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Zhao Y, Zeng Y, Lu R, Wang Z, Zhang X, Wu N, Zhu T, Wang Y, Zhang C. Rapid point-of-care detection of BK virus in urine by an HFman probe-based loop-mediated isothermal amplification assay and a finger-driven microfluidic chip. PeerJ 2023; 11:e14943. [PMID: 36915661 PMCID: PMC10007963 DOI: 10.7717/peerj.14943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 02/01/2023] [Indexed: 03/16/2023] Open
Abstract
Background BK virus (BKV)-associated nephropathy (BKVN) is one of the leading causes of renal dysfunction and graft loss in renal transplant recipients. Early monitoring of BKV in urine is crucial to minimize the deleterious effects caused by this virus on preservation of graft function. Methods We report a simple, rapid, sensitive loop-mediated isothermal amplification (LAMP) assay using an HFman probe for detecting BKV in urine. To evaluate the performance of the assay, a comparison of the HFman probe-based LAMP (HF-LAMP) assay with two qPCR assays was performed using urine samples from 132 HIV-1 infected individuals. We further evaluated the performance of HF-LAMP directly using the urine samples from these HIV-1 infected individuals and 30 kidney transplant recipients without DNA extraction. Furthermore, we combined the HF-LAMP assay with a portable finger-driven microfluidic chip for point-of-care testing (POCT). Results The assay has high specificity and sensitivity with a limit of detection (LOD) of 12 copies/reaction and can be completed within 30 min. When the DNA was extracted, the HF-LAMP assay showed an equivalent and potentially even higher sensitivity (93.5%) than the qPCR assays (74.2-87.1%) for 132 urine samples from HIV-1 infected individuals. The HF-LAMP assay can be applied in an extraction-free format and can be completed within 45 min using a simple heat block. Although some decreased performance was seen on urine samples from HIV-1 infected individuals, the sensitivity, specificity, and accuracy of the extraction-free BKV HF-LAMP assay were 95%, 100%, and 96.7% for 30 clinical urine samples from kidney transplant recipients, respectively. Conclusion The assay has high specificity and sensitivity. Combined with a portable finger-driven microfluidic chip for easy detection, this method shows great potential for POCT detection of BKV.
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Affiliation(s)
- Yongjuan Zhao
- Shanghai Public Health Clinical Center, Shanghai, China
| | - Yi Zeng
- Shanghai Public Health Clinical Center, Shanghai, China
| | - Renfei Lu
- Nantong Third Hospital Affiliated to Nantong University, Nantong, China
| | - Zhiying Wang
- Beijing Advanced Innovation Center for Biomedical Engineering, Key Laboratory for Biomechanics and Mechanobiology, School of Engineering Medicine, Beihang University, Beijing, China
| | | | - Nannan Wu
- Shanghai Public Health Clinical Center, Shanghai, China
| | - Tongyu Zhu
- Shanghai Medical College, Shanghai, China.,Zhongshan Hospital, Shanghai, China
| | - Yang Wang
- Beijing Advanced Innovation Center for Biomedical Engineering, Key Laboratory for Biomechanics and Mechanobiology, School of Engineering Medicine, Beihang University, Beijing, China
| | - Chiyu Zhang
- Shanghai Public Health Clinical Center, Shanghai, China
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2
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The effect of BK polyomavirus large T antigen on CD4 and CD8 T cells in kidney transplant recipients. Transpl Immunol 2022; 74:101655. [PMID: 35777612 DOI: 10.1016/j.trim.2022.101655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 06/01/2022] [Accepted: 06/22/2022] [Indexed: 11/20/2022]
Abstract
Human BK polyomavirus (BKPyV) can affect the machinery of the host cell to induce optimal viral replication or transform them into tumor cells. Reactivation of BKPyV happens due to immunosuppression therapies following renal transplantation which might result in BK polyomavirus nephropathy (BKPyVAN) and allograft loss. The first protein that expresses after entering into host cells and has an important role in pathogenicity is the Large T antigen (LT-Ag). In this review tries to study the molecular and cellular inter-regulatory counteractions especially between CD4 and CD8 T cells, and BKPyV LT-Ag may have role in nephropathy after renal transplantation.
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BK Virus-Associated Nephropathy after Renal Transplantation. Pathogens 2021; 10:pathogens10020150. [PMID: 33540802 PMCID: PMC7913099 DOI: 10.3390/pathogens10020150] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 01/29/2021] [Accepted: 01/29/2021] [Indexed: 02/06/2023] Open
Abstract
Recent advances in immunosuppressive therapy have reduced the incidence of acute rejection and improved renal transplantation outcomes. Meanwhile, nephropathy caused by BK virus has become an important cause of acute or chronic graft dysfunction. The usual progression of infection begins with BK viruria and progresses to BK viremia, leading to BK virus associated nephropathy. To detect early signs of BK virus proliferation before the development of nephropathy, several screening tests are used including urinary cytology and urinary and plasma PCR. A definitive diagnosis of BK virus associated nephropathy can be achieved only histologically, typically by detecting tubulointerstitial inflammation associated with basophilic intranuclear inclusions in tubular and/or Bowman’s epithelial cells, in addition to immunostaining with anti-Simian virus 40 large T-antigen. Several pathological classifications have been proposed to categorize the severity of the disease to allow treatment strategies to be determined and treatment success to be predicted. Since no specific drugs that directly suppress the proliferation of BKV are available, the main therapeutic approach is the reduction of immunosuppressive drugs. The diagnosis of subsequent acute rejection, the definition of remission, the protocol of resuming immunosuppression, and long-term follow-up remain controversial.
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Burek Kamenaric M, Ivkovic V, Kovacevic Vojtusek I, Zunec R. The Role of HLA and KIR Immunogenetics in BK Virus Infection after Kidney Transplantation. Viruses 2020; 12:v12121417. [PMID: 33317205 PMCID: PMC7763146 DOI: 10.3390/v12121417] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/04/2020] [Accepted: 12/08/2020] [Indexed: 12/13/2022] Open
Abstract
BK virus (BKV) is a polyomavirus with high seroprevalence in the general population with an unremarkable clinical presentation in healthy people, but a potential for causing serious complications in immunosuppressed transplanted patients. Reactivation or primary infection in kidney allograft recipients may lead to allograft dysfunction and subsequent loss. Currently, there is no widely accepted specific treatment for BKV infection and reduction of immunosuppressive therapy is the mainstay therapy. Given this and the sequential appearance of viruria-viremia-nephropathy, screening and early detection are of utmost importance. There are numerous risk factors associated with BKV infection including genetic factors, among them human leukocyte antigens (HLA) and killer cell immunoglobulin-like receptors (KIR) alleles have been shown to be the strongest so far. Identification of patients at risk for BKV infection would be useful in prevention or early action to reduce morbidity and progression to frank nephropathy. Assessment of risk involving HLA ligands and KIR genotyping of recipients in the pre-transplant or early post-transplant period might be useful in clinical practice. This review summarizes current knowledge of the association between HLA, KIR and BKV infection and potential future directions of research, which might lead to optimal utilization of these genetic markers.
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Affiliation(s)
- Marija Burek Kamenaric
- Tissue Typing Center, Clinical Department of Transfusion Medicine and Transplantation Biology, University Hospital Center Zagreb, 10 000 Zagreb, Croatia;
| | - Vanja Ivkovic
- Department of Nephrology, Hypertension, Dialysis and Transplantation, University Hospital Center Zagreb, 10 000 Zagreb, Croatia; (V.I.); (I.K.V.)
- Department of Public Health, Faculty of Health Studies, University of Rijeka, 51 000 Rijeka, Croatia
| | - Ivana Kovacevic Vojtusek
- Department of Nephrology, Hypertension, Dialysis and Transplantation, University Hospital Center Zagreb, 10 000 Zagreb, Croatia; (V.I.); (I.K.V.)
| | - Renata Zunec
- Tissue Typing Center, Clinical Department of Transfusion Medicine and Transplantation Biology, University Hospital Center Zagreb, 10 000 Zagreb, Croatia;
- Correspondence:
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Alwahaibi NY, Al Maskari TM, Aldairi N. Decoy Cells versus Plasma Real-Time Polymerase Chain Reaction for the Detection of Polyomaviruses in Renal Transplant Patients: A Single Institutional Experience. J Cytol 2019; 37:30-33. [PMID: 31942095 PMCID: PMC6947735 DOI: 10.4103/joc.joc_167_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 04/13/2019] [Accepted: 10/09/2019] [Indexed: 11/15/2022] Open
Abstract
Background and Aims: Microscopic detection of decoy cells is routinely performed in urine samples from renal transplant patients for the evaluation of polyomaviruses. However, they are scanty papers evaluated the diagnostic accuracy of decoy cells in urine samples. The aim of this study is to evaluate the diagnostic accuracy of decoy cells in urine samples and compare with plasma real-time polymerase chain reaction (RT-PCR) as a gold standard method. In addition, to compare the findings of this study with other similar studies. Methods: A retrospective study over a period of four years from January 2014 to December 2017 was performed. A total of 89 urine samples from renal transplant patients were assessed for the presence of polyomaviruses and compared with plasma RT-PCR. The sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) were measured. Results: There were 29 males and 18 females. The mean patient age was 40.3 years. The sensitivity, specificity, accuracy, PPV and NPV were 86.6%, 67.5%, 70.7%, 35.1% and 96.1%, respectively. Other similar studies reported a sensitivity of 41.9-84.6%, specificity of 65.8-100% and accuracy of 69.9-82%. Conclusion: The findings of this study show that the detection of decoy cells in urine samples is a sensitive screening method for polyomaviruses. The findings of this study are compatible with other similar studies.
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Affiliation(s)
- Nasar Y Alwahaibi
- Department of Allied Health Sciences, Sultan Qaboos University Hospital, Muscat, Oman
| | | | - Najat Aldairi
- Department of Pathology, Sultan Qaboos University Hospital, Muscat, Oman
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Ucar ZA, Sinangil A, Koc Y, Barlas S, Abouzahir S, Ecder ST, Akin EB. Clinical Prognosis of Renal Retransplant Patients: A Single-Center Experience. Transplant Proc 2019; 51:2274-2278. [PMID: 31474292 DOI: 10.1016/j.transproceed.2019.03.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 02/20/2019] [Accepted: 03/12/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Retransplantation is a treatment option in patients with end-stage renal failure due to graft loss. Outcomes of these patients due to high immunologic risk remain unclear. The aim of this study was to evaluate outcomes of renal retransplantation patients retrospectively. METHODS Renal retransplant patients in our unit were evaluated retrospectively between 2010 and 2018. Patients' demographic characteristics, primary diseases, the causes of prior graft loss, immunologic status, desensitization protocols, the induction and maintenance treatments, the complications during the follow-up period, numbers of acute rejections, and the clinical prognosis were all detected from the patients' files. RESULTS We retrospectively evaluated 17 patients who underwent a second or third renal allograft. Of these, 16 received a second and the remaining 1 patient received a third renal allograft. Immunologically, all of the 17 patients had negative flow cytometry crossmatch, 1 patient had a positive complement-dependent cytotoxicity crossmatch (Auto 12%), 16 patients had positive panel reactive antibody, the median HLA-mismatch was 3.5, and the score of donor-specific antibody relative intensity score (RIS) was 6.4 ± 6.3. Ten pretransplant patients had desensitization treatment. While scores for HLA-MM and HLA-RIS in the patients who had a desensitization therapy were determined higher, no statistical difference was observed (respectively, P = .28 and .55). No acute rejection episode developed. BK virus DNA viremia was detected in 4 patients during the posttransplant 6th month. We observed no patient death or no graft loss during the follow-up period. CONCLUSION Although the retransplant patients who had a graft loss previously have high immunologic risks, retransplantation is reliable in these patients, but they should be followed up carefully in terms of BKV nephropathy.
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Affiliation(s)
- Zuhal Atan Ucar
- Division of Nephrology, Department of Internal Medicine, Istanbul Bilim University Medical Faculty, Istanbul, Turkey.
| | - Ayse Sinangil
- Division of Nephrology, Department of Internal Medicine, Istanbul Bilim University Medical Faculty, Istanbul, Turkey
| | - Yener Koc
- Division of Nephrology, Department of Internal Medicine, Istanbul Bilim University Medical Faculty, Istanbul, Turkey
| | - Soykan Barlas
- Unit of Renal Transplantation, Department of General Surgery, Istanbul Bilim University Medical Faculty, Istanbul, Turkey
| | - Sana Abouzahir
- Division of Nephrology, Department of Internal Medicine, Istanbul Bilim University Medical Faculty, Istanbul, Turkey; Department of Nephrology, Cheikh Anta Diop University, Dakar, Senegal
| | - Suleyman Tevfik Ecder
- Division of Nephrology, Department of Internal Medicine, Istanbul Bilim University Medical Faculty, Istanbul, Turkey
| | - Emin Baris Akin
- Unit of Renal Transplantation, Department of General Surgery, Istanbul Bilim University Medical Faculty, Istanbul, Turkey
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7
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Popik W, Khatua AK, Fabre NF, Hildreth JEK, Alcendor DJ. BK Virus Replication in the Glomerular Vascular Unit: Implications for BK Virus Associated Nephropathy. Viruses 2019; 11:E583. [PMID: 31252545 PMCID: PMC6669441 DOI: 10.3390/v11070583] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 06/10/2019] [Accepted: 06/25/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND BK polyomavirus (BKV) reactivates from latency after immunosuppression in renal transplant patients, resulting in BKV-associated nephropathy (BKVAN). BKVAN has emerged as an important cause of graft dysfunction and graft loss among transplant patients. BKV infection in kidney transplant patients has increased over recent decades which correlates with the use of more potent immunosuppressive therapies. BKV infection of the Glomerular Vascular Unit (GVU) consisting of podocytes, mesangial cells, and glomerular endothelial cells could lead to glomerular inflammation and contribute to renal fibrosis. The effects of BKV on GVU infectivity have not been reported. METHODS We infected GVU cells with the Dunlop strain of BKV. Viral infectivity was analyzed by microscopy, immunofluorescence, Western blot analysis, and quantitative RT-PCR (qRT-PCR). The expression of specific proinflammatory cytokines induced by BKV was analyzed by qRT-PCR. RESULTS BKV infection of podocytes, mesangial cells, and glomerular endothelial cells was confirmed by qRT-PCR and positive staining with antibodies to the BKV VP1 major capsid protein, or the SV40 Large T-Antigen. The increased transcriptional expression of interferon gamma-induced protein 10 (CXCL10/IP-10) and interferon beta (IFNβ) was detected in podocytes and mesangial cells at 96 h post-infection. CONCLUSIONS All cellular components of the GVU are permissive for BKV replication. Cytopathic effects induced by BKV in podocytes and glomerular endothelial cells and the expression of CXCL10 and IFNβ genes by podocytes and mesangial cells may together contribute to glomerular inflammation and cytopathology in BKVAN.
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Affiliation(s)
- Waldemar Popik
- Department of Internal Medicine, Meharry Medical College, Nashville, TN 37208-3599, USA
| | - Atanu K Khatua
- Department of Microbiology, Immunology and Physiology, Center for AIDS Health Disparities Research, 1005 Dr. D.B. Todd Jr. Blvd., Nashville, TN 37208-3599, USA
| | - Noyna F Fabre
- Department of Microbiology, Immunology and Physiology, Center for AIDS Health Disparities Research, 1005 Dr. D.B. Todd Jr. Blvd., Nashville, TN 37208-3599, USA
| | - James E K Hildreth
- Department of Internal Medicine, Meharry Medical College, Nashville, TN 37208-3599, USA
| | - Donald J Alcendor
- Department of Microbiology, Immunology and Physiology, Center for AIDS Health Disparities Research, 1005 Dr. D.B. Todd Jr. Blvd., Nashville, TN 37208-3599, USA.
- Department of Obstetrics and Gynecology, Meharry Medical College, School of Medicine, 1005 Dr. D.B. Todd Jr. Blvd., Nashville, TN 37208-3599, USA.
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8
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Reduced Risk of BK Polyomavirus Infection in HLA-B51–positive Kidney Transplant Recipients. Transplantation 2019; 103:604-612. [DOI: 10.1097/tp.0000000000002376] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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9
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Korth J, Anastasiou OE, Bräsen JH, Brinkhoff A, Lehmann U, Kribben A, Dittmer U, Verheyen J, Wilde B, Ciesek S, Witzke O, Widera M. The detection of BKPyV genotypes II and IV after renal transplantation as a simple tool for risk assessment for PyVAN and transplant outcome already at early stages of BKPyV reactivation. J Clin Virol 2019; 113:14-19. [PMID: 30771597 DOI: 10.1016/j.jcv.2019.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 01/07/2019] [Accepted: 02/08/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND After reactivation the BK-polyomavirus (BKPyV) associated nephropathy (PyVAN) is observed in 1-10% of renal transplant recipients, of which up to 80% undergo graft failure. BKPyV reactivation after renal transplantation was associated with donor-derived serotypes against which the recipient has no immunological protection. However, PyVAN risk assessment seroactivity testing is a time-consuming and cost intensive process. OBJECTIVES Since BKPyV serotypes can be attributed to distinct genotypes I to IV, in the present study we retrospectively analyzed whether a simple PCR-based BKPyV genotyping assay might be a fast and inexpensive method to assess the risk for PyVAN and transplant outcome already at early stages of BKPyV reactivation. STUDY DESIGN 56 patients who were renal transplanted and tested positive for BKPyV viremia were included into the study. The BKPyV-VP1-coding sequences were PCR-amplified, sequenced, and subjected to genotyping. For group specific analysis patients were grouped in genotype I (n = 46) and a second group including genotype II and IV (n = 10) and associated with their clinical outcomes. RESULTS The most abundant genotype I was detected in 46 of 56 (82%) patients, however, in the genotype II and IV group PyVAN was twice as frequent as compared to the genotype I group 24 months after transplantation (8 of 10 (80%) vs. 17 of 46 (37%); p = 0.001). Accordingly, graft failure was significantly more frequent in the genotype II and IV group (3 of 10 (30%) vs. 2 of 46 (4%); p = 0.007). CONCLUSION PCR-based BKPyV genotyping might represent a fast and inexpensive method to assess the risk for PyVAN and transplant outcome already at early stages of BKPyV reactivation even if matched samples of the donor are not available.
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Affiliation(s)
- Johannes Korth
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany; Institute for Virology, University Hospital Essen, University of Duisburg-Essen Virchowstr. 179, 45147, Essen, Germany.
| | - Olympia Evdoxia Anastasiou
- Department of Gastroenterology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Jan Hinrich Bräsen
- Institute for Pathology, Hanover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany
| | - Alexandra Brinkhoff
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Ulrich Lehmann
- Institute for Pathology, Hanover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany
| | - Andreas Kribben
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Ulf Dittmer
- Institute for Virology, University Hospital Essen, University of Duisburg-Essen Virchowstr. 179, 45147, Essen, Germany
| | - Jens Verheyen
- Institute for Virology, University Hospital Essen, University of Duisburg-Essen Virchowstr. 179, 45147, Essen, Germany
| | - Benjamin Wilde
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Sandra Ciesek
- Institute for Virology, University Hospital Essen, University of Duisburg-Essen Virchowstr. 179, 45147, Essen, Germany
| | - Oliver Witzke
- Department of Infectious Diseases, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Marek Widera
- Institute for Virology, University Hospital Essen, University of Duisburg-Essen Virchowstr. 179, 45147, Essen, Germany
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周 易, 姚 雷, 于 哲, 崔 乃, 符 芳, 叶 悦, 邓 文, 徐 健, 付 绍, 刘 如, 于 立, 苗 芸. [Characteristics of BK polymavirus infection in kidney transplant recipients]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2019; 39:120-124. [PMID: 30692077 PMCID: PMC6765578 DOI: 10.12122/j.issn.1673-4254.2019.01.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To analyze the characteristics of BK polymavirus (BKV) infection and the optimal time window for intervention in kidney transplant recipients (KTRs). METHODS We retrospectively analyzed the clinical data and treatment regimens in 226 KTRs in our center between January, 2013 and January, 2018. Among the recipients, 157 had a urine BKV load ≥1.0×104 copy/mL after transplantation, and 69 had a urine BKV load below 1.0×104 copy/mL (control group). RESULTS Among the 157 KTRs, 60 (38.2%) recipients were positive for urine BKV, 66 (42.0%) had BKV viruria, and 31(19.7%) had BKV viremia. The incidence of positive urine occult blood was significantly higher in BKV-positive recipients than in the control group (P < 0.05). The change of urine BKV load was linearly related to that of Tacrolimus trough blood level (r2=0.351, P < 0.05). In urine BKV positive group, the average estimated glomerular filtration rate (eGFR) was below the baseline level (60 mL·min-1·1.73 m-2) upon diagnosis of BKV infection reactivation, and recovered the normal level after intervention. In patients with BKV viruria and viremia, the average eGFR failed to return to the baseline level in spite of improvement of the renal function after intervention. CONCLUSIONS Positive urine occult blood after transplantation may be associated with BKV infection reactivation in some of the KTRs. BKV infection is sensitive to changes of plasma concentration of immunosuppressive agents. Early intervention of BKV replication in KTRs with appropriate dose reduction for immunosuppression can help to control virus replication and stabilize the allograft function.
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Affiliation(s)
- 易 周
- 南方医科大学第一临床医学院,广东 广州 510515First Clinical Medical School, Southern Medical University, Guangzhou 510515, China
| | - 雷雨 姚
- 南方医科大学南方医院器官移植科,广东 广州 510515Department of Organ Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 哲 于
- 南方医科大学南方医院器官移植科,广东 广州 510515Department of Organ Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 乃千 崔
- 南方医科大学第一临床医学院,广东 广州 510515First Clinical Medical School, Southern Medical University, Guangzhou 510515, China
| | - 芳翔 符
- 南方医科大学南方医院器官移植科,广东 广州 510515Department of Organ Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 悦典 叶
- 南方医科大学第一临床医学院,广东 广州 510515First Clinical Medical School, Southern Medical University, Guangzhou 510515, China
| | - 文锋 邓
- 南方医科大学南方医院器官移植科,广东 广州 510515Department of Organ Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 健 徐
- 南方医科大学南方医院器官移植科,广东 广州 510515Department of Organ Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 绍杰 付
- 南方医科大学南方医院器官移植科,广东 广州 510515Department of Organ Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 如敏 刘
- 南方医科大学南方医院器官移植科,广东 广州 510515Department of Organ Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 立新 于
- 南方医科大学南方医院器官移植科,广东 广州 510515Department of Organ Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 芸 苗
- 南方医科大学南方医院器官移植科,广东 广州 510515Department of Organ Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
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11
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Herrmann A, Sandmann L, Adams O, Herrmann D, Dirks M, Widera M, Westhaus S, Kaiser R, di Cristanziano V, Manns MP, Korth J, Richter N, Anastasiou O, Timm J, von Hahn T, Ciesek S. Role of BK polyomavirus (BKV) and Torque teno virus (TTV) in liver transplant recipients with renal impairment. J Med Microbiol 2018; 67:1496-1508. [PMID: 30136921 DOI: 10.1099/jmm.0.000823] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Renal impairment is a common complication after liver transplantation (LT). While BK polyomavirus (BKV) has been linked to renal failure in kidney transplant recipients, Torque teno virus (TTV) is a surrogate marker for immunosuppression that does not have a clear association with any human disease. The impact of BKV and TTV on renal impairment after LT is unknown. METHODOLOGY In this retrospective study, urine and serum samples from 136 liver transplant recipients were screened for BKV and TTV by quantitative PCR. In addition, serum was screened for BKV-specific antibodies and the VP1 typing region was sequenced for BKV genotyping. All parameters were correlated with clinical data.Results/Key findings. BK viruria was detected up to 21 years after transplantation in 16.9 % of cases. BK viraemia was detected in 8.7 % of patients with BK viruria up to 4 years after LT. BKV-specific antibodies were detected in 93.6 % of all LT recipients and correlated with BKV viral load in urine. There was no correlation between renal impairment and the detection of BK DNA in urine (OR 0.983). TTV DNA was detected in 84.6 % of serum samples and in 66.6 % of urine samples. The TTV viral load in serum correlated with the BKV viral load but had no impact on renal impairment. CONCLUSION Our data indicate that the detection of BKV and TTV is not a risk factor for renal impairment after LT. A correlation of TTV and BKV viral load seems to be an indicator for the immune status of the host.
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Affiliation(s)
- Anke Herrmann
- 1Institute for Virology, University Hospital Essen, University of Duisburg-Essen, Essen, Hannover, Germany
| | - Lisa Sandmann
- 2Department of Gastroenterology, Hepatology and Endocrinology, Hanover Medical School, Hannover, Germany
| | - Ortwin Adams
- 3Institute for Virology, University Hospital Düsseldorf, Faculty of Medicine, University Düsseldorf, Düsseldorf, Germany
| | - Dominik Herrmann
- 4Thoraxzentrum Ruhrgebiet, Department of Thoracic Surgery, Evangelisches Krankenhaus, Herne, Germany
| | - Miriam Dirks
- 1Institute for Virology, University Hospital Essen, University of Duisburg-Essen, Essen, Hannover, Germany
| | - Marek Widera
- 1Institute for Virology, University Hospital Essen, University of Duisburg-Essen, Essen, Hannover, Germany
| | - Sandra Westhaus
- 1Institute for Virology, University Hospital Essen, University of Duisburg-Essen, Essen, Hannover, Germany
| | - Rolf Kaiser
- 5German Center for Infection Research, DZIF, Germany.,6Institute for Virology, University of Cologne, Cologne, Germany
| | | | - Michael P Manns
- 2Department of Gastroenterology, Hepatology and Endocrinology, Hanover Medical School, Hannover, Germany.,5German Center for Infection Research, DZIF, Germany
| | - Johannes Korth
- 1Institute for Virology, University Hospital Essen, University of Duisburg-Essen, Essen, Hannover, Germany
| | - Nico Richter
- 7Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany
| | - Olympia Anastasiou
- 1Institute for Virology, University Hospital Essen, University of Duisburg-Essen, Essen, Hannover, Germany
| | - Jörg Timm
- 3Institute for Virology, University Hospital Düsseldorf, Faculty of Medicine, University Düsseldorf, Düsseldorf, Germany
| | - Thomas von Hahn
- 2Department of Gastroenterology, Hepatology and Endocrinology, Hanover Medical School, Hannover, Germany.,5German Center for Infection Research, DZIF, Germany
| | - Sandra Ciesek
- 5German Center for Infection Research, DZIF, Germany.,1Institute for Virology, University Hospital Essen, University of Duisburg-Essen, Essen, Hannover, Germany
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12
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Trang VD, Rockett R, Jeoffreys N, Trung NV, Hai An HP, Kok J, Dwyer DE. BK polyomavirus: a review of the virology, pathogenesis, clinical and laboratory features, and treatment. Future Virol 2017. [DOI: 10.2217/fvl-2017-0013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BK polyomavirus (BKPyV) is a non-enveloped, circular dsDNA virus with a genome of approximately 5100 base pairs. It can be divided into four major genotypes, but the effects of different genotypes on clinical disease are uncertain. Primary BKPyV infection is generally acquired asymptomatically in childhood. It establishes low-level persistence in many tissues, particularly the genitourinary tract. Reactivation can lead to severe disease including BKPyV-associated nephropathy confirmed by renal biopsy, hemorrhagic cystitis and meningoencephalitis. Nucleic acid amplification testing of blood and urine is the main diagnostic and prognostic test for BKPyV infection. The treatment of BKPyV infection has concentrated on reduction in immunosuppressive therapy. Recent studies suggest that antiviral drugs have demonstrated only modest benefit, but adoptive T-cell therapies offer potential advances.
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Affiliation(s)
- Van Dinh Trang
- Clinical Laboratory, National Hospital of Tropical Diseases, 78-Giai Phong, Dong Da, Hanoi, Vietnam
- Western Clinical School, Westmead Hospital, The University of Sydney, NSW 2006, Australia
| | - Rebecca Rockett
- Center for Infectious Diseases & Microbiology Laboratory Services, Institute of Clinical Pathology & Medical Research, NSW Health Pathology, Westmead Hospital, Westmead NSW 2145, Australia
| | - Neisha Jeoffreys
- Center for Infectious Diseases & Microbiology Laboratory Services, Institute of Clinical Pathology & Medical Research, NSW Health Pathology, Westmead Hospital, Westmead NSW 2145, Australia
| | - Nguyen Vu Trung
- Clinical Laboratory, National Hospital of Tropical Diseases, 78-Giai Phong, Dong Da, Hanoi, Vietnam
- Department of Medical Microbiology, Hanoi Medical University, No. 1 Ton That Tung St, Dong Da, Hanoi, Vietnam
| | - Ha Phan Hai An
- Department of International Cooperation, Hanoi Medical University, No. 1 Ton That Tung St, Dong Da, Hanoi, Vietnam
- Kidney Diseases & Dialysis Department, Viet Duc Hospital, No. 40 Trang Thi St, Hoan Kiem, Hanoi, Vietnam
| | - Jen Kok
- Center for Infectious Diseases & Microbiology Laboratory Services, Institute of Clinical Pathology & Medical Research, NSW Health Pathology, Westmead Hospital, Westmead NSW 2145, Australia
| | - Dominic E Dwyer
- Western Clinical School, Westmead Hospital, The University of Sydney, NSW 2006, Australia
- Center for Infectious Diseases & Microbiology Laboratory Services, Institute of Clinical Pathology & Medical Research, NSW Health Pathology, Westmead Hospital, Westmead NSW 2145, Australia
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13
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Höller K, Fabeni L, Herling M, Holtick U, Scheid C, Knops E, Lübke N, Kaiser R, Pfister H, Di Cristanziano V. Dynamics of BKPyV reactivation and risk of hemorrhagic cystitis after allogeneic hematopoietic stem cell transplantation. Eur J Haematol 2017; 99:133-140. [DOI: 10.1111/ejh.12895] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2017] [Indexed: 12/20/2022]
Affiliation(s)
| | - Lavinia Fabeni
- National Institute for Infectious Diseases L. Spallanzani - IRCCS; Rome Italy
| | - Marco Herling
- Department I of Internal Medicine; Center for Integrated Oncology (CIO) Köln-Bonn and Excellence Cluster for Cellular Stress Response and Aging-Associated Diseases (CECAD); University Hospital of Cologne; Cologne Germany
| | - Udo Holtick
- Department I of Internal Medicine; Center for Integrated Oncology (CIO) Köln-Bonn and Excellence Cluster for Cellular Stress Response and Aging-Associated Diseases (CECAD); University Hospital of Cologne; Cologne Germany
| | - Christof Scheid
- Department I of Internal Medicine; Center for Integrated Oncology (CIO) Köln-Bonn and Excellence Cluster for Cellular Stress Response and Aging-Associated Diseases (CECAD); University Hospital of Cologne; Cologne Germany
| | - Elena Knops
- Institute of Virology; University of Cologne; Cologne Germany
| | - Nadine Lübke
- Institute of Virology; University of Cologne; Cologne Germany
| | - Rolf Kaiser
- Institute of Virology; University of Cologne; Cologne Germany
| | - Herbert Pfister
- Institute of Virology; University of Cologne; Cologne Germany
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14
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Agrawal N, Echenique IA, Meehan SM, Limaye AP, Cook L, Chang A, Harland RC, Javaid B, Kadambi PV, Matushek S, Williams J, Josephson MA. Variability in assessing for BK viremia: whole blood is not reliable and plasma is not above reproach - a retrospective analysis. Transpl Int 2017; 30:670-678. [PMID: 28295760 DOI: 10.1111/tri.12951] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 12/31/2016] [Accepted: 03/08/2017] [Indexed: 12/22/2022]
Abstract
Polyomavirus nephropathy (PVN) is a major complication of kidney transplantation. Most reports describe polyomavirus viremia either precedes or is detectable at the time of diagnosis of PVN. This association is the basis of current screening recommendations. We retrospectively reviewed the PCR results of blood and urine samples from 29 kidney transplant recipients with biopsy-proven PVN. Biopsies were performed for a rise in serum creatinine or persistent high-level BK viruria. All biopsies showed polyoma virus large T-antigen expression in tubular epithelium using immunohistochemistry. All had viruria preceding or at the time of biopsy (range, 5.2 × 104 to >25 × 106 BKV DNA copies/ml). Twenty (69%) had viremia ranging from 2.5 × 103 to 4.3 × 106 copies/ml at the time of the biopsy. Via blood BK PCR assay, nine (31%) had no BK viremia detected either preceding or at the time of the biopsy. In five recipients where sufficient specimen permitted, additional plasma BK assessment revealed positive detection of viremia. A comparative analysis of assays from two centres was performed with spiked samples. BK DNA may not be detected in the blood of some kidney transplant recipients with histologically confirmed PVN. This may reflect limitation of whole blood as opposed to plasma-based BK DNA assessment.
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Affiliation(s)
- Neerja Agrawal
- Department of Transplant Nephrology, Cleveland Clinic Florida, Weston, FL, USA
| | | | | | - Ajit P Limaye
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Linda Cook
- Department of Laboratory Medicine, University of Washington, Seattle, WA, USA
| | - Anthony Chang
- Department of Pathology, University of Chicago, Chicago, IL, USA
| | | | - Basit Javaid
- MedStar Georgetown Transplant Institute, Georgetown University Hospital, Georgetown, DC, USA
| | | | - Scott Matushek
- Department of Clinical Microbiology, University of Chicago, Chicago, IL, USA
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15
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Herberhold S, Hellmich M, Panning M, Bartok E, Silling S, Akgül B, Wieland U. Human polyomavirus and human papillomavirus prevalence and viral load in non-malignant tonsillar tissue and tonsillar carcinoma. Med Microbiol Immunol 2016; 206:93-103. [PMID: 27832373 DOI: 10.1007/s00430-016-0486-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 10/31/2016] [Indexed: 12/21/2022]
Abstract
Human papillomaviruses (HPVs) are an acknowledged cause of a subset of oropharyngeal cancers, especially of tonsillar cancer. Similar to HPV, some human polyomaviruses (HPyVs), such as Merkel cell polyomavirus (MCPyV), have an oncogenic potential. Recently, several novel HPyVs have been discovered. The aim of our study was to determine viral DNA prevalence and viral DNA load of 13 different HPyVs in benign and malignant tonsillar tissue and to compare the data with those found for HPV. A total of 78 biopsies of palatine tonsils with a histologic diagnosis of non-malignant disease (chronic tonsillitis, tonsillar hyperplasia, n = 40) or tonsillar squamous cell carcinoma (n = 38) were included in the study. HPyV DNA prevalence and viral load were determined by virus-specific quantitative real-time PCRs. JCPyV (1/40, 2.5%) and WUPyV (3/40, 7.5%) were only found in non-malignant tonsillar tissue. HPyV7 and HPyV10 were only detected in one (2.6%) and seven (18.4%) of the 38 cancer biopsies, respectively. Both MCPyV (8/38, 21.1 vs. 4/40, 10.0%) and HPyV6 (2/38, 5.3 vs. 1/40, 2.5%) were found more frequently in cancer samples than in non-malignant tissue, but the differences were not significant. BKPyV, KIPyV, TSPyV, HPyV9, STLPyV, HPyV12 and NJPyV were not discovered in any of the samples. HPyV loads found in HPyV DNA-positive biopsies were very low with no difference between non-malignant and malignant samples (median load <0.0001 HPyV DNA copies per beta-globin gene copy, respectively). In contrast to HPyV, high-risk HPV types (HPV16/HPV18) were found significantly more frequently in tonsillar cancers than in non-malignant tonsillar tissue (17/38, 44.7 vs. 2/40, 5.0%, p < 0.001). Furthermore, high-risk HPV DNA loads were significantly higher in the cancer compared to the non-malignant samples (median load 11.861 vs. 7 × 10-6 HPV DNA copies per beta-globin gene copy, p = 0.012). While both HPV and HPyV may persist in tonsillar tissue, our data on HPyV DNA prevalence and load do not support a role of HPyV in tonsillar carcinogenesis, neither alone nor as co-infecting agents of HPV.
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Affiliation(s)
- Stephan Herberhold
- ENT Department, Head and Neck Surgery, University of Bonn, Bonn, Germany.,ENT Department, Johanniter-Kliniken Bonn, Bonn, Germany
| | - Martin Hellmich
- Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Cologne, Germany
| | - Marcus Panning
- Institute for Virology, Medical Center - University of Freiburg, Freiburg, Germany
| | - Eva Bartok
- Institute of Clinical Chemistry and Clinical Pharmacology, University of Bonn, Bonn, Germany
| | - Steffi Silling
- Institute of Virology, National Reference Center for Papilloma- and Polyomaviruses, University of Cologne, Fürst-Pückler-Str. 56, 50935, Cologne, Germany
| | - Baki Akgül
- Institute of Virology, National Reference Center for Papilloma- and Polyomaviruses, University of Cologne, Fürst-Pückler-Str. 56, 50935, Cologne, Germany.
| | - Ulrike Wieland
- Institute of Virology, National Reference Center for Papilloma- and Polyomaviruses, University of Cologne, Fürst-Pückler-Str. 56, 50935, Cologne, Germany
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16
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Broeders EN, Hamade A, El Mountahi F, Racapé J, Hougardy JM, Le Moine A, Vereerstraeten P. Preemptive reduction of immunosuppression upon high urinary polyomavirus loads improves patient survival without affecting kidney graft function. Transpl Infect Dis 2016; 18:872-880. [PMID: 27615506 DOI: 10.1111/tid.12603] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Revised: 04/16/2016] [Accepted: 06/29/2016] [Indexed: 01/02/2023]
Abstract
BACKGROUND Polyomavirus (PV) is a major cause of kidney graft disease. Monitoring by polymerase chain reaction (PCR) on blood is currently recommended. In order to avoid irreversible lesions, we investigated the clinical impact of preemptive reduction of immunosuppression (IS) in kidney transplant recipients (KTR) upon detection of high urinary PV (Upv) load, including BK virus and JC virus. MATERIAL AND METHODS From 2000 to 2011, in our single center, 789 consecutive KTR were distributed into 4 groups, according to the maximal Upv levels (by PCR) during the first year and the therapeutic option: (A) Upv <104 copies (cp)/mL (n=573), (B) ≥104 Upv <107 cp/mL (n=100), and (C) Upv ≥107 cp/mL (n=116); in group C, the IS drug doses were reduced in subgroup Ca (n=102) only, as 14 patients (subgroup Cb) were at risk for graft rejection. RESULTS The preemptive reduction of IS (group Ca) increased patient survival as compared with all other groups (P<.05), did not modify graft function, and increased graft survival vs group A (risk ratio: 5.7, confidence interval: 1.8-18.1, P=.003). Differences for risk factors are as follows (groups Ca vs A): incidence of human leukocyte antigen (HLA) immunization (>5% panel reactive antibodies): 3% vs 8% (P=.05), number of HLA mismatches: 2.7 vs 2.5 (P=.049), and incidence of acute rejection: 9.8% vs 24.2% (P=.005). PV-associated nephropathy occurred only in group Ca (2% of total grafts) without effect on patient or graft outcome. CONCLUSION The reduction of IS in patients with high Upv loads is beneficial for patient survival and does not affect graft survival or graft function.
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Affiliation(s)
- Emine Nilufer Broeders
- Department of Nephrology, Dialysis and Transplantation, Cliniques Universitaires de Bruxelles, Hôpital Erasme, Brussels, Belgium
| | - Anwar Hamade
- Department of Nephrology, Dialysis and Transplantation, Cliniques Universitaires de Bruxelles, Hôpital Erasme, Brussels, Belgium
| | - Fadoua El Mountahi
- Department of Nephrology, Dialysis and Transplantation, Cliniques Universitaires de Bruxelles, Hôpital Erasme, Brussels, Belgium
| | - Judith Racapé
- Research Center of Biostatistics, Epidemiology and Clinical Research, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean-Michel Hougardy
- Department of Nephrology, Dialysis and Transplantation, Cliniques Universitaires de Bruxelles, Hôpital Erasme, Brussels, Belgium
| | - Alain Le Moine
- Department of Nephrology, Dialysis and Transplantation, Cliniques Universitaires de Bruxelles, Hôpital Erasme, Brussels, Belgium
| | - Pierre Vereerstraeten
- Department of Nephrology, Dialysis and Transplantation, Cliniques Universitaires de Bruxelles, Hôpital Erasme, Brussels, Belgium
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17
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Akhgari S, Mohraz M, Azadmanesh K, Vahabpour R, Kazemimanesh M, Aghakhani A, Jozpanahi M, Banifazl M, Bavand A, Ramezani A. Frequency and subtype of BK virus infection in Iranian patients infected with HIV. Med Microbiol Immunol 2015; 205:57-62. [PMID: 26141042 DOI: 10.1007/s00430-015-0426-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Accepted: 06/25/2015] [Indexed: 12/23/2022]
Abstract
Human polyomavirus BK virus (BKV) is a double-stranded DNA virus that infects approximately 90 % of the general population as a subclinical or mild infection. In immunosuppressed patients, such as HIV cases, BKV may be reactivated resulting hemorrhagic cystitis and tubulointerstitial nephritis. However, there are limited studies on prevalence and molecular epidemiology of BKV in Iran. We therefore aimed to evaluate the prevalence and subtypes of BKV in Iranian HIV patients. A total of 99 patients with HIV infection were enrolled in the study. Presence of BKV DNA in plasma was evaluated by nested PCR. PCR products were sequenced directly, and phylogenetic analysis was performed. BKV DNA was detected in 8.08 % of HIV patients. BKV viremia presented in 4 out of 25 patients (16 %) not receiving antiretroviral therapy in comparison with 4 out 74 of HAART-treated patients (5.4 %) (P = 0.023). In patients with CD4 counts ≥200 cells/mm(3), viremia was found more commonly (7/80 = 8.8 %) than in those with lower counts (1/19 = 5.2 %) (not significant). All sequenced BKV isolates belonged to subtype Ib-2. Our findings indicated that the prevalence of BKV viremia is relatively prevalent in patients with HIV infection and significantly higher in naïve than HAART-treated cases. Therefore, HAART can eliminate BKV infection from plasma and reduce viremia although the actual implication of BKV viremia in HIV patients is not clear.
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Affiliation(s)
| | - Minoo Mohraz
- Iranian Research Center for HIV/AIDS, Tehran, Iran.
| | | | | | | | - Arezoo Aghakhani
- Clinical Research Department, Pasteur Institute of Iran, 13164, Pasteur Ave., Tehran, Iran.
| | | | - Mohammad Banifazl
- Iranian Society for Support of Patients with Infectious Disease, Tehran, Iran.
| | - Anahita Bavand
- Clinical Research Department, Pasteur Institute of Iran, 13164, Pasteur Ave., Tehran, Iran.
| | - Amitis Ramezani
- Clinical Research Department, Pasteur Institute of Iran, 13164, Pasteur Ave., Tehran, Iran.
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