Poster Presentation ASDR Annual Scientific Meeting 2019

The association between human herpes viruses and mycophenolate mofetil. (#61)

Jenny SW Yun 1 , Tami Yap 1 2 , Raymond Martyres 1 , Johannes Kern 1 , George Varigos 1 2 , Laura Scardamaglia 1 2
  1. Dermatology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
  2. Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Victoria, Australia

Background:

Mycophenolate mofetil (MMF) is an immunosuppressive agent increasingly used to treat dermatological conditions with a good safety profile with lack of hepatorenal toxicity proven since its use in organ transplantation. Human herpesvirus (HHV) is known to manifest with enhanced pathogenicity in therapeutically immunocompromised hosts. This study aims to investigate if individuals taking MMF have a higher carriage of intraoral HHV than immunocompetent patients.

Methods:

Clinical information and oral mucosa swab and saliva samples were collected from individuals on MMF (I-) at Royal Melbourne Hospital (n=20) and were compared with samples from immunocompetent subjects (I+) at Royal Dental Hospital of Melbourne (n=92). Patients were further subgrouped into those with oral ulceration (U+) (n=25) and those without (U-) (n=87). Individuals were analysed in four groups (I+U+, I+U-, I-U+, I-U-). DNA extracted from all samples was quantified using a multiplex polymerase chain reaction (PCR).

Results:

Of 87 patients without oral ulceration, 60 (69%) had HHV detected, where most predominant was Epstein-Barr virus (EBV) (74.6%), followed by HHV-6 (19.7%). Neither presence of oral mucosal abnormality nor therapeutic immunocompromise was related to increased detection of HHV: I-U+ vs I+U+ (100% vs 77.3%, p= 0.356), and I-U- vs I+U- (41.7% vs 77.1%, p=0.001). Overall, intraoral HHV detection was not significantly associated with MMF dosage (p=0.574) or duration (p=0.621).

Conclusion:

Our study demonstrates no greater commensal intraoral HHV detection in individuals on MMF regardless of the presence of oral ulceration, supporting safe use of MMF. Yet, intraoral detection by qPCR HHV may be a common phenomenon and clinical interpretation of test positivity is warranted.

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