Viral reactivation associated with immunosuppressive therapy Kazuaki KAMEDA 1 1Division of Hematology Jichi Medical University Saitama Medical Center pp.125-134
Published Date 2019/1/1
DOI https://doi.org/10.11477/mf.3102200605
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Viral reactivation is a serious complication associated with immunosuppressive therapy. Both the type of drugs and the patients' background influence the risk of viral reactivation. Patients who undergo solid organ and hematopoietic stem cell transplant are especially susceptible to various viruses. Among them, cytomegalovirus, varicella-zoster virus and herpes simplex virus are the most important pathogens. In addition, extensive immunosuppressive treatment against graft rejection or graft-versus-host disease can result in reactivation with Epstein-Barr virus, human herpes virus-6, -7, -8, adenovirus and polyomavirus. Corticosteroids remain a part of most immunosuppressive regimens for autoimmune diseases and transplantation. Higher cumulative doses and a longer duration of corticosteroid therapy increase the risk of viral reactivation. Preventive strategies such as universal prophylaxis or preemptive therapy should be considered for “high-risk” patients. Some viral reactivations are asymptomatic and do not require antiviral treatment. However, antiviral drugs can induce serious adverse effects. Preventive and therapeutic treatment for viral reactivation should be given according to the individual patients' immunological status.

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