Clinical

Human herpesvirus-6 infection may cause fulminant liver failure in young children

Last Updated: 2008-07-08 9:33:56 -0400 (Reuters Health)

NEW YORK (Reuters Health) - The possibility that human herpesvirus (HHV)-6 may be a cause of liver disease in children is "strongly" supported by the results of a French study reported in the Journal of Medical Virology for June.

"HHV-6 infection, a generally benign infection, may cause fulminant hepatic failure in infancy and exacerbate liver damage in children with pre-existing liver disease," the researchers conclude.

Led by Dr. Laurent Chevret of CHU Bicetre, France, the investigators conducted a prospective study of 23 children undergoing liver transplantation to assess the role of HHV-6 in the hepatic disease process. The median age of the children was 24 months.

Ten children had chronic liver disease while13 children had acute or acute on chronic liver failure; of the latter. Six had fulminant hepatic failure of undetermined cause, 4 had fulminant hepatic failure with an identifiable cause, and 3 had acute decompensated chronic liver disease of unknown cause.

Dr. Chevret's team analyzed liver tissue obtained during transplantation for HHV-6 DNA using quantitative real-time polymerase chain reaction (QRT PCR).

HHV-6 genomic DNA was detected in 10 of 13 patients in the acute group compared with only 2 of 10 in the chronic group. Viral loads ranged from 6 copies/1,000,000 cells to 32,500 copies/1,000,000 cells.

Four of nine children with acute liver failure of unknown origin and one child with fulminant autoimmune hepatitis had particularly high viral loads.

"Screening for HHV-6 infection should therefore be included in the diagnostic workshop of acute onset liver failure," Dr. Chevret and colleagues advise.

"Although a viral load threshold measured in the liver to discriminate latent from active infection among immunocompetent children still remains to be determined," the investigators comment, "QRT-PCR applied to the liver appears the best diagnostic tool to demonstrate an association between active infection and acute liver injury."

J Med Virology 2008;80:1051-1057.