LAUSR

Epstein et al.1 point out that proof of a causal relationship between HHV-6 reactivation and septic shock is tenuous in Bonnafous et al.2 and stated that "no high-quality data support the use of antivirals for HHV-6-associated syndromes". HHV-6 can cause significant disease in hematopoietic stem cell transplant (HCT) and solid organ transplant (SOT) patients, which have been successfully treated with foscarnet, ganciclovir, or less commonly, cidofovir3-7 and we recently showed that foscarnet prophylaxis (90mg/kg/day) may be able to reduce the severity of HHV-6 encephalitis7 , which affects 5.0-8.3% of CBT patients and 0.5-2.3% of non-CBT alloHCT patients3,8 . Though HHV-6 disease is less common in liver transplantation compared to HCT, it is underappreciated as infection can persist in the liver without evidence in peripheral blood4,5 . This article is protected by copyright. All rights reserved.