Preventive Strategies Against Cytomegalovirus and Incidence of α‐Herpesvirus Infections in Solid Organ Transplant Recipients: A Nationwide Cohort Study |
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| Authors: | C Martin‐Gandul S Stampf D Héquet N J Mueller A Cusini C van Delden N Khanna K Boggian C Hirzel P Soccal H H Hirsch M Pascual P Meylan O Manuel Swiss Transplant Cohort Study |
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| Institution: | 1. Transplantation Center, University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland;2. Infectious Diseases Service, University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland;3. Institute for Clinical Epidemiology and Biostatistics, University Hospital of Basel, Basel, Switzerland;4. Division of Infectious Diseases and Hospital Epidemiology, University Hospital, University of Zurich, Zürich, Switzerland;5. Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland;6. Transplant Infectious Diseases Unit, University Hospital Geneva, Geneva, Switzerland;7. Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Basel, Basel, Switzerland;8. Division of Infectious Diseases and Hospital Hygiene, Kantonsspital St. Gallen, St. Gallen, Switzerland;9. Division of Pneumology, Department of Medicine, University Hospital Geneva, Geneva, Switzerland;10. Transplantation & Clinical Virology, Department Biomedicine (Haus Petersplatz), University of Basel, Basel, Switzerland;11. Institute of Microbiology, University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland |
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| Abstract: | We assessed the impact of antiviral preventive strategies on the incidence of herpes simplex virus (HSV) and varicella‐zoster virus (VZV) infections in a nationwide cohort of transplant recipients. Risk factors for the development of HSV or VZV infection were assessed by Cox proportional hazards regression. We included 2781 patients (56% kidney, 20% liver, 10% lung, 7.3% heart, 6.7% others). Overall, 1264 (45%) patients received antiviral prophylaxis (ganciclovir or valganciclovir, n = 1145; acyclovir or valacyclovir, n = 138). Incidence of HSV and VZV infections was 28.9 and 12.1 cases, respectively, per 1000 person‐years. Incidence of HSV and VZV infections at 1 year after transplant was 4.6% (95% confidence interval CI] 3.5–5.8) in patients receiving antiviral prophylaxis versus 12.3% (95% CI 10.7–14) in patients without prophylaxis; this was observed particularly for HSV infections (3% 95% CI 2.2–4] versus 9.8% 95% CI 8.4–11.4], respectively). A lower rate of HSV and VZV infections was also seen in donor or recipient cytomegalovirus‐positive patients receiving ganciclovir or valganciclovir prophylaxis compared with a preemptive approach. Female sex (hazard ratio HR] 1.663, p = 0.001), HSV seropositivity (HR 5.198, p < 0.001), previous episodes of rejection (HR 1.95, p = 0.004), and use of a preemptive approach (HR 2.841, p = 0.017) were significantly associated with a higher risk of HSV infection. Although HSV and VZV infections were common after transplantation, antiviral prophylaxis significantly reduced symptomatic HSV infections. |
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| Keywords: | clinical research/practice infectious disease antibiotic: antiviral‐ganciclovir/valganciclovir infection and infectious agents viral: herpes zoster/Varicella infection and infectious agents viral |
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