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Delirium associated with HHV-6B reactivation in cord blood transplant patients: time for an antiviral prophylaxis trial?

In All, Chronic Fatigue Syndrome, Cognitive Dysfunction, Encephalitis & Encephalopathy, Showcase, Transplant Complications by Kristin Loomis

A prospective study authored by Joshua Hill and Danielle Zerr determined that higher than average HHV-6B DNA levels increased the odds of developing delirium after cord blood transplantation (CBT) by almost three fold. Patients with DNA loads in the top quartile had a 4.5 fold increase in delirium.

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HSCT patients with HHV-6 reactivation have significantly worse survival rates and higher rates of acute GVHD

In All, GVHD, Transplant Complications by Kristin Loomis

A group from Sapporo Medical University studied 105 post HSCT patients and determined that 7 developed CNS dysfunction in the first 42 days after transplant. Six out of the 7 were positive for HHV-6, but none of the other 12 pathogens tested. Four or 3.8% of the population were diagnosed with HHV-6 encephalitis.

Multiplex PCR; HHV-6 loads higher with steroids

In All, Transplant Complications by hhv6foundation

A large-scale multiplex PCR assay developed by a team in Japan was used to study 13 DNA viruses in 105 allogenic hematopoietic stem cell transplant patients. Their findings identify HHV-6 as the most common virus (found in 60% of all patients), and also as the only virus tied to the onset of acute GVHD (p=0.016). Interestingly, HHV-6 reactivation was associated with a more severe stage of skin but not liver or gut aGVHD (P=0.005). In addition, patients treated with steroids had a significantly higher risk of HHV-6 reactivation (p=0.027) and cord blood transplant patients were 10.4x more likely to reactivate with HHV-6. The authors looked at the association of HHV-6 reactivation in the absence of GVHD, and found that it …

Expert Opinion: Dr. Louis Flamand calls for screening of transplant organs and cells for ciHHV-6 status

In All, ciHHV-6, Featured, Transplant Complications by hhv6foundation

Dr. Flamand, a professor and molecular virologist at Université Laval in Quebec city, has written an editorial calling for screening of organ donors for ciHHV-6 status and careful monitoring of recipients of ciHHV-6 donor tissues for signs of active HHV-6 infection and HHV-6 antigen-induced immune rejection. Flamand also questions whether solid organs and stem cells derived from persons with ciHHV-6 should be used in transplantation.