Human herpesvirus 6

Human herpesvirus 6 (HHV-6) is the common collective name for human herpesvirus 6A (HHV-6A) and human herpesvirus 6B (HHV-6B). These closely related viruses are two of the nine known herpesviruses that have humans as their primary host. HHV-6A and HHV-6B are double-stranded DNA viruses within the Betaherpesvirinae subfamily and of the genus Roseolovirus. HHV-6A and HHV-6B infect almost all of the human populations that have been tested. HHV-6A has been described as more neurovirulent, and as such is more frequently found in patients with neuroinflammatory diseases such as multiple sclerosis. HHV-6 (and HHV-7) levels in the brain are also elevated in people with Alzheimer's disease. HHV-6B primary infection is the cause of the common childhood illness exanthema subitum (also known as roseola infantum or sixth disease). It is passed on from child to child. It is uncommon for adults to contract this disease as most people have had it by kindergarten, and once contracted, immunity arises and prevents future reinfection. Additionally, HHV-6B reactivation is common in transplant recipients, which can cause several clinical manifestations such as encephalitis, bone marrow suppression, and pneumonitis. A variety of tests are used in the detection of HHV-6, some of which do not differentiate the two species. Both viruses can cause transplacental infection and be passed on to a newborn.

HHV-6A and Infertility A 2016 study showed that 43% of women with unexplained infertility tested positive for HHV-6A compared to 0% in the fertile control group. HHV-6A was found present in endometrial epithelial cells from women with unexplained infertility but not in their blood. In the context of infertility, this discovery underscores the importance of targeted testing for HHV-6A within the uterine environment, as the virus was not detected in the bloodstream of the affected individuals. Effective diagnosis, therefore, requires tests that are capable of distinguishing between active and latent HHV-6A infections specifically in endometrial tissue, highlighting the need for tissue-specific viral detection methods in assessing and managing infertility associated with HHV-6A. A 2018 study found 37% of women experiencing recurrent implantation failure after IVF/ET had HHV-6A in their endometrial biopsies, compared to 0% in control groups. A 2019 study confirmed the presence of HHV-6A infection in 40% of idiopathic infertile women. Identifying the effect of HHV-6A infection on endometrial immune status opens up a new perspectives on fertility care. It is possible to choose antiviral therapies and non-hormonal approaches for women with unexplained infertility characterized by HHV-6A to increase their pregnancy rate.

Testing for HHV-6 The table below presents a comprehensive overview of various diagnostic tests used to detect human herpesvirus 6 (HHV-6), detailing their ability to distinguish between active and latent infections. It also includes insights on the interpretation of test results, identifies providers that offer these tests, and indicates which methods are suitable for detecting HHV-6A in the endometrial lining—an important consideration for evaluating potential causes of infertility in women. The table serves as a guide for healthcare professionals to select appropriate diagnostic tests for HHV-6.

History

During 1986, Syed Zaki Salahuddin, Dharam Ablashi, and Robert Gallo cultivated peripheral blood mononuclear cells from patients with AIDS and lymphoproliferative illnesses. Short-lived, large, refractile cells that frequently contained intranuclear and/or intracytoplasmic inclusion bodies were documented. Electron microscopy revealed a novel virus that they named human B-lymphotropic virus (HBLV). Shortly after its discovery, Ablashi et al. described five cell lines that can be infected by the newly discovered HBLV. They published that HSB-2, a particular T-cell line, is highly susceptible to infection. Ablashi's pioneering research concluded by suggesting that the virus name be changed from HBLV to HHV-6, in accord with the published provisional classification of herpes viruses. Years later, HHV-6 was divided into subtypes. Early research (1992) described two very similar, yet unique variants: HHV-6A and HHV-6B. The distinction was warranted due to unique restriction endonuclease cleavages, monoclonal antibody reactions, and growth patterns. HHV-6A includes several adult-derived strains and its disease spectrum is not well defined, although it is thought by some to be more neurovirulent. HHV-6B is commonly detected in children with roseola infantum, as it is the etiologic agent for this condition. Within these two viruses is a sequence homology of 95%. In 2012, HHV-6A and HHV-6B were officially recognized as distinct species.

Taxonomy HHV-6A and HHV-6B were recognized by the International Committee on Taxonomy of Viruses (ICTV) as distinct species in 2012. Human roseoloviruses include HHV-6A, HHV-6B and HHV-7. Herpesvirus was established as a genus in 1971 in the first report of the ICTV. This genus consisted of 23 viruses among 4 groups. In 1976, a second ICTV report was released in which this genus was elevated to the family level — the herpetoviridae. Because of possible confusion with viruses derived from reptiles, the family name was changed in the third report (1979) to herpesviridae. In this report, the family Herpesviridae was divided into 3 subfamilies (alphaherpesvirinae, betaherpesvirinae and gammaherpesvirinae) and 5 unnamed genera; 21 viruses were recognized as members of the family. In 2009, the order Herpesvirales was created. This was necessitated by the discovery that the herpes viruses of fish and molluscs are only distantly related to those of birds and mammals. Order Herpesvirales contains three families, the Herpesviridae, which contains the long-recognized herpesviruses of mammals, birds, and reptiles, plus two new families — the family Alloherpesviridae which incorporates herpes viruses of bony fish and frogs, and the family Malacoherpesviridae which contains viruses of molluscs. As of 2012, this order currently has 3 families, 4 subfamilies (1 unassigned), 18 genera (4 unassigned) and 97 species.

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