The prevalence of latent/chronic infection in liver transplant candidates in Taleghani Hospital of Tehran, Iran, from 2020 until 2021

Aim

The present study aimed to study the prevalence of various latent infections in pre-transplanted patients.

Background

Due to chronic immunosuppressive therapy, patients receiving organ transplants are at risk for reactivation of various infections. Due to the complications in the course of diagnosing and treating the post-transplant infection, screening transplant recipients and donors is vital.

Methods

This retrospective cohort study was performed between March 2020 and 2021. A total of 193 patients receiving a liver transplant in Taleghani Hospital, Tehran, Iran were enrolled.

Results

One-hundred and three (53.4%) patients were men, with an average age of 48.4 ± 13.3 years. Among viruses, 177 (91.7%) patients had a positive IgG titer for CMV. Anti-EBV IgG was positive in 169 (87.6%) patients. One-hundred and seventy-five (90.7%) patients had a positive IgG titer for the VZV. One-hundred and sixty-six (86.0%) cases had positive IgG anti-HSV antibodies. According to our findings, none of the patients were infected with HIV, but 9 (4.7%) cases and 141 (73.1%) had positive anti-HCV and anti-HAV IgG antibodies, respectively. HBV surface (HBs) antigen was also reported positive in 17 (8.8%) patients, while the HBs antibody was positive in 29 (15.0%) patients.

Conclusion

In our study, most of the patients had positive serology for latent viral infections such as CMV, EBV, VZV, and HSV, but the prevalence of latent tuberculosis and viral hepatitis was low among transplant candidates.

Antiviral therapy use and related outcomes in patients with cancer and viral infections: results from SWOG S1204

PURPOSE

Information is limited about adherence to practice guidelines in patients with hepatitis B virus (HBV), hepatitis C virus (HCV), or HIV infection receiving anticancer treatment.

METHODS

Newly diagnosed adult cancer patients were enrolled in a multicenter, prospective cohort study (SWOG S1204) during 2013-2017 to evaluate the prevalence of HBV, HCV, or HIV in patients initiating anticancer treatment. At 6 months, records of virus-positive patients were reviewed for antiviral therapy use; anticancer treatment dose reduction; and HBV reactivation (elevated viral load). Categorical variables were compared using chi-square or Fisher's exact test.

RESULTS

Of 3055 enrolled patients with viral testing, 230 had chronic or past HBV, HCV, or HIV with 6-month follow-up data (chronic HBV, 15 patients; past HBV, 158; HCV, 49; HIV, 30). Twenty percent (3/15) of chronic HBV and 11% (17/158) of past HBV patients were co-infected with HCV and/or HIV. Rates of antiviral therapy use by 6 months were as follows: chronic HBV, 85% (11/13); past HBV receiving anti-B cell therapy, 60% (3/5); past HBV receiving systemic anticancer therapy without anti-B cell therapy, 8% (8/105); HCV, 6% (2/35); and HIV, 90% (19/21). Among patients with available data, anticancer treatment dose was reduced in 1 of 145 patients with past HBV and 1 of 42 with HCV. HBV reactivation occurred in 1 of 15 patients with chronic HBV; this patient was not receiving antiviral therapy.

CONCLUSION

Many patients with cancer and viral infections either do not receive guideline-recommended antiviral treatment or receive antiviral treatment that is not recommended in guidelines. Further education is needed to improve adherence to guidelines.

Enteritis induced by reactivation of congenital latent infection of human cytomegalovirus in mice

AIM: To establish the model of hemorrhagic necrotic enteritis induced by reactivation of congenital latent infection of human cytomegalovirus (HCMV) in aged mice, and to explore the pathogenic mechanism of HCMV reactivation.

METHODS: Congenital latent HCMV-infected mice were raised in specific pathogen free (SPF) barrier system for 18 months. Eighteen virus-infected mice served as controls and 9 offspring mice were both treated with cyclophosphamide to reactivate the HCMV infection. Each group of the mice was sacrificed to obtain small intestine tissues for virus isolation. The expression of HCMV UL83 mRNA was determined using polymerase chain reaction (PCR), reverse transcription PCR (RT-PCR), HE staining and immunofluorescence with aseptic technique.

RESULTS: HCMV was isolated from the supernatant of small bowel tissue homogenate only in the group of infection-reactivated mice. Under microscopy, cytopathic effect caused by endogenous multiplication of HCMV in HF was observed. HCMV UL83 DNA was detected using PCR in the supernatant of cell culture with cytopathogenic effect (CPE). Masccline signal of apple green was seen using immunofluorescence. Pathological changes in bowels consisted of swollen cytoplasm, destroyed nuclei of enterocyte, distinct intranuclear inclusion in the enterocyte, and predominant infiltration of phagocytes. HCMV DNA was found by PCR in the group of infection-reactivated and latently-infected mice, but HCMV mRNA was only found in the group of infection-reactivated mice by RT-PCR.

CONCLUSION: A rat model of enteritis induced by reactivation of congenital latent HCMV infection was successfully established, and its pathological presentations indicate hemorrhagic necrotic enteritis.

Study on liver damage induced by reactivation of congenital latent infection of human cytomegalovirus in aged mice

AIM: To establish the model of liver damage induced by reactivation of congenital latent infection of human cytomegalovirus (HCMV) in aged mice, and to explore the pathogenic mechanism of HCMV reactivation.

METHODS: Firstly, the mouse model of congenital latent HCMV infection was established. After raised in specific pathogen free (SPF) barrier system for 18 mo, 9 offspring mice served as cell controls and 18 were taken out for experiment, half of which were treated with cyclophosphamide to reactivate the HCMV infection. The mice without HCMV infection were used as normal controls. All the mice were sacrificed to obtain liver tissues for virus isolation, polymerase chain reaction (PCR), reverse transcription PCR (RT-PCR) and HE stainging.

RESULTS: HCMV was isolated from the supernatant of liver tissue homogenate only in the group of infection- reactivated mice. HCMV DNA was detected by PCR in the supernatant of cell culture with cytopathogenic effect (CPE). Pathological changes in liver consisted of swollen cytoplasm, destroyed nuclei of hepatocytes, distinct intranuclear inclusion in the hepatocytes, and predominant infiltration of phagocytic cells. HCMV DNA was found by PCR in the group of infection-reactivated and latently-infected mice, but HCMV mRNA was only found in the group of infection-reactivated mice by RT-PCR.

CONCLUSION: Reactivation of congenital latent HCMV infection can induce liver damage in mice.