Human Herpesvirus 6 (HHV-6) Infection Treatment & Management

Updated: Aug 16, 2019
  • Author: John L Kiley, MD; Chief Editor: Burke A Cunha, MD  more...
  • Print
Treatment

Approach Considerations

Treatment of human herpesvirus 6 (HHV-6) infection varies according to the clinical scenario. In infants with roseola infantum, treatment is supportive. Infants who present with other manifestations of HHV-6 infection (eg, febrile seizures or CNS involvement) should undergo workup and treatment appropriate for these complications; overall, about 13% of infants with acute HHV-6 infection require hospitalization.

There is no vaccine for HHV-6 infection, and none currently exists in development.

Next:

Supportive Care

Supportive therapy, including acetaminophen for fever and adequate hydration, is indicated in all patients with symptomatic HHV-6 infection.

Previous
Next:

Antiviral Therapy

Decisions regarding antiviral therapy should carefully weigh the clinical scenario with the degree of diagnostic certainty, likelihood of a response or benefit, and the risk of systemic therapeutics. In immunocompetent patients, no antiviral pharmacologic therapy is recommended.

In immunosuppressed hosts with HHV-6 encephalitis, antiviral therapy is recommended. [17, 4] Foscarnet, ganciclovir, and cidofovir are the three antivirals that have in vitro activity against HHV-6. Brincidofovir may offer an additional mode of therapy with less toxicity in the future, but this has not been studied. There are no in vivo or randomized controlled trials that provide supporting evidence for any of these therapies, and use of them in this clinical scenarios is considered off-label. Therapy is often limited by toxicities. Ganciclovir is associated with cytopenias and bone-marrow suppression. Foscarnet is associated with renal failure. Close monitoring of cell counts and renal function in the setting of antiviral therapy for HHV-6 disease is required.

Given the concern for HHV-6 encephalitis morbidity and mortality, elucidation of an effective pre-emptive strategy for prophylaxis with antivirals has been attempted several times. These have not been successful for two reasons. First, the dynamics of HHV-6 DNA levels in serum and its correlation to risk of encephalitis is not well understood. Second, the toxicities of prophylactic antivirals (eg, foscarnet and its risk for renal failure, ganciclovir and its risk for cytopenia) are unacceptably high in the transplant setting, in which they are typically considered for treatment. Ultimately, prophylaxis for HHV-6 infection in HSCT recipients is not recommended.

Previous