eMedicine Specialties > Infectious Diseases > Viral Infections

Human Herpesvirus Type 6: Treatment & Medication

Author: Michelle R Salvaggio, MD, Assistant Professor, Department of Internal Medicine, Section of Infectious Diseases, University of Oklahoma College of Medicine; Medical Director of Infectious Diseases Institute, University of Oklahoma Health Sciences Center
Coauthor(s): Peter S Miele, MD, Fellow, Department of Internal Medicine, Section of Infectious Diseases, Washington Hospital Center; Margo A Smith, MD, Associate Program Director, Department of Medicine, Washington Hospital Center; Assistant Professor, Department of Internal Medicine, Section of Infectious Diseases, George Washington University
Contributor Information and Disclosures

Updated: Oct 8, 2008

Treatment

Medical Care

  • Treatment of human herpesvirus 6 (HHV-6) infection varies according to the presenting clinical situation.
  • In infants with roseola infantum only, treatment is mainly supportive.
  • Infants who present with other manifestations of HHV-6 infection (eg, febrile seizures, CNS involvement) require hospitalization.
  • About 13% of infants with acute HHV-6 infection require hospitalization.

Medication

  • The role of antiviral therapy for human herpesvirus 6 (HHV-6) infection has yet to be determined.
  • Therapy is usually unnecessary in primary infection in immunocompetent hosts.
  • In immunosuppressed hosts in whom active HHV-6 infection has been documented, some studies have suggested using antiviral therapy in cases of hepatitis, bone marrow suppression, pneumonitis, or encephalitis. In particular, they recommend ganciclovir or foscarnet. Ganciclovir has also been reported to be beneficial against HHV-6 reactivation in patients undergoing stem cell transplantation.

Antivirals

Nucleoside analogs are initially phosphorylated by viral thymidine kinase to eventually form a nucleoside triphosphate, resulting in the inhibition of viral replication.


Ganciclovir (Cytovene, Vitrasert)

Acyclic nucleoside analog of 2'-deoxyguanosine that inhibits replication of herpes viruses both in vitro and in vivo.

Adult

10 mg/kg IV qd over 1 h, usually divided bid; course of therapy depends on clinical scenario; therapeutic dose monitoring may be helpful in some situations (Janoly-Duménil, 2006)

Pediatric

Not established; therapeutic dose monitoring used in pediatric population with some success (Janoly-Duménil, 2006)

Concomitant administration with cytotoxic drugs such as dapsone, vinblastine, Adriamycin, pentamidine, flucytosine, vincristine, amphotericin B, trimethoprim/sulfamethoxazole combinations, or other nucleoside analogs may result in additive toxicity in bone marrow, spermatogonia, and germinal layers of skin and GI mucosa (coadminister only if potential benefits outweigh risks); coadministration with imipenem-cilastatin may cause generalized seizures (use only if potential benefits outweigh risks); serum creatinine levels may increase following concurrent use of ganciclovir with either cyclosporine or amphotericin B; in presence of probenecid, ganciclovir renal clearance is reduced; bioavailability may increase when didanosine is administered either 2 h prior to or simultaneously with ganciclovir; bioavailability of ganciclovir may decrease in presence of zidovudine, while bioavailability of zidovudine is increased in presence of ganciclovir

Documented hypersensitivity; pancytopenia; may be contraindicated in patients who received as prophylaxis and failed

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Clinical toxicity of ganciclovir includes granulocytopenia, anemia, and thrombocytopenia; because oral ganciclovir is associated with higher rate of CMV retinitis progression compared to IV formulation, use only when benefits outweigh risks (advanced HIV disease); half-life and plasma/serum concentrations of ganciclovir may be increased as result of reduced renal clearance; dosages >6 mg/kg IV may result in increased toxicity; rapid infusions may result in increased toxicity; initially, reconstituted solutions of IV ganciclovir have high pH (11); phlebitis or pain may occur at site of IV infusion despite further dilution in IV fluids; administration of ganciclovir should be accompanied by adequate hydration; photosensitization (photoallergy or phototoxicity) may occur


Foscarnet (Foscavir)

Organic analog of inorganic pyrophosphate that inhibits replication of known herpesviruses. Inhibits viral replication at pyrophosphate-binding site on virus-specific DNA polymerases. Poor clinical response or persistent viral excretion during therapy may be due to viral resistance.

Adult

120 mg/kg/d IV early in treatment in patients who can tolerate the drug well; individualize dosing based on renal function status

Pediatric

Not established

Coadministration with potentially nephrotoxic drugs (eg, aminoglycosides, amphotericin B, IV pentamidine) may increase nephrotoxicity (do not administer unless potential benefits outweigh risks); coadministration with IV pentamidine may cause hypocalcemia

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

May cause decline in renal function; for correct dosing, obtain 24-h serum creatinine at baseline and continue to monitor (discontinue if serum creatinine <0.4 mL/min/kg); hydration may reduce nephrotoxicity; carefully monitor electrolytes (eg, calcium, magnesium); assess for electrolyte and mineral level abnormalities if mild perioral numbness, paresthesias symptoms, or seizures occur; granulocytopenia and anemia may occur (regularly monitor CBC count); infuse foscarnet solutions into veins with adequate blood flow to avoid local irritation; to avoid toxicity, do not administer by rapid or bolus IV injection

More on Human Herpesvirus Type 6

Overview: Human Herpesvirus Type 6
Differential Diagnoses & Workup: Human Herpesvirus Type 6
Treatment & Medication: Human Herpesvirus Type 6
Follow-up: Human Herpesvirus Type 6
References
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References

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Further Reading

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Keywords

human herpesvirus 6, human herpesvirus type 6, HHV-6, HHV6, human herpes virus 6, HHV-6A, HHV-6B, roseola infantum, exanthema subitum, sixth disease

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Contributor Information and Disclosures

Author

Michelle R Salvaggio, MD, Assistant Professor, Department of Internal Medicine, Section of Infectious Diseases, University of Oklahoma College of Medicine; Medical Director of Infectious Diseases Institute, University of Oklahoma Health Sciences Center
Michelle R Salvaggio, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America
Disclosure: Merck Honoraria Speaking and teaching

Coauthor(s)

Peter S Miele, MD, Fellow, Department of Internal Medicine, Section of Infectious Diseases, Washington Hospital Center
Peter S Miele, MD is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Margo A Smith, MD, Associate Program Director, Department of Medicine, Washington Hospital Center; Assistant Professor, Department of Internal Medicine, Section of Infectious Diseases, George Washington University
Margo A Smith, MD is a member of the following medical societies: American Society for Microbiology
Disclosure: Nothing to disclose.

Medical Editor

Thomas J Marrie, MD, Chair, Professor, Department of Medicine, Division of Infectious Diseases, University of Alberta College of Medicine
Thomas J Marrie, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Society for Microbiology, Canadian Infectious Disease Society, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Ronald A Greenfield, MD, Professor, Department of Internal Medicine, Section of Infectious Diseases, University of Oklahoma College of Medicine
Ronald A Greenfield, MD is a member of the following medical societies: American College of Physicians, American Federation for Medical Research, American Society for Microbiology, Central Society for Clinical Research, Infectious Diseases Society of America, Medical Mycology Society of the Americas, Phi Beta Kappa, Southern Society for Clinical Investigation, and Southwestern Association of Clinical Microbiology
Disclosure: Pfizer Honoraria Speaking and teaching; Gilead Honoraria Speaking and teaching; Ortho McNeil Honoraria Speaking and teaching; Wyeth Honoraria Speaking and teaching; Abbott Honoraria Speaking and teaching; Astellas Honoraria Speaking and teaching; Cubist  Speaking and teaching

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

 
 
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