title: Different expression of human herpesvirus-6 (HHV-6) load in whole blood may have a significant impact on the diagnosis of active infection.
abstract: BACKGROUND
  Viral load in whole blood is the main virological marker for assessing HHV-6 infection and is used as an indication to begin antiviral therapy. Results are usually expressed as the number of genomic equivalent copies (gec) per mL of blood, although HHV-6 DNA in blood is mainly localized in lymphocytes and polymorphonuclear leukocytes.
  
  
  OBJECTIVE
  Since leukocyte counts vary in immunocompromised patients, especially in stem cell transplant recipients, the aim of this study was to compare HHV-6 load expressed as gec per mL with load expressed as gec per million cells (mc), using quantitative real-time PCR for HHV-6 and cell DNA.
  
  
  METHODS
  194 blood samples from 101 patients were analyzed. Leukocyte count was obtained for 142 samples.
  
  
  RESULTS
  The two modes of expression were incompletely correlated (p<0.0001; R(2)=0.732). To understand this relative discrepancy, samples were classified according to hematological criteria (normal leukocyte count, leukopenia, agranulocytosis, lymphopenia). The expression modes were correlated in all cases except for agranulocytosis (p=0.21; R(2)=0.087). Moreover, the median of ratio between gec per mc and gec per mL ranged from 0.5 when leukocyte count was normal, to 8.2 in cases of agranulocytosis. HHV-6 load follow-up suggested that in agranulocytosis expressing results as gec per mc tended to provide a more representative result.
  
  
  CONCLUSIONS
  The different expression of HHV-6 load in whole blood, as either gec per mL or gec per mc resulted in different estimations of infection in the case of agranulocytosis. In this situation, the latter mode of expression is preferred.
authors.affiliation: UPMC Univ Paris 06, UPRES EA 2387, 83 Boulevard de l'Hôpital, Paris, F-75013 France. agnes.gautheret@psl.aphp.fr
authors.forename: Agnès
authors.initials: A
authors.lastname: Gautheret-Dejean
authors.forename: Cécile
authors.initials: C
authors.lastname: Henquell
authors.forename: Fabienne
authors.initials: F
authors.lastname: Mousnier
authors.forename: David
authors.initials: D
authors.lastname: Boutolleau
authors.forename: Pascale
authors.initials: P
authors.lastname: Bonnafous
authors.forename: Nathalie
authors.initials: N
authors.lastname: Dhédin
authors.forename: Catherine
authors.initials: C
authors.lastname: Settegrana
authors.forename: Henri
authors.initials: H
authors.lastname: Agut
mesh_terms: D001769:Blood / Q000821:virology*; D004279:DNA, Viral / Q000235:genetics; D015654:Herpesvirus 6, Human / Q000302:isolation & purification*; D006801:Humans; D007958:Leukocyte Count; D019349:Roseolovirus Infections / Q000175:diagnosis*; D019562:Viral Load / Q000379:methods*
chemical_list: D004279:DNA, Viral