Hantavirus Treatment — Supportive Critical Care
There is no specific licensed antiviral for HPS in Europe or North America. Treatment is supportive critical care — mechanical ventilation, fluid management, vasopressors, ECMO where indicated, and renal replacement therapy for HFRS. Early recognition and intensive care are the strongest survival predictors.
HPS supportive care
Patients meeting clinical criteria should be transferred to an ICU with ECMO capability where geographically feasible. Per CDC and Argentine Ministerio de Salud guidance:
- Oxygenation — early high-flow nasal cannula or intubation; lung-protective ventilation (low tidal volume, plateau pressure ≤30 cmH₂O).
- Fluid management — cautious; the cardiopulmonary phase has profound vascular leak with relative hypovolaemia, but over-resuscitation worsens pulmonary oedema. Crystalloids first; vasopressors early.
- ECMO — veno-arterial ECMO has improved outcomes in Andes-virus HPS in Chile and Argentina. CDC and PAHO both list ECMO availability as a survival determinant.
- Antibiotics — empirical broad-spectrum cover until diagnosis confirmed (atypical pneumonia, sepsis, leptospirosis must be excluded).
HFRS supportive care
- Fluid and electrolyte management calibrated to the five-stage clinical course — restrictive during the oliguric phase, then permissive during the diuretic phase.
- Renal replacement therapy (haemodialysis or CRRT) for acute kidney injury — required in 30 to 60 percent of severe HFRS cases.
- Blood-product transfusion for haemorrhagic complications.
- Avoid nephrotoxic drugs (NSAIDs, aminoglycosides) where possible.
Antiviral therapy
Ribavirin has demonstrated benefit in early HFRS (meta-analyses of Chinese HTNV cohorts show roughly halved mortality when started within 7 days of symptom onset). Evidence in HPS is weaker and most trials have shown no benefit; the US placebo-controlled trial in SNV-HPS was stopped early for futility. Ribavirin is not licensed for hantavirus in the EU or US but is used off-label in Latin America.
Monoclonal antibody and convalescent plasma approaches have been investigated in Argentine and Chilean ANDV cohorts with suggestive but inconclusive efficacy data. Several mAb candidates are in Phase I/II trials in 2026.
Long-term sequelae
Survivors of HFRS may have persistent renal impairment (around 5 to 10 percent), hypertension, and proteinuria. HPS survivors generally recover normal pulmonary function within 6 to 12 months but report prolonged fatigue. Both syndromes have documented neurocognitive sequelae in case series — assessment and rehabilitation are recommended.