title: An assessment of the effect of human herpesvirus-6 replication on active cytomegalovirus infection after allogeneic stem cell transplantation.
abstract: Human herpesvirus-6 (HHV-6) may enhance cytomegalovirus (CMV) replication in allogeneic stem cell transplant (allo-SCT) recipients either through direct or indirect mechanisms. Definitive evidence supporting this hypothesis are lacking. We investigated the effect of HHV-6 replication on active CMV infection in 68 allo-SCT recipients. Analysis of plasma HHV-6 and CMV DNAemia was performed by real-time PCR. Enumeration of pp65 and IE-1 CMV-specific IFNgamma CD8(+) and CD4(+)T cells was performed by intracellular cytokine staining. HHV-6 DNAemia occurred in 39.8% of patients, and was significantly associated with subsequent CMV DNAemia in univariate (P=.01), but not in multivariate analysis (P=.65). The peak of HHV-6 DNAemia was not predictive of the development of CMV DNAemia. Timing and kinetics of active CMV infection were comparable in patients either with or without a preceding episode of HHV-6 DNAemia. The occurrence of HHV-6 DNAemia had no impact on CMV-specific T cell immunity reconstitution early after transplant. The receipt of a graft from an HLA-mismatched donor was independently associated with HHV-6 (P=.009) and CMV reactivation (P=.04). The data favor the hypothesis that a state of severe immunosuppression leads to HHV-6 and CMV coactivation, but argue against a role of HHV-6 in predisposing to the development of CMV DNAemia or influencing the course of active CMV infection.
authors.affiliation: Microbiology Service, Hospital Clínico Universitario, Valencia, Spain.
authors.forename: Nuria
authors.initials: N
authors.lastname: Tormo
authors.forename: Carlos
authors.initials: C
authors.lastname: Solano
authors.forename: Rafael
authors.initials: R
authors.lastname: de la Cámara
authors.forename: Ana
authors.initials: A
authors.lastname: Garcia-Noblejas
authors.forename: Laura
authors.initials: L
authors.lastname: Cardeñoso
authors.forename: María Angeles
authors.initials: MA
authors.lastname: Clari
authors.forename: José
authors.initials: J
authors.lastname: Nieto
authors.forename: Javier
authors.initials: J
authors.lastname: López
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Hernández-Boluda
authors.forename: María José
authors.initials: MJ
authors.lastname: Remigia
authors.forename: Isabel
authors.initials: I
authors.lastname: Benet
authors.forename: David
authors.initials: D
authors.lastname: Navarro
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003586:Cytomegalovirus Infections / Q000209:etiology* / Q000821:virology; D004279:DNA, Viral / Q000097:blood; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D015654:Herpesvirus 6, Human / Q000502:physiology*; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D019349:Roseolovirus Infections / Q000150:complications; D014184:Transplantation, Homologous; D014775:Virus Activation; D014779:Virus Replication; D055815:Young Adult
chemical_list: D004279:DNA, Viral