HHV-6 infection after allogeneic hematopoietic stem cell transplantation: From chromosomal integration to viral co-infections and T-cell reconstitution patterns

• DOI: 10.1016/j.jinf.2015.09.039
• Publication Date: 2015-10-30T18:01:39Z
• Authors: Adrien Quintela; Vanessa Escuret; Sandrine Roux; Pascale Bonnafous; Lila Gilis; Fiorenza Barraco; Hélène Labussière...; Sophie Duscastell...; Franck-Emmanuel N...; Xavier Thomas; Christian Chidiac; Tristan Ferry; Emilie Frobert; Stéphane Morisset; Françoise Poitevi...; Guillaume Monneret; Mauricette Michallet; Florence Ader; F. Ader; E. Bachy; M. Balsat; F. Barraco; A.L. Bienvenu; G. Billaud; F. Biron; A. Boibieux; C. Chidiac; A. Conrad; S. Ducastelle-Lep...; O. Dumitrescu; D. Dupont; V. Escuret; T. Ferry; E. Frobert; L. Gilis; A. Grateau; M. Heiblig; H. Labussière-Wallet; M. Le Maréchal; L. Lebras; B. Lina; G. Lina; A. Quintela; P. Miailhes; A.-S. Michallet; M. Michallet; M.-C. Michallet; G. Monneret; F. Morfin-Sherpa; F.E. Nicolini; T. Perpoint; M. Peyrouse de Mo...; S. Picot; F. Poitevin-Later; A.G. Ranc; S. Roux; G. Salles; J. Saison; A. Sénéchal; M. Sobh; X. Thomas; F. Valour; E. Wattel
• Keywords: Risk; Adult; Male; 570; Patients; Survival; Adolescent; [SDV]Life Sciences [q-bio]; Herpesvirus 6, Human; Virus Integration; 610; Roseolovirus Infections; [SDV.CAN]Life Sciences [q-bio]/Cancer; CD8-Positive T-Lymphocytes; methods; immunology; Young Adult; 03 medical and health sciences; Bone Marrow; Risk Factors; blood; 616; Humans; Transplantation, Homologous; Aged; 0303 health sciences; Coinfection; Hematopoietic Stem Cell Transplantation; Viral Load; Middle Aged; virology; 3. Good health; Case-Control Studies; Female; Virus Activation; France; Infection; Laboratories; transplantation; Stem Cell Transplantation

Human herpes virus 6 (HHV-6) can reactivate after allogeneic hematopoietic stem cell transplantation (allo-HSCT) and may be associated with significant clinical manifestations.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.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.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.