Human Herpesvirus 6 and the Liver
Abstract
Human Herpesvirus 6 (HHV-6) is an interesting member of the herpesvirus family that infects humans. There are 2 HHV-6 species, designated HHV-6A and HHV-6B, which infect humans with most clinical disease caused by HHV-6B. The virus is ubiquitous and most infections take place in very young children, where the infection is either asymptomatic or mild and result in a syndrome called Exanthem subitum with fever and a characteristic skin rash. Occasionally the infection can result in CSF infection and encephalitis. Much less commonly, the infection can cause more severe damage to internal organs and rarely liver or other organ failure. A total of 12 pediatric and 11 adult case reports of liver failure in the context of HHV-6 infections are reviewed in this paper. These reports highlight the need to better characterize this rare complication and determine the frequency of occurrence as well as identify possible therapies to prevent complete organ failure. Significant organ disease is also described during HHV-6 reactivation episodes secondary to hematopoietic and solid organ transplant, and is possibly more common in liver than in hematopoietic transplantation. Because of the relatively new descriptions of significant disease post-transplant caused by HHV-6, much work is left to be done to improve diagnosis of this reactivation disease and define the best therapies to be used. A very important component of this process should be the improvement of laboratory diagnostics to standardize the assay across laboratories and establish clinical cut-off values to clarify the detection of latent virus vs active HHV-6 disease replication. Because of the unique ability of HHV-6 to establish latency via integration into host chromosomal telomers, laboratory testing needs to be improved to be able to distinguish between latent, inactive, chromosomal HHV-6, and active HHV-6 replication associated with clinical disease and organ damage.
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DOI: http://dx.doi.org/10.18103/imr.v4i1.604
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