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Watanabe D, Iida S, Hirota K, Ueji T, Matsumura T, Nishida Y, Uehira T, Katano H, Shirasaka T. Evaluation of human herpesvirus-8 viremia and antibody positivity in patients with HIV infection with human herpesvirus-8-related diseases. J Med Virol 2023; 95:e29324. [PMID: 38103015 DOI: 10.1002/jmv.29324] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 11/20/2023] [Accepted: 12/04/2023] [Indexed: 12/17/2023]
Abstract
Human herpesvirus-8 (HHV-8) viremia is associated with refractory conditions in patients infected with HIV-1. Therefore, we evaluated the factors related to plasma HHV-8-DNA. Participants included patients infected with HIV-1 who visited our hospital. Plasma HHV-8-DNA levels were measured using real-time polymerase chain reaction, and anti-HHV-8 antibodies were assessed through enzyme immunoassays using multiple antigens (K8.1, ORF59, ORF65, and LANA). Factors related to plasma HHV-8-DNA were examined using Fisher's exact test or Mann-Whitney U test. The study involved 36 patients infected with HIV-1, of whom 19 were histologically diagnosed with Kaposi's sarcoma (KS), two had multicentric Castleman's disease (MCD), and 15 did not exhibit HHV-8-related disease. Before the introduction of antiretroviral therapy (ART), plasma HHV-8-DNA was detected in 44% (7/16) of patients with KS and in 9% (1/11) of patients without HHV-8-related disease. Among patients with KS, elevated plasma HHV-8-DNA levels (≥0.05 copies/µL) correlated with the presence of CDC category C diseases other than KS (p = 0.0337), anti-HHV-8 antibody negativity (p = 0.0337), anemia (p = 0.0474), and thrombocytopenia (p = 0.0146). Following ART initiation, the percentage of patients positive for plasma HHV-8-DNA decreased from 44% (7/16) to 6% (1/17), and the percentage of patients positive for anti-HHV-8 antibodies increased from 44% (7/16) to 88% (15/17). Finally, plasma HHV-8-DNA positivity and anti-HHV-8 antibody negativity were observed in two patients with MCD. Our findings suggest that insufficient production of anti-HHV-8 antibodies was associated with HHV-8 viremia, and that anti-HHV-8 antibody production was recovered with ART; thus, indicating the possibility of involvement of humoral immunity in suppressing HHV-8 viremia.
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Affiliation(s)
- Dai Watanabe
- AIDS Medical Center, NHO Osaka National Hospital, Osaka, Japan
- Department of Advanced Medicine for HIV Infection, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shun Iida
- Department of Pathology, National Institute of Infectious Diseases, Tokyo, Japan
| | - Kazuyuki Hirota
- AIDS Medical Center, NHO Osaka National Hospital, Osaka, Japan
| | - Takashi Ueji
- AIDS Medical Center, NHO Osaka National Hospital, Osaka, Japan
| | | | | | - Tomoko Uehira
- AIDS Medical Center, NHO Osaka National Hospital, Osaka, Japan
| | - Harutaka Katano
- Department of Pathology, National Institute of Infectious Diseases, Tokyo, Japan
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Mendes-de-Almeida DP, Bokel JPB, Alves ADR, Vizzoni AG, Tavares ICF, Silva MST, Netto JDSB, Grinsztejn BGJ, Amado Leon LA. Clinical Presentation of Parvovirus B19 Infection in Adults Living with HIV/AIDS: A Case Series. Viruses 2023; 15:v15051124. [PMID: 37243210 DOI: 10.3390/v15051124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/02/2023] [Accepted: 05/04/2023] [Indexed: 05/28/2023] Open
Abstract
Parvovirus B19 (B19V) infection varies clinically depending on the host's immune status. Due to red blood cell precursors tropism, B19V can cause chronic anemia and transient aplastic crisis in patients with immunosuppression or chronic hemolysis. We report three rare cases of Brazilian adults living with human immunodeficiency virus (HIV) with B19V infection. All cases presented severe anemia and required red blood cell transfusions. The first patient had low CD4+ counts and was treated with intravenous immunoglobulin (IVIG). As he remained poorly adherent to antiretroviral therapy (ART), B19V detection persisted. The second patient had sudden pancytopenia despite being on ART with an undetectable HIV viral load. He had historically low CD4+ counts, fully responded to IVIG, and had undiagnosed hereditary spherocytosis. The third individual was recently diagnosed with HIV and tuberculosis (TB). One month after ART initiation, he was hospitalized with anemia aggravation and cholestatic hepatitis. An analysis of his serum revealed B19V DNA and anti-B19V IgG, corroborating bone marrow findings and a persistent B19V infection. The symptoms resolved and B19V became undetectable. In all cases, real time PCR was essential for diagnosing B19V. Our findings showed that adherence to ART was crucial to B19V clearance in HIV-patients and highlighted the importance of the early recognition of B19V disease in unexplained cytopenias.
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Affiliation(s)
- Daniela P Mendes-de-Almeida
- Hematology Department, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro 21040-360, RJ, Brazil
- Research Center, Instituto Nacional de Câncer (INCA), Rio de Janeiro 20220-430, RJ, Brazil
- Department of Medical Affairs, Clinical Studies, and Post-Registration Surveillance (DEAME), Institute of Technology in Immunobiologicals/Bio-Manguinhos, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro 21040-360, RJ, Brazil
| | - Joanna Paes Barreto Bokel
- Hematology Department, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro 21040-360, RJ, Brazil
- Onco-Hematology Unit, Clínica São Vicente, Rio de Janeiro 22451-100, RJ, Brazil
| | - Arthur Daniel Rocha Alves
- Laboratory of Technological Development in Virology, Instituto Oswaldo Cruz, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro 21040-360, RJ, Brazil
| | - Alexandre G Vizzoni
- Hematology Department, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro 21040-360, RJ, Brazil
| | - Isabel Cristina Ferreira Tavares
- Laboratory of Clinical Research on STD/AIDS, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro 21040-360, RJ, Brazil
| | - Mayara Secco Torres Silva
- Laboratory of Clinical Research on STD/AIDS, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro 21040-360, RJ, Brazil
| | - Juliana Dos Santos Barbosa Netto
- Laboratory of Clinical Research on STD/AIDS, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro 21040-360, RJ, Brazil
| | - Beatriz Gilda Jegerhorn Grinsztejn
- Laboratory of Clinical Research on STD/AIDS, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro 21040-360, RJ, Brazil
| | - Luciane Almeida Amado Leon
- Laboratory of Technological Development in Virology, Instituto Oswaldo Cruz, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro 21040-360, RJ, Brazil
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Mogensen TH, Skouboe MK, Mølle I. Successful use of interferon alfa-2a for persistent parvovirus B19 infection. THE LANCET. INFECTIOUS DISEASES 2023; 23:e160-e165. [PMID: 36436534 DOI: 10.1016/s1473-3099(22)00685-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 09/22/2022] [Accepted: 10/04/2022] [Indexed: 11/27/2022]
Abstract
Human infection with parvovirus B19 causes a range of clinical manifestations, including benign erythema infectiosum in children, arthralgias in adults, aplastic crisis in patients with bone marrow failure, and potentially fatal congenital hydrops fetalis. Persistent parvovirus B19 infection is a rare disease presentation mostly seen in adult women or immunocompromised individuals. Treatment options include corticosteroids and intravenous immunoglobulin; however, viral clearance is difficult to obtain and rarely maintained. In this Grand Round, we report the case of a 43-year-old man with persistent parvovirus B19 infection and anaemia, who was refractory to standard treatment regimens, and whom we successfully treated with pegylated interferon alfa-2a. Initial treatment led to viral clearance and remission of anaemia, although secondary recurrence of virus required treatment extension. Despite extensive genetic and immunological evaluations, no underlying primary or secondary immunodeficiency was identified in the patient. We propose interferon alfa-2a as a treatment option for persistent parvovirus B19 infection and advocate long-term follow-up of patients and potentially repeated treatment.
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Affiliation(s)
- Trine H Mogensen
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark; Department of Biomedicine, Aarhus University, Aarhus, Denmark.
| | - Morten Kelder Skouboe
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark; Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Ingolf Mølle
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
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Tun MM, Chowdhury T, Nway N, Noel P, Gousy N, Roy A, Htet SY. Parvovirus Infection Leading to Severe Anemia in an Adult Patient With HIV Disease. Cureus 2022; 14:e29148. [PMID: 36258998 PMCID: PMC9562260 DOI: 10.7759/cureus.29148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2022] [Indexed: 11/05/2022] Open
Abstract
Individuals with human immunodeficiency virus (HIV) disease frequently suffer from anemia. The causes include anemia of chronic disease, vitamin B12 and iron deficiency, opportunistic infections (Mycobacterium tuberculosis, Pneumocystis jiroveci), HIV-related bone marrow suppression, AIDS-associated malignancies, and antiretroviral therapy (ART), specifically zidovudine. In HIV patients with advanced immunodeficiency, failure to produce neutralizing antibodies can lead to chronic parvovirus B19 (B19) infection. Normally, in persons with intact immunity, the progression of B19 is self-limited. However, in chronic B19 infection, it can lead to pure red cell aplasia (PRCA) and chronic anemia. In human immunodeficiency virus (HIV)-infected patients, B19-related anemia is rare and underdiagnosed. It has a great response to intravenous immunoglobulin (IVIG) therapy. Hence, early diagnosis and prompt treatment can significantly reduce mortality. In this article, we described the case of a 25-year-old male with HIV infection who presented with a headache. He had severe normocytic anemia with a low reticulocyte count. The workup for blood loss, hemolysis, hemoglobinopathy, and iron deficiency was negative. Because of extremely low reticulocytopenia with severe anemia, the investigations favored multiple myeloma, parvovirus infection, and bone marrow aspiration biopsy. He was tested for parvovirus B19 deoxyribonucleic acid (DNA) polymerase chain reaction (PCR) test due to insufficient seroconversion. It turned out to be positive and he was treated with IVIG therapy.
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Mahomed N, Reubenson G. Immune Reconstitution Inflammatory Syndrome in children. SA J Radiol 2017; 21:1257. [PMID: 31754484 PMCID: PMC6837832 DOI: 10.4102/sajr.v21i2.1257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 09/19/2017] [Indexed: 11/24/2022] Open
Abstract
Immune Reconstitution Inflammatory Syndrome (IRIS) refers to a collection of inflammatory disorders, predominantly related to infectious processes that manifest after the initiation of antiretroviral therapy (ART) and can be classified as unmasking or paradoxical. The prevalence of IRIS in children in sub-Saharan Africa is low. Approximately half of all cases are associated with Mycobacterium tuberculosis. It may be difficult to distinguish IRIS from tuberculosis and other opportunistic infections radiologically; therefore, radiological findings must be interpreted with clinical and laboratory findings. In this review article, we describe the clinical and radiological manifestations of IRIS in children and provide illustrative radiological examples.
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Affiliation(s)
- Nasreen Mahomed
- Department of Radiology, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Gary Reubenson
- Department of Paediatrics & Child Health, Faculty of Health Sciences, University of the Witwatersrand, South Africa
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Pedranti MS, Rodriguez-Lombardi G, Bracciaforte R, Romano N, Lujan P, Ricchi B, Mautino J, Adamo MP. Parvovirus B19 in HIV+ adult patients with different CD4+ lymphocyte counts. J Med Microbiol 2017; 66:1715-1721. [PMID: 29095139 DOI: 10.1099/jmm.0.000629] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Human parvovirus B19 (B19V) can cause anemia in immunocompromised patients. We aimed to investigate the presence of B19V in HIV+ adults with different CD4+ T cell counts, to recognise the frequency of B19V in these different conditions and its possible association with anemia. METHODOLOGY We studied B19V specific IgM, IgG and DNA in 98 HIV+ patients and in 52 healthy individuals. HIV load, CD4+ counts and haemoglobin level were also determined in the patients. RESULTS No individual in the control group had detectable IgM, 41/52 (78.8 %) had IgG and 5/52 (9.6 %) had B19V DNA. Among HIV+ patients, we found 5/98 (5.1 %) IgM+, 66/98 (67.3 %) IgG+ and 15/98 (15.3 %) had B19V DNA (no significant differences between the two groups compared). Considering the CD4+ cell range in HIV patients, 37 had <200 CD4+ cells ml-1, 31 had 200-500, and 30 had >500. Anti-B19V IgG prevalence in patients with >500 CD4+ cells ml-1 was significantly higher than in the rest (P=0.004) and compared to the control (P=0.046). B19V DNA concentration was always <103 IU ml-1, including 5 healthy individuals and 15 HIV+ patients. There was no significant association between B19V IgM or DNA and anemia nor between B19V DNA and HIV load. CONCLUSIONS The results indicate that B19V is not a high-risk factor for anemia in adult HIV+ patients under HAART treatment. Further studies will contribute to elucidate the mechanisms and significance of B19V DNA prevalence/persistence in adults, independently of the CD4+ cell status.
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Affiliation(s)
- Mauro Sebastian Pedranti
- Institutode Virología 'Dr J. M. Vanella', Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina.,Fundaciónpara el Progreso de la Medicina, Córdoba, Argentina
| | | | - Romina Bracciaforte
- Institutode Virología 'Dr J. M. Vanella', Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | | | - Pablo Lujan
- Hospital Privado, Centro Médico de Córdoba, Córdoba, Argentina
| | - Brenda Ricchi
- Hospital Privado, Centro Médico de Córdoba, Córdoba, Argentina
| | - Jorge Mautino
- Fundaciónpara el Progreso de la Medicina, Córdoba, Argentina
| | - Maria Pilar Adamo
- Institutode Virología 'Dr J. M. Vanella', Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
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Karrasch M, Schmidt V, Hammer A, Hochhaus A, Rosée PL, Petersen I, Sauerbrei A, Baier M, Sayer HG, Hermann B. Chronic persistent parvovirus B19 bone marrow infection resulting in transfusion-dependent pure red cell aplasia in multiple myeloma after allogeneic haematopoietic stem cell transplantation and severe graft versus host disease. Hematology 2016; 22:93-98. [DOI: 10.1080/10245332.2016.1183288] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Matthias Karrasch
- Institute of Medical Microbiology, Jena University Hospital, Jena, Germany
| | - Volker Schmidt
- Dep. of Internal Medicine II, Hematology/Oncology, Jena University Hospital, Jena, Germany
- Department of Hematology/Oncology/Hemostaseology, Helios Klinikum, Erfurt, Germany
| | - Andreas Hammer
- Institute for Pathology, Jena University Hospital, Jena, Germany
| | - Andreas Hochhaus
- Dep. of Internal Medicine II, Hematology/Oncology, Jena University Hospital, Jena, Germany
| | - Paul La Rosée
- Dep. of Internal Medicine II, Hematology/Oncology, Jena University Hospital, Jena, Germany
| | - Iver Petersen
- Institute for Pathology, Jena University Hospital, Jena, Germany
| | - Andreas Sauerbrei
- Institute for Virology and Antiviral Therapy, Jena University Hospital, Jena, Germany
| | - Michael Baier
- Institute of Medical Microbiology, Jena University Hospital, Jena, Germany
| | - Herbert G. Sayer
- Department of Hematology/Oncology/Hemostaseology, Helios Klinikum, Erfurt, Germany
| | - Beate Hermann
- Institute of Medical Microbiology, Jena University Hospital, Jena, Germany
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Naidoo S, Louis Naicker V. Retrospective comparison of cytological and histological bone marrow morphology in adult antiretroviral-naïve and antiretroviral experienced human immunodeficiency virus-infected patients with peripheral blood cytopaenias. S Afr J Infect Dis 2016. [DOI: 10.1080/23120053.2016.1128147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Sterpu R, Ichou H, Mahé I, Mortier E. [Reactivation of parvovirus B19 infection in an HIV-infected woman]. Rev Med Interne 2013; 35:396-8. [PMID: 23791089 DOI: 10.1016/j.revmed.2013.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 04/30/2013] [Accepted: 05/07/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Infection by human parvovirus B19 (erythrovirus B19) is common and usually asymptomatic during childhood conferring lasting protection against a new infection. Parvovirus B19 infection may cause erythema infectiosum (5th disease) and aplastic crisis. Secondary symptomatic parvovirus B19 infection in the same patient is rare and its physiopathology is not always clear. CASE REPORT A 48-year-old HIV-infected female patient presented within 5 years two acute episodes of parvovirus B19 infection although her CD4 cells count was above 500/mm(3). Absence of specific antibodies production after the first episode and persisting parvovirus viremia suggested viral reactivation rather than re-infection. During the second episode, specific antibodies were produced. CONCLUSION Similarly to most DNA viruses, parvovirus B19 reactivation is possible in HIV-infected patients while effectively treated by antiretroviral therapy.
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Affiliation(s)
- R Sterpu
- Service de médecine interne, hôpital Louis-Mourier (AP-HP), 178, rue des Renouillers, 92700 Colombes, France
| | - H Ichou
- Service de microbiologie, hôpital Louis-Mourier (AP-HP), 178, rue des Renouillers, 92700 Colombes, France
| | - I Mahé
- Service de médecine interne, hôpital Louis-Mourier (AP-HP), 178, rue des Renouillers, 92700 Colombes, France
| | - E Mortier
- Service de médecine interne, hôpital Louis-Mourier (AP-HP), 178, rue des Renouillers, 92700 Colombes, France.
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Azevedo KMLD, Setúbal S, Camacho LAB, Garcia RDCNC, Siqueira MM, Pereira RFA, Oliveira SAD. Parvovirus B19 seroconversion in a cohort of human immunodeficiency virus-infected patients. Mem Inst Oswaldo Cruz 2012; 107:356-61. [DOI: 10.1590/s0074-02762012000300010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Accepted: 01/11/2012] [Indexed: 11/21/2022] Open
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Slavov SN, Kashima S, Pinto ACS, Covas DT. Human parvovirus B19: general considerations and impact on patients with sickle-cell disease and thalassemia and on blood transfusions. ACTA ACUST UNITED AC 2011; 62:247-62. [DOI: 10.1111/j.1574-695x.2011.00819.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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