Author(s): Nichols WG, Boeckh M, Carter RA, Wald A, Corey L
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Abstract Herpes simplex virus (HSV) commonly reactivates after stem-cell transplantation (SCT), despite acyclovir prophylaxis. Whether HSV-seropositive recipients with HSV-seronegative or type-discordant donors had more frequent and severe HSV infections than those with HSV type-concordant donors was explored. Banked serum samples from HSV-positive SCT recipients and their donors were tested for the presence of HSV antibodies. HSV-1-positive SCT recipients from HSV-1-negative donors had more frequent and longer episodes than HSV-1-positive SCT recipients from HSV-1-positive donors; the proportion of patients receiving antiviral treatment for >10\% of follow-up days was 27.4\% versus 7.2\% (P<.001). Both HSV-1 visceral infection (9.8\% vs. 2.2\%; P=.001) and acyclovir resistance (5.8\% vs. 1.8\%; P=.03) were more common in type-discordant than -concordant patients, respectively; these associations were confirmed in multivariable models. Serological testing of donors can identify patients who are at highest risk for HSV-related morbidity, for whom prolonged prophylaxis or donor vaccination (once available) could be considered.
This article was published in J Infect Dis
and referenced in Journal of Stem Cell Research & Therapy