Prevalence of antibody to human herpesvirus 6 among blood donors infected with HIV

Epidemiology of viral encephalitis in 2011

Encephalitis is an inflammation of the brain structures: neurons, vessels or glial cells. However, a consensual definition of the syndrome is difficult to obtain, and it is even more difficult to define encephalitis due a specific agent. Most viruses can be responsible for infectious encephalitis, but the number of encephalitis cases is very limited with regards of the incidence of benign infections from these pathogens. Viruses responsible for encephalitis can be animal-borne, vector-borne or human-to-human transmitted, they can infect preferentially immunocompetent or immunosuppressed patients, and some of them have demonstrated their epidemic potential. Herpes simplex encephalitis is recognized worldwide as the most frequent infectious encephalitis, and the only one with a validated specific treatment. Encephalitis following some viral infections such as measles or rabies can be prevented by vaccination. Unfortunately, effective treatment currently lacks for most encephalitic viral agents identified so far.

Characterization of an Epstein-Barr virus-related gammaherpesvirus from common marmoset (Callithrix jacchus)

A gammaherpesvirus related to Epstein-Barr virus (EBV; Human herpesvirus 4) infects otherwise healthy common marmosets (Callithrix jacchus). Long-term culture of common marmoset peripheral blood lymphocytes resulted in outgrowth of spontaneously immortalized lymphoblastoid cell lines, primarily of B cell lineage. Electron microscopy of cells and supernatants showed herpesvirus particles. There were high rates of serological cross-reactivity to other herpesviruses (68-86%), but with very low geometric mean antibody titres [1:12 to human herpesvirus 6 and 1:14 to Herpesvirus papio (Cercopithecine herpesvirus 12)]. Sequence analysis of the conserved herpesvirus DNA polymerase gene showed that the virus is a member of the lymphocryptovirus subgroup and is most closely related to a lymphocryptovirus from rhesus macaques and is closely related to EBV and Herpesvirus papio. High seroprevalence (79%, with geometric mean antibody titre of 1:110) among 28 common marmosets from two geographically distinct colonies indicated that the virus is likely present in many common marmosets in captivity. A New World primate harbouring a lymphocryptovirus suggests that this subgroup arose much earlier than previously thought.

HHV-6, 7 and their related diseases

Human herpesvirus 6 (HHV-6) and human herpesvirus 7 (HHV-7) are relatively recently discovered beta-herpesvirus. They are prevalent in the human population. Primary infection of HHV-6 has been associated with exanthem subitum and febrile illness. Little information is known about the clinical characteristics of primary infection with HHV-7, although some cases of exanthem subitum have been linked to it. HHV-6 has been recently recognized as an opportunistic pathogen in patients with HIV infection and in transplant recipients. The techniques now available to detect these two viruses remain limited, though putative roles for HHV-6 and HHV-7 in several diseases linked to viral infection have been reported. This report reviews the current knowledge of HHV-6 and HHV-7 biology and their pathogenesis.

Human herpesvirus 6 infection and associated pathogenesis following bone marrow transplantation

Human herpesvirus 6 (HHV-6) infections following bone marrow transplantation (BMT) have been shown to be associated with fever, skin rash, graft versus host disease, encephalitis, delay in engraftment, marrow suppression, and pneumonia. Unfortunately several of these studies were case reports and although the results were suggestive they prompted us to study these pathological events systematically. These associations were primarily based on either HHV-6 isolation, HHV-6 DNA detection, antigen detection or increases in HHV-6 specific antibodies. HHV-6 activity was more frequent during the post- rather than the pre-transplantation period. All HHV-6 isolates from BMT patients have been shown to be variant B. A better understanding of HHV-6 associated pathogenesis gained by larger prospective trials is needed to facilitate proper treatment of cases of idiopathic illnesses or those associated with symptoms (fever, skin rash) similar to those caused by HHV-6.

Human herpesvirus 6

Human herpesvirus 6 variant A (HHV-6A) and human herpesvirus 6 variant B (HHV-6B) are two closely related yet distinct viruses. These visuses belong to the Roseolovirus genus of the betaherpesvirus subfamily; they are most closely related to human herpesvirus 7 and then to human cytomegalovirus. Over 95% of people older than 2 years of age are seropositive for either or both HHV-6 variants, and current serologic methods are incapable of discriminating infection with one variant from infection with the other. HHV-6A has not been etiologically linked to any human disease, but such an association will probably be found soon. HHV-6B is the etiologic agent of the common childhood illness exanthem subitum (roseola infantum or sixth disease) and related febrile illnesses. These viruses are frequently active and associated with illness in immunocompromised patients and may play a role in the etiology of Hodgkin's disease and other malignancies. HHV-6 is a commensal inhabitant of brains; various neurologic manifestations, including convulsions and encephalitis, can occur during primary HHV-6 infection or in immunocompromised patients. HHV-6 and distribution in the central nervous system are altered in patients with multiple sclerosis; the significance of this is under investigation.

Human herpesvirus-6 infections

HHV-6 is ubiquitous in the community, appears to be acquired early in life, and has been proved to cause the clinical syndrome of exanthem subitum, and rarely to cause encephalitis. Like other herpesviruses, HHV-6 is capable of establishing latent infection and reactivating under a variety of stimuli. Improved diagnostic techniques have led to increased recognition of HHV-6 in the presence of many diseases, but much of the evidence for an aetiological role is inconclusive. There is accruing evidence for possible pathological roles in the immunocompromised host, but the evidence is less convincing for the range of associations otherwise listed for the normal host at the present time.

No direct relationship between HIV1/2 infection and HHV-6 antibody response in a large-scale European and African trial

BACKGROUND

Tropism of both human herpesvirus-6 (HHV-6) and human immunodeficiency virus (HIV) for CD4+ lymphocytes, and several studies on HIV enhancer transactivation by HHV-6 have suggested that HHV-6 could be implicated as a cofactor in the progression of HIV infection to AIDS.

OBJECTIVES

To determine if there is any relationship between HHV-6 infection and the course of HIV infection.

STUDY DESIGN

527 French and 558 African sera (210 from Senegal, 348 from Ivory Coast) were tested for HHV-6 titers by immunofluorescence assay (IFA). For each country, patients studied were divided into several groups; those with AIDS, those who were HIV-seropositive but symptomless, and HIV-seronegative patients.

RESULTS

No statistical difference could be found between HHV-6 prevalences or HHV-6 geometric mean titers obtained for each geographical area in the different HIV-1- and/or HIV-2-positive and HIV-negative groups. HIV patients with clinical manifestations of AIDS did not differ in percent seropositivity or distribution of titers from the HIV-asymptomatic patients or HIV-seronegative patients.

CONCLUSION

These findings suggest that there is no correlation between HHV-6 antibodies and HIV seropositivity or with the stage of HIV infection.

Human herpesvirus-6: the latest human herpes virus

Human herpesvirus-6 (HHV-6) was first isolated in 1986 from peripheral blood leukocytes of patients with lymphoproliferative disorders. Although HHV-6 is distinct from the other human herpes viruses, DNA studies have revealed some genomic similarities with cytomegalovirus. It has recently become evident that up to 95% of older children and adults are HHV-6 seropositive. Infection is believed to occur early in life, after maternal antibody has waned. Up to 92% of healthy adults shed HHV-6 in saliva, and evidence indicates that this secretion is important in spread of the virus. In situ hybridization and immunochemical studies suggest that the salivary glands themselves may be the site of replication and persistence of HHV-6. There is good evidence that HHV-6 is causally linked to exanthema subitum, a common febrile disease of infants. Associations of HHV-6 with postviral fatigue syndrome, lymphoproliferative disorders and progression of AIDS have all been examined, but the evidence in these cases remains conflicting.

Enzyme-linked immunosorbent assay for detection of IgG antibody to human herpesvirus 6

A lysate of human herpesvirus 6 (HHV-6)-infected cord blood mononuclear cells was used as antigen for enzyme-linked immunosorbent assay for the detection of IgG antibody to HHV-6. Antibody responses after exanthem subitum were well correlated with clinical recovery from the disease and the level of antibody activities was well correlated with indirect immunofluorescence assay and the neutralization test. Seroconversion to other human herpesvirus, including cytomegalovirus, was not observed in infants with exanthem subitum. All of the infants had by the age of 1 month antibodies to HHV-6, which decreased with age to the lowest level at the age of 3 to 6 months and then increased and reached the maximum level by 1 to 2 years of age. After 3 years of age, the prevalence was almost stable.

In vitro susceptibility of T lymphocytes from chimpanzees (Pan troglodytes) to human herpesvirus 6 (HHV-6): a potential animal model to study the interaction between HHV-6 and human immunodeficiency virus type 1 in vivo

The in vitro susceptibility of several nonhuman primate species to human herpesvirus 6 (HHV-6) was investigated. Only peripheral blood mononuclear cells from chimpanzees (Pan troglodytes) were found permissive to productive infection by HHV-6, indicating that the host range of HHV-6, albeit limited, may not be restricted to Homo sapiens. However, natural HHV-6 infection in chimpanzees, as well as in the other species tested, could not be documented by serological analysis. As previously observed with human cells, HHV-6 infection of chimpanzee peripheral blood mononuclear cells was highly cytopathic and the infected cells exhibited phenotypic features of activated T lymphocytes. Although in humans the majority of HHV-6-infected lymphocytes displayed the CD4 antigen, in chimpanzees a mixed CD4+ and CD8+ phenotype was observed. HHV-6 was also shown to productively coinfect individual chimpanzee T cells with human immunodeficiency virus type 1, resulting in an accelerated induction of cytopathicity. In light of these findings, we propose the utilization of chimpanzees as a potential animal model system to investigate the in vivo interaction between HHV-6 and human immunodeficiency virus type 1 and its relevance to the development of acquired immune deficiency syndrome.

Effect of primary Epstein-Barr virus infection on human herpesvirus 6, cytomegalovirus, and measles virus immunoglobulin G titers

Immunoglobulin G antibody titers to human herpesvirus 6 (HHV-6), measles virus, and cytomegalovirus (CMV) were examined in serum samples from 31 patients with Epstein-Barr virus (EBV)-induced infectious mononucleosis (IM). Sera were drawn sequentially from the same patients less than or equal to 7 days until 3 years after onset of IM. In seropositive patients, there was a significant decrease with time after IM of the immunoglobulin G titers to the three viruses in the majority of patients; HHV-6 IgG titers decreased in 80%, measles virus IgG titers decreased in 75%, and CMV IgG titers decreased in 67%. Four patients contracted CMV infection during the observation period after IM. In these, HHV-6 IgG titers increased, while EBV and measles virus IgG titers remained essentially stationary. Polyclonal B-cell stimulation during IM is suggested to augment antiviral titers in general, but the increases of HHV-6 IgG titers during EBV and CMV infections may also be due to selective stimulation of memory B cells by related antigens or to reactivation of HHV-6 during infection with these herpesviruses.

Neutralizing antibody assay for human herpesvirus-6

Antibody to human herpesvirus-6 (HHV-6) was measured in cord blood mononuclear cell cultures by a neutralization (NT) test, in which the presence or absence of characteristic large cell formation in cells infected with HHV-6 was used as an indicator for neutralization of the virus. The NT test could measure antibodies during and just after the appearance of the skin rash in patients with exanthem subitum. The levels of antibodies measured by the NT test was generally higher than that by an indirect immunofluorescence assay.

[Human B lymphotropic virus (HBLV) or human herpesvirus (HHV-6)]

HHV.6 (or HBLV) herpesvirus was isolated in 1986. This virus has a specific tropism for T cells. It is ubiquitous. Most subjects are infected in early childhood. HHV.6 is responsible for exanthema subitum. Its possible involvement in the aggravation of immunodeficiency syndromes and its action on malignant haematologic disorders, has been suggested but has not been clearly demonstrated.