HHV-6 infection after allogeneic hematopoietic stem cell transplantation: From chromosomal integration to viral co-infections and T-cell reconstitution patterns. Issue 2 (February 2016)

• Record Type: Journal Article
• Authors: Quintela, Adrien; Escuret, Vanessa; Roux, Sandrine; Bonnafous, Pascale; Gilis, Lila; Barraco, Fiorenza; Labussière-Wallet, Hélène; Duscastelle-Leprêtre, Sophie; Nicolini, Franck-Emmanuel; Thomas, Xavier; Chidiac, Christian; Ferry, Tristan; Frobert, Emilie; Morisset, Stéphane; Poitevin-Later, Françoise; Monneret, Guillaume; Michallet, Mauricette; Ader, Florence
• Is Part Of: Journal of infection. Volume 72:Issue 2(2016)
• Page Start: 214
• Page End: 222
• Publication Date: 2016-02
• Subjects: Human herpes virus 6 -- Hematopoietic stem cell transplantation -- T lymphocytes -- Cytomegalovirus -- BK virus -- Chromosomally integrated HHV-6; Infection -- Periodicals; Bacterial Infections -- Periodicals; Communicable Diseases -- Periodicals; Electronic journals; 616.905
• DOI: 10.1016/j.jinf.2015.09.039
• Languages: English
• ISSNs: 0163-4453

Abstract

Summary: Objectives: Human herpes virus 6 (HHV-6) can reactivate after allogeneic hematopoietic stem cell transplantation (allo-HSCT) and may be associated with significant clinical manifestations. Methods: Case control study of HHV-6 infections after allo-HSCT. Chromosomal integration (ciHHV-6) for viral loads ≥ 5.5-log10 copies/mL was investigated. Viral co-infections, T-cell recovery, risk factors and outcome were compared in HHV-6- and non-HHV-6-infected patients. Antiviral treatment strategies were reviewed. Results: Among 366 adult allo-HSCT recipients, 75 HHV-6 infections occurred. Three (4%) recipients were ciHHV-6. HHV-6 infections were associated with CMV ( p = 0.05; sdHR 1.73, CI 0.99–3.02) and/or BKV infections ( p < 0.0001; sdHR 4.63, CI 2.04–10.53) but not EBV reactivation ( p = 0.34). A slower CD8+ T-cells recovery was observed until 6 months after allo-HSCT in the HHV-6-infected group ( p < 0.001), independently of acute and/or chronic graft- versus -host disease. The overall probability of survival after allo-HSCT was diminished for active HHV-6-infected patients ( p = 0.0326). Cord blood unit recipients had a higher risk of developing HHV-6 infection compared to bone marrow recipients ( p = 0.0007; sdHR 3.82, CI 1.76–8.27). Anti-HHV-6 treatment achieved complete response in only 2/3 of the cases. Conclusions: In this series of allo-HSCT recipients, 4% were ciHHV-6, active HHV-6 infection was likely associated with CMV and BKV co-reactivations, delayed CD8+ T-cell recovery and poorer outcome. Highlights: 4% of the HHV-6-infected patients after allogeneic hematopoietic stem cell transplantation were chromosomally integrated. HHV-6 likely co-reactivates with CMV and BK virus after allogeneic hematopoietic stem cell transplantation. HHV-6 infection is likely associated with delayed CD8+ T-cell recovery independently of graft- versus -host disease. HHV-6 infection reduces the overall probability of survival after allogeneic hematopoietic stem cell transplantation.