Program Schedule

433
Human Herpesvirus 6 Reactivation, Delirium, and the Effect of Antiviral Prophylaxis Strategies After Cord Blood Transplantation

Session: Poster Abstract Session: Transplant Infectious Diseases
Thursday, October 9, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Posters
  • Cords_IDSA_Poster_Sept11.pdf (314.7 kB)
  • Background: Human herpesvirus 6 (HHV-6) reactivates in the majority of cord blood transplantation (CBT) recipients and is associated with significant morbidity. We previously reported that HHV-6 reactivation after hematopoietic cell transplantation (HCT) is associated with delirium (Zerr et. al. 2011, Blood 117: 5243), but only 21 patients (7%) of the cohort received CBT. Here we examine whether HHV-6 reactivation increases the risk for delirium after CBT and if intensive antiviral prophylaxis can reduce its impact.

    Methods: We tested for HHV-6 by twice weekly plasma PCR until day +84 in a prospective cohort of 44 CBT recipients, 34 of whom were assessed for delirium 3 times weekly. Twenty patients were included in our original study (one patient receiving foscarnet was excluded). Antiviral prophylaxis strategies in CMV seropositive patients changed during enrollment from standard prophylaxis (acylcovir 800 mg twice daily) to intensive prophylaxis (ganciclovir 5 mg/kg daily on days -8 to -2 and acyclovir 800 mg three times daily on days 0 to +100) (Milano et. al. 2011, Blood 118: 5689). Delirium was modeled using longitudinal logistic regression with generalized estimating equations, and Cox proportional hazards were used to evaluate risk factors for HHV-6 reactivation.

    Results: HHV-6 was detected in 66% of the cohort, and 27% of assessed patients had delirium. Patients with high-level viremia (>1000 copies/ml, 48%) were more likely to develop delirium (odds ratio [OR], 3.05; 95% confidence interval [CI], 1.03-9; p=0.043). This relationship was maintained in a series of bivariate models except when adjusting for comorbidity, which was a stronger predictor of delirium. Comorbidity score was not associated with HHV-6 reactivation. Intensive prophylaxis was given to 39% of patients and appeared to reduce risk of high-level viremia (adjusted hazard ratio, 0.28; 95% CI, 0.1-0.76; p=0.013) (Fig. 1). We were unable to analyze the effect of intensive prophylaxis on delirium due to sample size.

    Conclusion:

    HHV-6 reactivation with high-level viremia after CBT is independently associated with delirium. An intensive antiviral prophylaxis strategy mitigated HHV-6 reactivation, but larger studies are needed to assess this association with outcomes.


    Joshua Hill, MD1,2, Michael Boeckh, MD1,2, Wendy Leisenring, Sc.D.2, Hu Xie, MSc3, Colleen Delaney, MD, MSc3,4, Amanda Adler5 and Danielle Zerr, MD, MPH, FPIDS3,4,5, (1)Division of Allergy and Infectious Disease, University of Washington, Seattle, WA, (2)Fred Hutchinson Cancer Research Center, Seattle, WA, (3)Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, (4)Department of Pediatrics, University of Washington, Seattle, WA, (5)Seattle Children's Research Institute, Seattle, WA

    Disclosures:

    J. Hill, None

    M. Boeckh, Chimerix, Inc.: Consultant, Research support
    Genentech/Roche: Consultant, Research support
    Gilead: Consultant, Research support
    Clinigen: Consultant, Research support

    W. Leisenring, None

    H. Xie, None

    C. Delaney, None

    A. Adler, None

    D. Zerr, Sage Products: Investigator, Research support
    Chimerix, Inc.: Investigator, Research support

    Findings in the abstracts are embargoed until 12:01 a.m. EDT, Oct. 8th with the exception of research findings presented at the IDWeek press conferences.

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