title: Transferred herpes simplex virus immunity after stem-cell transplantation: clinical implications.
abstract: Herpes simplex virus (HSV) commonly reactivates after stem-cell transplantation (SCT), despite acyclovir prophylaxis. Whether HSV-seropositive recipients with HSV-seronegative or type-discordant donors had more frequent and severe HSV infections than those with HSV type-concordant donors was explored. Banked serum samples from HSV-positive SCT recipients and their donors were tested for the presence of HSV antibodies. HSV-1-positive SCT recipients from HSV-1-negative donors had more frequent and longer episodes than HSV-1-positive SCT recipients from HSV-1-positive donors; the proportion of patients receiving antiviral treatment for >10% of follow-up days was 27.4% versus 7.2% (P<.001). Both HSV-1 visceral infection (9.8% vs. 2.2%; P=.001) and acyclovir resistance (5.8% vs. 1.8%; P=.03) were more common in type-discordant than -concordant patients, respectively; these associations were confirmed in multivariable models. Serological testing of donors can identify patients who are at highest risk for HSV-related morbidity, for whom prolonged prophylaxis or donor vaccination (once available) could be considered.
authors.affiliation: Program in Infectious Diseases, Fred Hutchinson Cancer Research Center, University of Washington, 1100 Fairview Avenue N, D3-100, Seattle, WA 98109-4417, USA. gnichols@fhcrc.org
authors.forename: W Garrett
authors.initials: WG
authors.lastname: Nichols
authors.forename: Michael
authors.initials: M
authors.lastname: Boeckh
authors.forename: Rachel A
authors.initials: RA
authors.lastname: Carter
authors.forename: Anna
authors.initials: A
authors.lastname: Wald
authors.forename: Lawrence
authors.initials: L
authors.lastname: Corey
mesh_terms: D000212:Acyclovir / Q000494:pharmacology; D000328:Adult; D000914:Antibodies, Viral / Q000097:blood* / Q000276:immunology; D000998:Antiviral Agents / Q000494:pharmacology; D024882:Drug Resistance, Viral; D005260:Female; D006561:Herpes Simplex / Q000276:immunology* / Q000503:physiopathology; D018259:Herpesvirus 1, Human / Q000187:drug effects / Q000276:immunology*; D018258:Herpesvirus 2, Human / Q000187:drug effects / Q000276:immunology; D006801:Humans; D007109:Immunity; D008297:Male; D008875:Middle Aged; D033581:Stem Cell Transplantation; D013234:Stem Cells; D014019:Tissue Donors; D014775:Virus Activation
chemical_list: D000914:Antibodies, Viral; D000998:Antiviral Agents; D000212:Acyclovir