Human cytomegalovirus and Epstein-Barr virus infections, risk factors, and their influence on the liver function of patients with acute-on-chronic liver failure

Jianhua Hu,Xuan Zhang,Hong Zhao,Lanjuan Li,Hainv Gao,Danfeng Lou,Meifang Yang,Hongyu Jia

doi:10.1186/s12879-018-3488-8

Jianhua Hu, Xuan Zhang + Show 6 more

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https://doi.org/10.1186/s12879-018-3488-8

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Abstract

BackgroundStudies on human cytomegalovirus (HCMV) and Epstein-Barr virus (EBV) have focused primarily on the immunosuppressed population. Few studies have considered immunocompetent and not severely immunocompromised patients. We determined the infection rates of HCMV and EBV, their risk factors and their influence on liver function in patients with HBV-related acute-on-chronic liver failure (ACLF).MethodsPatients infected with ACLF-based hepatitis B virus (HBV) from 1 December 2016 to 31 May 2018 were enrolled in our study and were divided into infected and uninfected groups. The risk factors for HCMV and EBV infection and their influence on liver function were analysed.ResultsA total of 100 hospitalized patients with ACLF due to HBV infection were enrolled in this study. Of these patients, 5% presented HCMV deoxyribonucleic acid (DNA) and 23.0% presented EBV DNA. An HBV DNA count of < 1000 IU/mL increased the occurrence of HCMV infection (P = 0.003). Age, especially older than 60 years, was a risk factor for EBV infection (P = 0.034, P = 0.033). HCMV-infected patients had lower alanine aminotransferase (ALT) levels; albumin levels and Child–Pugh scores in EBV-infected patients were higher than those in uninfected patients.ConclusionsHCMV and EBV were detected in patients with ACLF caused by HBV infection. Lower replication of HBV (HBV DNA < 1000 IU/mL) may increase the probability of HCMV infection; age, especially older than 60 years of age, was a risk factor for EBV infection. HCMV infection may inhibit HBV proliferation and did not increase liver injury, while co-infection with EBV may influence liver function and may result in a poor prognosis.

Highlights

Studies on human cytomegalovirus (HCMV) and Epstein-Barr virus (EBV) have focused primarily on the immunosuppressed population
HCMV and EBV infection As described in Fig. 1 and Table 1, a total of 1011 patients hospitalized in our hospital with acute-on-chronic liver failure (ACLF) were screened between 1 January 2016 and 1 September 2017
Risk factors for HCMV and EBV infection Among the aforementioned possible risk factors, we found that hepatitis B virus (HBV) deoxyribonucleic acid (DNA) < 1000 IU/mL was a risk factor for HCMV infection (P = 0.003), with a dramatically increased risk of 34.00-fold

Summary

Introduction

Studies on human cytomegalovirus (HCMV) and Epstein-Barr virus (EBV) have focused primarily on the immunosuppressed population. Few studies have considered immunocompetent and not severely immunocompromised patients. Human cytomegalovirus (HCMV) is a β human herpesvirus with positive rates of antibodies of 50–100% [1, 2]. Epstein-Barr virus (EBV) is a γ human herpesvirus with positive rates of antibodies of up to 90% [7, 8]. After a primary infection occurs, EBV develops a lifelong latency in B cells [9]. Studies on EBV have mostly examined patients with neoplastic disease [10] and post-transplant lymphoproliferative disorder following HSCT [5, 11, 12]. Limited studies have considered immunocompetent and not severely immunocompromised patients

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