title: Co-infection and clinical impact of human herpesvirus 5 and 6 in liver transplantation.
abstract: BACKGROUND
  Human herpesvirus (HHV) 5 and 6 remain latent after primary infection and can be reactivated after immunosuppression for organ transplantation. An association between HHV-5 and HHV-6 has been reported in liver transplant patients. The coinfection is associated with clinical manifestations and graft dysfunction.
  
  
  OBJECTIVE
  The aim of this study was to monitor herpesviruses in liver transplant recipients to better understand issues involving coinfection with HHV-5/6 and correlations with acute cellular rejection episodes and bacterial infections.
  
  
  METHODS
  Forty-five adult liver transplant patients of median age 47 years (range, 18-66), gave blood samples and liver biopsies in the first 6 months after their surgeries. Viremia was detected with the use of nested PCR and antigenemia; the Banff classification was used to detect allograft rejection.
  
  
  RESULTS
  IgG positive for HHV-5 was observed in 94% of subjects whose main indication (67%) for transplantation was hepatitis C. Twenty-three (51.1%) displayed cytomeg virus (CMV) infections and 12 (26.7%) HHV-6 infection. There were 6 patients (13.3%) with HHV-5/6 coinfections. Eighteen of the 23 patients had CMV disease, showing a strong correlation between a positive test and CMV disease; 6 displayed an acute cellular rejection episode in the same period (χ(2) = 6.62; P < .03). Four out of 6 patients who displayed coinfections (HHV-5/6) had concomitant bacterial infections; 3/6 experienced graft rejection episodes. During follow-up, 1 patient had HHV-6 infection diagnosed as encephalitis followed by fever on the 24th day after surgery. The median 32 days for HHV-6 detection by nested PCR positivity was shorter than 38 days for HHV-5.
  
  
  CONCLUSIONS
  HHV-5/6-infected patients displayed more allograft rejection episodes, coinfections, and concomitant bacterial infections, besides an higher risk for CMV disease.
authors.affiliation: Unit of Liver Transplantation, Diagnosis of Molecular Infection Disease, Faculty of Medical Science, State University of Campinas, SP, Brazil.
authors.forename: A M
authors.initials: AM
authors.lastname: Sampaio
authors.forename: A C
authors.initials: AC
authors.lastname: Guardia
authors.forename: A
authors.initials: A
authors.lastname: Milan
authors.forename: A N
authors.initials: AN
authors.lastname: Sasaki
authors.forename: P D
authors.initials: PD
authors.lastname: Andrade
authors.forename: S H A
authors.initials: SH
authors.lastname: Bonon
authors.forename: R S B
authors.initials: RS
authors.lastname: Stucchi
authors.forename: S C
authors.initials: SC
authors.lastname: Botelho Costa
authors.forename: I F S F
authors.initials: IF
authors.lastname: Boin
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000914:Antibodies, Viral / Q000097:blood; D001424:Bacterial Infections / Q000175:diagnosis / Q000209:etiology* / Q000276:immunology / Q000382:microbiology; D001706:Biopsy; D016009:Chi-Square Distribution; D060085:Coinfection; D003587:Cytomegalovirus / Q000235:genetics / Q000276:immunology / Q000472:pathogenicity*; D003586:Cytomegalovirus Infections / Q000150:complications* / Q000175:diagnosis / Q000276:immunology / Q000821:virology; D006084:Graft Rejection / Q000175:diagnosis / Q000209:etiology* / Q000276:immunology / Q000821:virology; D015654:Herpesvirus 6, Human / Q000235:genetics / Q000276:immunology / Q000472:pathogenicity*; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects* / Q000276:immunology; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D019349:Roseolovirus Infections / Q000150:complications* / Q000175:diagnosis / Q000276:immunology / Q000821:virology; D013997:Time Factors; D016896:Treatment Outcome; D019562:Viral Load; D014775:Virus Activation; D017735:Virus Latency; D055815:Young Adult
chemical_list: D000914:Antibodies, Viral