A hematology group in Australia reported a case of biopsy-proven HHV-6 myocarditis post-hematopoietic stem cell transplantation (HSCT). he post-mortem exam confirmed dilated cardiomyopathy and focal changes consistent with viral myocarditis and cardiac tissue was positive for HHV-6 DNA by nested and quantitative PCR. Separately, A Japanese group reported a worman who developed pericarditis with over 10,000 copies/ml of HHV-6 DNA in the pericardial fluid, after a cord blood transplant.
HHV-6 induced Parkinsonism post-transplant
A group of researchers from Sao Paulo, Brazil reported the development of HHV-6 infection in the striatum of a 32-year-old man six weeks after allogeneic hematopoietic stem cell transplantation. This is the first reported case of HHV-6 infection affecting the striatum and presenting with Parkinsonism post-HSCT.
HHV-6 the only pathogen identified in early post-transplant CNS dysfunction
A group from Sapporo Medical University studied 105 post HSCT patients and determined that 7 developed CNS dysfunction in the first 42 days after transplant. Six out of the 7 were positive for HHV-6, but none of the other 12 pathogens tested. Four patients (3.8%) were diagnosed with HHV-6 encephalitis. The group used a qualitative multiplex PCR and then used a quantitative PCR to confirm the results.
Delirium associated with HHV-6B reactivation in cord blood transplant patients: time for an antiviral prophylaxis trial?
A prospective study authored by Joshua Hill and Danielle Zerr determined that higher than average HHV-6B DNA levels increased the odds of developing delirium after cord blood transplantation (CBT) by almost three fold. Patients with DNA loads in the top quartile had a 4.5 fold increase in delirium.
HHV-6B associated with severe GVHD and may explain “fever of unknown origin” in 30% of pediatric stem cell transplant patients
HHV-6 may be the cause of “fever of unknown origin” in 30% of stem cell transplant (SCT) patients. By the third week after SCT, 70% of HHV-6 positive patients had a skin rash, compared to 39% of HHV-6 negative patients.
HSCT patients with HHV-6 reactivation have significantly worse survival rates and higher rates of acute GVHD
A group from Sapporo Medical University studied 105 post HSCT patients and determined that 7 developed CNS dysfunction in the first 42 days after transplant. Six out of the 7 were positive for HHV-6, but none of the other 12 pathogens tested. Four or 3.8% of the population were diagnosed with HHV-6 encephalitis.
HHV-6B-induced neutropenia in primary infection associated with specific chemokines
In an article published in the Pediatric Infectious Disease Journal, Tetsushi Yoshikawa’s team from Fujita Health University School of Medicine determined that the severe neutropenia in primary HHV-6B infection is tied to reduced platelet counts, lower RANTES and higher levels of MCP-1, MIG and IP-10.
HHV-6 Reactivation Tied to acute GvHD and Steroid Administration
A large-scale multiplex PCR assay developed by a team in Japan was used to study 13 DNA viruses in 105 allogenic hematopoietic stem cell transplant patients. They found that patients treated with steroids had a significantly higher risk of HHV-6 reactivation (p=0.027), and that HHV-6 was the only virus tied to the onset of acute GVHD (p=0.016).
Poor Outcome in ICU Patients with HHV-6 & CMV
Intensive care (ICU) patients with co-infections of HHV-6 and CMV are 7.5x more likely to die or have an extended stay in the hospital. On the other hand, single infections with either HHV-6 or CMV did not significantly impact outcome.
Multiplex PCR; HHV-6 loads higher with steroids
A large-scale multiplex PCR assay developed by a team in Japan was used to study 13 DNA viruses in 105 allogenic hematopoietic stem cell transplant patients. Their findings identify HHV-6 as the most common virus (found in 60% of all patients), and also as the only virus tied to the onset of acute GVHD (p=0.016). Interestingly, HHV-6 reactivation was associated with a more severe stage of skin but not liver or gut aGVHD (P=0.005). In addition, patients treated with steroids had a significantly higher risk of HHV-6 reactivation (p=0.027) and cord blood transplant patients were 10.4x more likely to reactivate with HHV-6. The authors looked at the association of HHV-6 reactivation in the absence of GVHD, and found that it …
Expert Opinion: Dr. Louis Flamand calls for screening of transplant organs and cells for ciHHV-6 status
Dr. Flamand, a professor and molecular virologist at Université Laval in Quebec city, has written an editorial calling for screening of organ donors for ciHHV-6 status and careful monitoring of recipients of ciHHV-6 donor tissues for signs of active HHV-6 infection and HHV-6 antigen-induced immune rejection. Flamand also questions whether solid organs and stem cells derived from persons with ciHHV-6 should be used in transplantation.
HHV-6 DNA in the CSF results in poor survival for HSCT patients
Should physicians automatically discount HHV-6 if any other pathogen is found in the CSF? Should patients with both HHV-6 and EBV DNA in the CSF be treated only for EBV? These are the questions that UW group tried to sort out in this study.
Interview with Michael Boeckh and Joshua Hill on potential risks for ciHHV6 patients undergoing HCT
The University of Washington and the Fred Hutchinson Cancer Research Center are at the forefront of studying the role of HHV-6 and ciHHV-6 in stem cell transplant patients. We asked their view on the implications immunocompromised patients with integrated HHV-6A reactivating with their own inherited virus.
HHV-6 reactivation predicts graft failure in cord blood transplant patients
HHV-6 reactivation before engraftment strongly predictive of graft failure
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