TY - JOUR AU - Oikonomou, Katerina AU - Taimur, Sarah PY - 2019 DA - 2019/06/17 TI - Non-CMV Viral Infections Following Solid-Organ Transplantation – Focus on Human T-Cell Lymphotropic Virus Type-1 and Human Herpesviruses-6,-7 and -8 JO - OBM Transplantation SP - 066 VL - 03 IS - 02 AB - In non-endemic areas, HTLV-1 is an uncommon pathogen in the transplant host but can be associated with significant morbidity and mortality. Careful assessment of risk factors, targeted screening and heightened awareness of the clinical presentation of HTLV-1 associated disease is necessary for timely recognition and management in the transplant host. The use of antiretroviral agents in the management of symptomatic disease due to HTLV-1 remains controversial. HHV-6 has long been recognized as a pathogen in the transplant host however, establishing pathogenicity remains a challenge in clinical situations due to its ubiquitous nature, overlapping clinical manifestations and clustering of infection with other beta-herpesviruses. HHV-6 has the unique ability to undergo integration into the host chromosome and has been reported in ~1% of solid-organ and allogeneic stem cell transplant population. Increased recognition of this entity is needed as it can be mistaken for active viral infection and can lead to unnecessary use of antiviral medications. Current guidelines recommend against screening and treatment of asymptomatic HHV-6 infection in the solid-organ transplant host. HHV-7 is often diagnosed as co-infection with other beta-herpesviruses but pathogenicity is less clear. No clinical syndrome solely attributable to HHV-7 has been identified. HHV-8 infection following organ transplantation can be due to primary acquisition from donor or non-donor derived exposures; or secondary to reactivation of latent infection in a seropositive recipient. Kaposi sarcoma is the most common HHV-8 associated post-transplant complication however, there is increasing recognition of non-neoplastic syndromes of febrile illness with bone marrow suppression and hemophagocytic syndrome. Lack of standardized laboratory assays remains an impediment to targeted screening and diagnosis of HHV-8 associated complications. There is accumulating data on the role of mTOR inhibitors and HIV protease inhibitors particularly nelfinavir in the treatment of KS however, data in the transplant host is sparse. Multi-disciplinary approach is needed for management of HHV-8 associated complications. SN - 2577-5820 UR - https://doi.org/10.21926/obm.transplant.1902066 DO - 10.21926/obm.transplant.1902066 ID - Oikonomou2019 ER -