European guidelines recommend treating HHV-6 disease with either foscarnet or ganciclovir, in contrast to the Japanese guidelines that recommend foscarnet as first line treatment due to a lower mortality rate.
HHV-6B lung infection doubles the mortality rate of transplant patients with respiratory disease
Investigators at the Fred Hutchinson Cancer Research Center and University of Washington in Seattle found that HHV-6B in lung fluid of bone marrow transplant recipients with pneumonia is associated with a 2-fold increased risk of death. Importantly, HHV-6B positive patients who were treated with an antiviral had a 60% lower risk of death.
HHV-6 found in 22% of acute liver failure of “unknown etiology”
A third of patients with acute liver failure were found to have a betaherpesvirus infection when tested for all herpesviruses. HHV-6 was the most common infection, followed by CMV and HHV-7. No other herpesviruses were found.
HHV-6 DNA in bile fluid correlates with higher mortality in liver transplant patients
Persistent HHV-6 infection in the liver is hard to detect from plasma samples and liver biopsies may miss spotty infections. Bile fluid may be the best method for detecting herpesviruses that impact the liver.
HHV-6 encephalitis: Mayo clinic finds a high rate of severe hippocampal atrophy and neurological deficits
A Mayo clinic review of long-term outcome of patients with HHV-6 encephalitis showed that over 60% showed persistent sequelae associated with severe bilateral hippocampal atrophy. Symptoms included anterograde amnesia, aphasia, headaches, confusion and persistent memory deficits.
BioFire’s FilmArray multiplex encephalitis panel is causing headaches due to confusion over ciHHV-6 status and the meaning of a qualitative positive result
A rapid point-of-care test for patients with encephalitis and meningitis was heralded as a breakthrough, but because the test is not able to determine ciHHV-6 status or viral load, it now has physicians frustrated over how to interpret a positive result.
HHV-6 linked to neutropenia, thrombocytopenia, longer hospital stays and a 5X increased risk of serious complications after autologous transplant
In a prospective study, patients with HHV-6 infection took longer to recover neutrophils and platelets. They also spent significantly more time in the hospital with complications.
Does corticosteroid use for aGVHD prophylaxis lower HHV-6 reactivation by reducing IL-6?
A new study reports a surprisingly low rate of HHV-6 reactivation in recipients of half-matched bone marrow grafts using a reduced-intensity conditioning regimen. The authors speculate that the corticosteroid used for prophylaxis may have suppressed cytokine production which in turn limited reactivation of HHV-6.
Foscarnet approved for HHV-6 encephalitis in Japan
Although foscarnet is widely used for HHV-6 encephalitis, it has never been specifically approved for HHV-6. Japan’s Ministry of Health, Labor and Welfare was the first to approve foscarnet (Foscavir) for the treatment of HHV-6 encephalitis.
HHV-6 increases risk of an “idiopathic” pneumonia syndrome after HCT as does murine roseolovirus in a BMT mouse model. Early HHV-6 was also found to increase non-relapse mortality
Investigators from University of Michigan have demonstrated that murine roseolovirus is a useful homolog for the study of HHV-6 reactivation in lung disease. In a large retrospective study of HCT patients, they also found early HHV-6 reactivation to increase the risk of both idiopathic pneumonia syndrome and non-relapse mortality.
89% of the virus found in the spinal fluid of HCT patients in the first 60 days is HHV-6
An analysis of 165 central nervous system viral infections by the Center for International Blood and Bone Marrow Transplant Research found that most were positive for HHV-6. The outcome for patients with viral infection was poor with 50% mortality within 6 months and only 30% survival at 5 years.
HHV-6 is a greater risk than CMV for rejection in pediatric kidney transplantation
Investigators from the Children’s Hospital of Mexico found that although CMV caused the biggest increase in risk for liver rejection, HHV-6 was the more important infection associated with rejection of kidney transplants. A single HHV-6 infection resulted in an increased risk of over 5 fold, while a coinfection of EBV, HHV-6 and HHV-7 increased the risk of kidney rejection by over 17 fold.
Stanford finds high levels of HHV-6 in the tissues of children with liver failure
A team at Stanford reported that 48% of young children with “liver failure of unknown etiology” had high viral loads of HHV-6 in their liver tissues. As a result, Stanford has now instituted routine evaluation for HHV-6 in all children who present with liver failure.
RNA sequencing of HHV-6B transcriptome identifies U38 as the best target for HHV-6 RT-PCR testing
Investigators at University of Washington studied multiple samples to develop an assay that can detect active infection in patients with chromosomally integrated HHV-6. Current quantitative PCR DNA testing cannot determine whether a ciHHV6 patient has active replication.
Rapid lymphocyte expansion after HCT predicts increased HHV-6 reactivation
A team of researchers at Kyoto University in Japan reported that rapid lymphocyte expansion is a good predictive factor for increased HHV-6 reactivation, as well as reduced CMV antigenemia. Patients with aplastic anemia as a primary disease had a 5 fold increased risk of HHV-6 reactivation.