses two different species: HHV-6A and HHV-6B. HHV-6 exhibits a wide cell tropism in vivo and, like other herpesviruses, induces a lifelong latent infection in humans. As a noticeable difference with respect to other human herpesviruses, genomic HHV-6 DNA is covalently integrated into the subtelomeric region of cell chromosomes (ciHHV-6) in about 1% of the general population. Although it is infrequent, this may be a confounding factor for the diagnosis of active viral infection. The diagnosis of HHV-6 infection is performed by both serologic and direct methods. The most prominent technique is the quantification of viral DNA in blood, other body fluids, and organs by means of real-time PCR. Many active HHV-6 infections, corresponding to primary infections, reactivations, or exogenous reinfections, are asymptomatic. However, the virus may be the cause of serious diseases, particularly in immunocompromised individuals. As emblematic examples of HHV-6 pathogenicity, exanthema subitum, a benign disease of infancy, is associated with primary infection, whereas further virus reactivations can induce severe encephalitis cases, particularly in hematopoietic stem cell transplant recipients. Generally speaking, the formal demonstration of the causative role of HHV-6 in many acute and chronic human diseases is difficult due to the ubiquitous nature of the virus, chronicity of infection, existence of two distinct species, and limitations of current investigational tools. The antiviral compounds ganciclovir, foscarnet, and cidofovir are effective against active HHV-6 infections, but the indications for treatment, as well as the conditions of drug administration, are not formally approved to date. There are still numerous pending questions about HHV-6 which should stimulate future research works on the pathophysiology, diagnosis, and therapy of this remarkable human virus.

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HHV‐6 in liver transplantation: A literature review

Phan

Lautenschlager

Razonable

et al. 2017

Liver International

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Human herpesvirus 6 (HHV-6A and HHV-6B) can cause primary infection or reactivate from latency in liver transplant recipients, which can result in a variety of clinical syndromes, including fever, hepatitis, encephalitis and higher rates of graft dysfunction as well as indirect effects including increased risks of mortality, CMV disease, hepatitis C progression and greater fibrosis scores. Although HHV-6 infection is currently diagnosed by quantifying viral DNA in plasma or blood, biopsy to demonstrate

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HHV-6A and HHV-6B in Solid Organ Transplantation

Cited by 5 publications

References 99 publications

Human herpes virus 6 infection in pediatric organ transplant patients

Human herpes virus 6 infection in pediatric organ transplant patients

Laboratory and Clinical Aspects of Human Herpesvirus 6 Infections

HHV‐6 in liver transplantation: A literature review

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