Clinical relevance of high HHV-6B viral load in immunocompromised host
Abstract
The peculiarity of the chromosomally integrated form of human herpesvirus type 6 (ciHHV-6) is its wide distribution (up to 1% of the population), the possibility of transmission by inheritance, the problem of diagnosis, including issues of differential diagnosis with the acute form of HHV-6 infection, which, in turn, makes it difficult to resolve the problem of the therapy necessity. In addition, activation of ciHHV-6 is possible sometimes with acute infection clinical symptoms and the need for antiviral therapy, especially in patients after bone marrow transplantation and chemotherapy. We report a 10-years-old girl after chiasmal-sellar germinoma surgery and subsequent chemotherapy with ciHHV-6B. The child was treated with ganciclovir. This did not significantly influence the reduction of the viral load HHV-6B DNA in serum and cerebrospinal fluid. No adverse effects of antiviral treatment were registered. It’s important to exclude ciHHV-6 before the diagnosis of HHV-6 active disease is made, as this screening may prevent the unnecessary use of antivirals.
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HHV-6A and HHV-6B as distinct viruses. Arch Virol. 2014 May;159(5):863-70. doi: 10.1007/ s00705-013-1902-5.
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primary human herpesvirus 6 infection. N Engl J Med. 2005 Feb 24;352(8):768-76. doi: 10.1056/ NEJMoa042207.
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9. Flamand L. Pathogenesis from the reactivation of chromosomally integrated human herpesvirus type 6: facts rather than fiction. Clin Infect Dis. 2014 Aug 15;59(4):549-51. doi: 10.1093/cid/ ciu326.
10. Clark DA, Nacheva EP, Leong HN, Brazma D, Li Y, Tsao E, et al. Transmission of integrated human herpesvirus 6 through stem cell transplantation: implications for laboratory diagnosis. J Infect Dis. 2006 Apr 1;193(7):912-6. doi: 10.1086/500838.
11. Pellett PE, Ablashi DV, Ambros PF, Agut H, Caserta MT, Descamps V, et al. Chromosomally integrated human herpesvirus 6: questions and answers. Rev Med Virol. 2012 May;22(3):144-55. doi: 10.1002/rmv.715.
12. Clark DA. Clinical and laboratory features of human herpesvirus 6 chromosomal integration. Clin Microbiol Infect. 2016 Apr;22(4):333-339. doi: 10.1016/j.cmi.2015.12.022.
13. Ward KN, Leong HN, Nacheva EP, Howard J, Atkinson C, Davies N, et al. Human herpesvirus 6 chromosomal integration in immunocompetent patients results in high levels of viral DNA in blood, sera, and hair follicles. J Clin Microbiol. 2006 Apr;44(4):1571-4. doi: 10.1128/ JCM.44.4.1571-1574.2006.
14. Endo A, Watanabe K, Ohye T, Suzuki K, Matsubara T, Shimizu, et al. Molecular and virological evidence of viral activation from chromosomally integrated human herpesvirus 6A in a patient with X-linked severe combined immunodeficiency. Clin Infect Dis. 2014 Aug 15;59(4):545-8. doi: 10.1093/cid/ciu323.
15. Kaufer BB, Flamand L. Chromosomally integrated HHV-6: impact on virus, cell and organismal biology. Curr Opin Virol. 2014 Dec;9:111-8. doi: 10.1016/j.coviro.2014.09.010.
16. Hall CB, Long CE, Schnabel KC, Caserta MT, Mclntyre KM, Costanzo MA, Knott A, et al. Human herpesvirus-6 infection in children. A prospective study of complications and reactivation. N Engl J Med. 1994 Aug 18;331(7):432-8. doi: 10.1056/ NEJM199408183310703.
17. Caserta MT, McDermott MP, Dewhurst S, Schnabek K, Carnahan JA, Gilbert L, et al. Human herpesvirus 6 (HHV6) DNA persistence and reactivation in healthy children. J Pediatr. 2004 Oct;145(4):478-84. doi: 10.1016/j.
jpeds.2004.06.016.
HHV-6A and HHV-6B as distinct viruses. Arch Virol. 2014 May;159(5):863-70. doi: 10.1007/ s00705-013-1902-5.
2. Agut H, Bonnafous P, Gautheret-Dejean A. Laboratory and clinical aspects of human herpesvirus 6 infections. Clin Microbiol Rev. 2015 Apr;28(2):313-35. doi: 10.1128/CMR.00122-14.
3. Ward KN. The natural history and laboratory diagnosis of human herpesviruses-6 and -7 infections in the immunocompetent. J Clin Virol. 2005 Mar;32(3):183-93. doi: 10.1016/j.jcv.2004.11.008.
4. Zerr DM, Meier AS, Selke SS, Frenkel L, Huang M, Wald A, et al. A population-based study of
primary human herpesvirus 6 infection. N Engl J Med. 2005 Feb 24;352(8):768-76. doi: 10.1056/ NEJMoa042207.
5. Flamand L. Chromosomal Integration by Human Herpesviruses 6A and 6B. Adv Exp Med Biol. 2018;1045:209-226. doi: 10.1007/978-981-10- 7230-7_10.
6. Telford M, Navarro A, Santpere G. Whole genome diversity of inherited chromosomally integrated HHV-6 derived from healthy individuals of diverse geographic origin. Sci Rep. 2018 Feb 22;8(1):3472. doi: 10.1038/s41598-018-21645-x. Erratum in: Sci Rep. 2018 Apr 17;8(1):6357. doi: 10.1038/s41598-018-24603-9.
7. Godet AN, Soignon G, Koubi H, Bonnafous P, Agut H, Poirot C, et al. Presence of HHV-6 genome in spermatozoa in a context of couples with low fertility: what type of infection? Andrologia. 2015 Jun;47(5):531-5. doi: 10.1111/and.12299.
8. Hall CB, Caserta MT, Schnabel K, Shelley L, Marino A, Carnahan J, et al. Chromosomal integration of human herpesvirus 6 is the major mode of congenital human herpesvirus 6 infection. Pediatrics. 2008 Sep;122(3):513-20. doi: 10.1542/peds.2007- 2838.
9. Flamand L. Pathogenesis from the reactivation of chromosomally integrated human herpesvirus type 6: facts rather than fiction. Clin Infect Dis. 2014 Aug 15;59(4):549-51. doi: 10.1093/cid/ ciu326.
10. Clark DA, Nacheva EP, Leong HN, Brazma D, Li Y, Tsao E, et al. Transmission of integrated human herpesvirus 6 through stem cell transplantation: implications for laboratory diagnosis. J Infect Dis. 2006 Apr 1;193(7):912-6. doi: 10.1086/500838.
11. Pellett PE, Ablashi DV, Ambros PF, Agut H, Caserta MT, Descamps V, et al. Chromosomally integrated human herpesvirus 6: questions and answers. Rev Med Virol. 2012 May;22(3):144-55. doi: 10.1002/rmv.715.
12. Clark DA. Clinical and laboratory features of human herpesvirus 6 chromosomal integration. Clin Microbiol Infect. 2016 Apr;22(4):333-339. doi: 10.1016/j.cmi.2015.12.022.
13. Ward KN, Leong HN, Nacheva EP, Howard J, Atkinson C, Davies N, et al. Human herpesvirus 6 chromosomal integration in immunocompetent patients results in high levels of viral DNA in blood, sera, and hair follicles. J Clin Microbiol. 2006 Apr;44(4):1571-4. doi: 10.1128/ JCM.44.4.1571-1574.2006.
14. Endo A, Watanabe K, Ohye T, Suzuki K, Matsubara T, Shimizu, et al. Molecular and virological evidence of viral activation from chromosomally integrated human herpesvirus 6A in a patient with X-linked severe combined immunodeficiency. Clin Infect Dis. 2014 Aug 15;59(4):545-8. doi: 10.1093/cid/ciu323.
15. Kaufer BB, Flamand L. Chromosomally integrated HHV-6: impact on virus, cell and organismal biology. Curr Opin Virol. 2014 Dec;9:111-8. doi: 10.1016/j.coviro.2014.09.010.
16. Hall CB, Long CE, Schnabel KC, Caserta MT, Mclntyre KM, Costanzo MA, Knott A, et al. Human herpesvirus-6 infection in children. A prospective study of complications and reactivation. N Engl J Med. 1994 Aug 18;331(7):432-8. doi: 10.1056/ NEJM199408183310703.
17. Caserta MT, McDermott MP, Dewhurst S, Schnabek K, Carnahan JA, Gilbert L, et al. Human herpesvirus 6 (HHV6) DNA persistence and reactivation in healthy children. J Pediatr. 2004 Oct;145(4):478-84. doi: 10.1016/j.
jpeds.2004.06.016.
| Files | ||
| Issue | Vol 8, No 4 (2025) | |
| Section | Case Report | |
| DOI | https://doi.org/10.18502/igj.v8i4.20103 | |
| Keywords | ||
| Antiviral Therapy ciHHV-6 HHV-6 Infection | ||
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How to Cite
1.
Kishkurno E, Amvrosieva T, Dmitriev E, Divakova K. Clinical relevance of high HHV-6B viral load in immunocompromised host. Immunol Genet J. 2025;8(4):374-377.
