title: Preventive Strategies Against Cytomegalovirus and Incidence of α-Herpesvirus Infections in Solid Organ Transplant Recipients: A Nationwide Cohort Study.
abstract: We assessed the impact of antiviral preventive strategies on the incidence of herpes simplex virus (HSV) and varicella-zoster virus (VZV) infections in a nationwide cohort of transplant recipients. Risk factors for the development of HSV or VZV infection were assessed by Cox proportional hazards regression. We included 2781 patients (56% kidney, 20% liver, 10% lung, 7.3% heart, 6.7% others). Overall, 1264 (45%) patients received antiviral prophylaxis (ganciclovir or valganciclovir, n = 1145; acyclovir or valacyclovir, n = 138). Incidence of HSV and VZV infections was 28.9 and 12.1 cases, respectively, per 1000 person-years. Incidence of HSV and VZV infections at 1 year after transplant was 4.6% (95% confidence interval [CI] 3.5-5.8) in patients receiving antiviral prophylaxis versus 12.3% (95% CI 10.7-14) in patients without prophylaxis; this was observed particularly for HSV infections (3% [95% CI 2.2-4] versus 9.8% [95% CI 8.4-11.4], respectively). A lower rate of HSV and VZV infections was also seen in donor or recipient cytomegalovirus-positive patients receiving ganciclovir or valganciclovir prophylaxis compared with a preemptive approach. Female sex (hazard ratio [HR] 1.663, p = 0.001), HSV seropositivity (HR 5.198, p < 0.001), previous episodes of rejection (HR 1.95, p = 0.004), and use of a preemptive approach (HR 2.841, p = 0.017) were significantly associated with a higher risk of HSV infection. Although HSV and VZV infections were common after transplantation, antiviral prophylaxis significantly reduced symptomatic HSV infections.
authors.affiliation: Transplantation Center, University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland.|Infectious Diseases Service, University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland.
authors.forename: C
authors.initials: C
authors.lastname: Martin-Gandul
authors.affiliation: Institute for Clinical Epidemiology and Biostatistics, University Hospital of Basel, Basel, Switzerland.
authors.forename: S
authors.initials: S
authors.lastname: Stampf
authors.affiliation: Transplantation Center, University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland.|Infectious Diseases Service, University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland.
authors.forename: D
authors.initials: D
authors.lastname: Héquet
authors.affiliation: Division of Infectious Diseases and Hospital Epidemiology, University Hospital, University of Zurich, Zürich, Switzerland.
authors.forename: N J
authors.initials: NJ
authors.lastname: Mueller
authors.affiliation: Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland.
authors.forename: A
authors.initials: A
authors.lastname: Cusini
authors.affiliation: Transplant Infectious Diseases Unit, University Hospital Geneva, Geneva, Switzerland.
authors.forename: C
authors.initials: C
authors.lastname: van Delden
authors.affiliation: Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Basel, Basel, Switzerland.
authors.forename: N
authors.initials: N
authors.lastname: Khanna
authors.affiliation: Division of Infectious Diseases and Hospital Hygiene, Kantonsspital St. Gallen, St. Gallen, Switzerland.
authors.forename: K
authors.initials: K
authors.lastname: Boggian
authors.affiliation: Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland.
authors.forename: C
authors.initials: C
authors.lastname: Hirzel
authors.affiliation: Division of Pneumology, Department of Medicine, University Hospital Geneva, Geneva, Switzerland.
authors.forename: P
authors.initials: P
authors.lastname: Soccal
authors.affiliation: Transplantation & Clinical Virology, Department Biomedicine (Haus Petersplatz), University of Basel, Basel, Switzerland.
authors.forename: H H
authors.initials: HH
authors.lastname: Hirsch
authors.affiliation: Transplantation Center, University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Pascual
authors.affiliation: Infectious Diseases Service, University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland.|Institute of Microbiology, University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland.
authors.forename: P
authors.initials: P
authors.lastname: Meylan
authors.affiliation: Transplantation Center, University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland.|Infectious Diseases Service, University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland.
authors.forename: O
authors.initials: O
authors.lastname: Manuel
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D003587:Cytomegalovirus / Q000187:drug effects; D003586:Cytomegalovirus Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000821:virology; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology / Q000517:prevention & control* / Q000821:virology; D006085:Graft Survival; D006566:Herpesviridae Infections / Q000453:epidemiology / Q000517:prevention & control* / Q000821:virology; D014645:Herpesvirus 3, Human / Q000187:drug effects; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000009:adverse effects*; D011379:Prognosis; D012307:Risk Factors; D013557:Switzerland / Q000453:epidemiology; D066027:Transplant Recipients
chemical_list: D000998:Antiviral Agents
keywords: antibiotic: antiviral-ganciclovir/valganciclovir; clinical research/practice; infection and infectious agents; infectious disease; viral; viral: herpes zoster/Varicella