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Human Herpesvirus 6 in Acute Liver Failure: Leading Role, Supporting Actor or Innocent Bystander? A Case Series,
Andrés Conthe1,2, Pablo Ramón Fueyo1, Fernando Aguilera1
1Department of Gastroenterology & Hepatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Journal of Viral Hepatitis
|October 23, 2025
Summary
Human herpesvirus 6 (HHV-6) is increasingly linked to acute liver failure (ALF), but its role is debated. This study highlights HHV-6 as a potential cause of ALF, especially in young women, and proposes a management algorithm.
Area of Science:
- Hepatology
- Virology
- Immunology
Background:
- Human herpesvirus 6 (HHV-6) is increasingly implicated in acute liver failure (ALF) cases.
- Its pathogenic role and diagnostic criteria remain debated, leading to potential underrecognition.
- HHV-6 infection can cause significant liver injury, even in immunocompetent adults.
Purpose of the Study:
- To investigate the role of HHV-6 in acute liver injury and failure.
- To review existing literature on HHV-6-associated hepatitis in immunocompetent adults.
- To develop a management algorithm for HHV-6-associated liver injury.
Main Methods:
- Conducted a narrative review of 20 previously reported cases of HHV-6 hepatitis in immunocompetent adults.
- Analyzed clinical presentation, diagnostic methods, treatment, and outcomes.
- Designed a management algorithm based on available evidence.
Main Results:
- HHV-6 hepatitis predominantly affects young women (80%) and is associated with fever (75%) and DRESS syndrome (30%).
- 65% of patients met ALF criteria, with a 30% mortality rate.
- Blood RT-PCR was the primary diagnostic tool; antiviral and corticosteroid therapies were used, and 25% required liver transplantation.
Conclusions:
- HHV-6 should be considered in the differential diagnosis of ALF, particularly in young febrile women and patients with DRESS syndrome.
- The proposed algorithm provides a structured approach to managing HHV-6-associated liver injury.
- Further research is needed to standardize diagnostic criteria and treatment strategies for HHV-6 hepatitis.
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