An assessment of herpesvirus co-infections in patients with CMV disease: correlation with clinical and virologic outcomes

Am J Transplant. 2009 Feb;9(2):374-81. doi: 10.1111/j.1600-6143.2008.02501.x. Epub 2008 Dec 15.

Abstract

The effect of herpesvirus co-infections (HHV-6, HHV-7) on cytomegalovirus (CMV) disease and its response to therapy is unknown. We prospectively analyzed herpesvirus co-infections in transplant recipients with CMV disease. All patients received 3 weeks of antiviral therapy. Samples were collected at baseline (day 0) and then day 3, 7, 14 and 21 poststart of therapy. Viral load testing for CMV, HHV-6 and HHV-7 was done using quantitative PCR assays in 302 patients of whom 256 had documented symptomatic CMV viremia. In this subset, day 0 HHV-6 co-infection was present in 23/253 (9.1%) and HHV-7 in 17/253 (6.7%). Including those positive at any time point raised the prevalence to 79/256 (30.9%) for HHV-6 and 75/256 (29.3%) for HHV-7. Viral co-infection did not influence the response of CMV disease to antiviral therapy. Baseline CMV viral loads, time to eradication and risk of recurrence were similar in patients with and without HHV-6 or HHV-7 co-infection. Ganciclovir and valganciclovir had no clear effect on HHV-6 and HHV-7 viremia. In conclusion, herpesvirus co-infections are common in patients with CMV disease but with standard antiviral therapy, no clear clinical effects are discernable. Routine monitoring for viral co-infection in patients with CMV disease is not indicated.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Antiviral Agents / therapeutic use
  • Cohort Studies
  • Cytomegalovirus / genetics
  • Cytomegalovirus / isolation & purification*
  • Cytomegalovirus Infections / complications*
  • Cytomegalovirus Infections / virology
  • DNA, Viral / genetics
  • Ganciclovir / analogs & derivatives
  • Ganciclovir / therapeutic use
  • Herpesvirus 6, Human / genetics
  • Herpesvirus 6, Human / isolation & purification*
  • Herpesvirus 7, Human / genetics
  • Herpesvirus 7, Human / isolation & purification*
  • Humans
  • Incidence
  • International Agencies
  • Middle Aged
  • Organ Transplantation
  • Polymerase Chain Reaction
  • Postoperative Complications / epidemiology
  • Postoperative Complications / virology*
  • Prospective Studies
  • Roseolovirus Infections / complications*
  • Roseolovirus Infections / virology
  • Treatment Outcome
  • Valganciclovir
  • Viral Load
  • Young Adult

Substances

  • Antiviral Agents
  • DNA, Viral
  • Valganciclovir
  • Ganciclovir