Infections due to human herpesvirus 6 in solid organ transplant recipients

This article summarizes the current state of the epidemiology, diagnosis, and management of human herpesvirus 6 (HHV-6) infection after solid organ transplantation.

HHV-6 reactivates commonly during the early weeks after solid organ transplantation. However, disease due to HHV-6 is uncommon and is manifested as a febrile illness associated with rash and tissue-invasive manifestations such as encephalitis, hepatitis, pneumonitis, and gastrointestinal disease. HHV-6 has also been indirectly associated with other opportunistic infections such as cytomegalovirus and fungal infections. Molecular tests such as PCR assays are preferred methods for the diagnosis of HHV-6 infection. Recent guideline from the American Society of Transplantation Infectious Disease Community of Practice does not recommend specific antiviral prophylaxis or preemptive therapy for HHV-6 infection. For established disease, intravenous ganciclovir and foscarnet are considered first-line agents.

Infection due to HHV-6 is a common after transplantation, but clinical disease is rare. Nonetheless, this infection has been indirectly associated with poor allograft and patient survival after transplantation. No specific prevention strategy is recommended, but treatment of established HHV-6 disease consists of antiviral therapy with intravenous ganciclovir and/or foscarnet, and reduction in immunosuppression.