Resumo: O Herpesvirus Humano 5 (HHV-5), Herpesvirus Humano 6 (HHV-6) e o Herpesvírus Humano 7 (HHV-7), são vírus universais pertencentes à subfamília betaherpesvirinae, e apresentam alta prevalência na população brasileira. Em adultos saudáveis, após infecção primária, esses vírus permanecem latentes, podendo ser reativados em um período de imunossupressão, como acontece em pacientes submetidos a transplantes, o que pode causar complicações graves, que vão desde rejeição de enxertos ao óbito. Esse estudo visou a monitorização da co-infecção pelo HHV-5, HHV-6 e HHV-7 em pacientes submetidos a transplante hepático no Hospital das Clínicas da UNICAMP e a correlação dos dados obtidos com o impacto clínico nesse grupo de pacientes para compreender melhor os aspectos que envolvem a infecção ativa pelo HHV-5, HHV-6, HHV-7 e suas inter-relações,
utilizando técnicas laboratoriais que fazem diagnóstico precoce de infecção ativa, avaliação da terapia antiviral específica e prevenção da doença causada por esses vírus. Foram monitorizados 53 pacientes transplantados hepáticos através de testes de antigenemia e NESTED-PCR (N-PCR) em sangue periférico para a detecção do HHV-5, NESTED-PCR em sangue periférico para a detecção do HHV-6, NESTED-PCR em soro
para detecção do HHV-7, que foram realizadas no pré-operatório e periodicamente no pós-operatório. Com essa metodologia 33/53 (62,3%) dos pacientes apresentaram infecção ativa por HHV-5, 21/53 (39,6%) por HHV-6 e 23/53 (43,4%) por HHV-7. A co-infecção ocorreu em 8/53 (15,1%) para HHV-5/HHV-6, e 5/53 (9,4%) para HHV-5/HHV-7, 2/53 (3,8%) por HHV-6/HHV-7, e 1/5 (1,9%) pelos três vírus estudados (HHV-5/HHV-6/HHV-7). Apresentaram infecções oportunistas 31/53 (58,5%) dos pacientes estudados, e destes 21/31 (39,6%) tiveram infecção ativa isoladamente por
HHV-5, 14/31 (26,4%) tiveram infecção ativa isoladamente por HHV-6, e 11/31 (20,8%) tiveram infecção ativa isoladamente por HHV-7. Os resultados obtidos e os inúmeros estudos sobre o impacto clínico da detecção e tratamento desses betaherpsvírus em pacientes transplantados hepáticos mostram a importância de estudarmos sua prevalência, métodos diagnósticos e seu impacto clínico em nosso meio Ver menos

Abstract: The human herpesvirus 5, human herpesvirus 6 e human herpesvirus 7 to the ß-herpesvirus subfamily of the Herpesviridae family. They show a hight prevalence in the population. Many times the infection remains assintomatic in healthy adults and can be reactivated from immunosuppression period especially after organ transplantation, as it happens to patients that underwent an organ transplantation, though it can cause several complication that are since allograft rejection to mortality. This study shows the monitoring of concurrent infection by HHV-5, HHV-6 and HHV-7 in patients that had been undergone to liver transplantation and the results among them with the clinic impact in this infection by HHV-5, HHV-6 and HHV-7 and its concurrent, using lab tecnique that present an early diagnostic of the active infection, management of specific therapy antiviral and prevention of the deseases caused by these virus. Fifty three patients posttranplanted were assisted though antigenemia and nested-pcr tests in peripheral blood to detection of HHV-5, and N-pcr in peripheral blood to detection of HHV-6 and N-pcr in serum to detection of HHV-7 that were done during before transplantation and always in the posttransplantation in these patients and its medical record analysis. The antigenemia to the HHV-6 and
HHV-7 was (standard) for the first part of the test and the part is in the standard time. With this methodological, 62,3% of the patients showed active infection by HHV-5, 39,6% by HHV-6 and 43,4% by HHV-7, 15,1% of the patients, showed ( co-infection) HHV-5 and HHV-6, 9,4% by HHV-5/HHV-7, 3,8% by HHV-6/HHV-7 and 1,9% by three virus (HHV-5/HHV-6/HHV-7). 58,5% of the patients studied showed opportunistics infections, and 39,6% showed isoled active infection by HHV-5, (26,4%) showed isoled active infection by HHV-6 and (20,8%) showed isoled active infection by HHV-7.
(58,5%) showed oportunites infection , 29% showed any kind of allograft rejection, 44,4% showed active infection by HHV-5, 44,4% showed active infection by HHV-6 and 33,3% by HHV-7. Human herpesvírus (HHV) 6 and 7 are novel members of the ß-herpesvirus family that maintain latency in the human host after primary infection. Reactivation from latency and/or increased degree of viral replication occurs during periods of immune dysfunction.
The clinical effect of HHV-6 and HHV-7 reactivation in recipients of liver transplats is now being reconized. A gronving body of evidence suggests that the more important effect of HHV-6 and HHV-7 reactivation on the outcomes of liver transplantation may be mediated indirectly by their interactions with the other ß-herpesvirus - cytomegalovirus (HHV-5) we conducted a prospective study in fifthy three liver transplant patients to detect active
infection by HHV-5, 6 and 7, using Nested PCR and antigenemia tests. Active infection with HHV-5 was detected in 62,3% by HHV-6 in 39,6% and 43,4% by HHV-7. Co- infection by HHV-5/HHV-6 occured in 15,1% of the patients, by HHV-5/HHV-7 in 9,4%, by HHV-6/HHV-7 in 3,8% and by HV-5/HHV-6/HHV-7 in 1,9%. Fivety eigth percent of the patients studied showed opportunistics infections, of this 39,6% had isolated active infection by HHV-5, 26,4% isolated active infection by HHV-6 and 20,8% isolated active infection by HHV-7. In conclusion, HHV-5, HHV-6 and HHV-7 active infection, are frequent in liver transplant patients and early diagnose to prevent clinical impact are necessary Ver menos