Human Herpesvirus 6 Infection Treatment & Management

Updated: Nov 10, 2015
  • Author: Michelle R Salvaggio, MD, FACP; Chief Editor: Burke A Cunha, MD  more...
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Treatment

Approach Considerations

Treatment of human herpesvirus 6 (HHV-6) infection varies according to the presenting clinical situation. Therapy is usually unnecessary for primary infection in immunocompetent hosts. In infants with roseola infantum only, treatment is mainly supportive. Infants who present with other manifestations of HHV-6 infection (eg, febrile seizures or CNS involvement) must be admitted to the hospital; overall, about 13% of infants with acute HHV-6 infection require hospitalization.

Treatment of individuals with acute HHV-6 infection remains under investigation. Some experts recommend ganciclovir and foscarnet in severe incidents.

Note that infection with HHV-6 cannot be prevented; no vaccine exists. According to guidelines regarding donor sepsis, HHV-6 may be transmitted to recipients but is not screened for. [57]

Advise rest for children with roseola until the fever breaks and the rash appears. Consult a pediatrician for evaluation of any atypical findings. No further outpatient care for roseola is necessary once the eruption appears (if presentation is typical).

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Supportive Care

Supportive therapy is indicated for patients with symptomatic HHV-6 infection. In roseola, symptomatic treatment of the fever is recommended, including baths, lightweight clothing, and rest. Adequate fluid balance should be ensured.

Acetaminophen or ibuprofen should be administered to patients with high-grade fever, patients who are uncomfortable, or patients who have a previous history of febrile seizures; avoid aspirin in children, because of the risk of Reye syndrome. If the patient has a febrile seizure, no seizure medication is necessary.

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Antiviral Therapy

For immunosuppressed hosts with documented active HHV-6 infection, 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. The effectiveness of ganciclovir was evaluated against HHV-6 excreted in saliva in stem-cell transplant recipients [58] ; ganciclovir was found to be capable of decreasing the HHV-6 viral load in saliva.

Ganciclovir can worsen bone-marrow suppression in patients who have undergone bone-marrow transplantation. Foscarnet may be used, but renal function and calcium levels must be monitored closely.

To evaluate the influence of ganciclovir prophylaxis on HHV-6 replication in renal transplant recipients, Galarraga et al [59] studied 3 groups: (1) patients not receiving ganciclovir, (2) patients receiving short-term (< 30 days) ganciclovir prophylaxis, and (3) patients receiving long-term (>60 days) ganciclovir prophylaxis. [59] The antiviral did not affect the prevalence of HHV-6 (67.2%), but HHV-6 viremia appeared later and was of shorter duration among patients on long-term prophylaxis.

Because HHV-6 and HHV-7 are possibly associated with pityriasis rosea (PR), it has been suggested that systemic administration of drugs directed against HHV may hasten the recovery of patients who have PR. High-dose acyclovir may be effective for treating PR, especially in patients treated in the first week from onset, when the replicative viral activity of HHV is probably very high. [60]

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