RESUMO
The effect of herpesvirus co-infections (HHV-6, HHV-7) on cytomegalovirus (CMV) disease and its response to therapy is unknown. We prospectively analyzed herpesvirus co-infections in transplant recipients with CMV disease. All patients received 3 weeks of antiviral therapy. Samples were collected at baseline (day 0) and then day 3, 7, 14 and 21 poststart of therapy. Viral load testing for CMV, HHV-6 and HHV-7 was done using quantitative PCR assays in 302 patients of whom 256 had documented symptomatic CMV viremia. In this subset, day 0 HHV-6 co-infection was present in 23/253 (9.1%) and HHV-7 in 17/253 (6.7%). Including those positive at any time point raised the prevalence to 79/256 (30.9%) for HHV-6 and 75/256 (29.3%) for HHV-7. Viral co-infection did not influence the response of CMV disease to antiviral therapy. Baseline CMV viral loads, time to eradication and risk of recurrence were similar in patients with and without HHV-6 or HHV-7 co-infection. Ganciclovir and valganciclovir had no clear effect on HHV-6 and HHV-7 viremia. In conclusion, herpesvirus co-infections are common in patients with CMV disease but with standard antiviral therapy, no clear clinical effects are discernable. Routine monitoring for viral co-infection in patients with CMV disease is not indicated.
Assuntos
Infecções por Citomegalovirus/complicações , Citomegalovirus/isolamento & purificação , Herpesvirus Humano 6/isolamento & purificação , Herpesvirus Humano 7/isolamento & purificação , Complicações Pós-Operatórias/virologia , Infecções por Roseolovirus/complicações , Adolescente , Adulto , Idoso , Antivirais/uso terapêutico , Estudos de Coortes , Citomegalovirus/genética , Infecções por Citomegalovirus/virologia , DNA Viral/genética , Ganciclovir/análogos & derivados , Ganciclovir/uso terapêutico , Herpesvirus Humano 6/genética , Herpesvirus Humano 7/genética , Humanos , Incidência , Agências Internacionais , Pessoa de Meia-Idade , Transplante de Órgãos , Reação em Cadeia da Polimerase , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Infecções por Roseolovirus/virologia , Resultado do Tratamento , Valganciclovir , Carga Viral , Adulto JovemRESUMO
Both prophylaxis and preemptive therapy are used to prevent the development of cytomegalovirus (CMV) disease after transplantation. Preemptive therapy exposes the least number of patients to costly and potentially toxic drugs. Prophylaxis is less labor intensive and requires less expensive monitoring. While the overall cost of the two modalities is similar, current literature suggests that prophylaxis has an advantage in avoiding secondary effects of CMV. Randomized comparative trials are imperative.