Epstein-Barr Virus (EBV) treatment
Study – authors & date
Protocol 1
https://www.hopkinsguides.c Johns Hopkins abx guide
om/hopkins/view/Johns_Hop
kins_ABX_Guide/540208/all
/Epstein_Barr_Virus
Study 1
Tynell, E., Aurelius, E.,
Brandell, A., Julander, I.,
Wood, M., Yao, Q. Y.,
Rickinson, A., Akerlund, B.,
& Andersson, J. (1996).
Acyclovir and prednisolone
treatment of acute infectious
mononucleosis: a
multicenter, double-blind,
placebo-controlled
study. The Journal of
infectious diseases, 174(2),
324–331.
https://doi.org/10.1093/infdis
/174.2.324
Study 2
Andrei, G., Trompet, E., &
Snoeck, R. (2019). Novel
Therapeutics for
Epstein⁻Barr
Virus. Molecules (Basel,
Switzerland), 24(5), 997.
Purpose of evaluation or Methods Summary of findings
research
Infectious mononucleosis (IM)
• Usually, self-limited <3 weeks with supportive care
• If needed corticosteroid (prednisone 40-60mg/d)
for airway obstruction, severe thrombocytopenia, or
hemolytic anemia
Antivirals (Acyclovir, valacyclovir, ganciclovir) have no
role in IM
• Reduce oral viral shedding, but no clinical benefit
To compare the • Multicenter Result
effectiveness of Acyclovir • Double-blind
with Prednisolone • Placebo- Total 94 patients
treatment versus Placebo controlled
in patients with Epstein Acyclovir (800mg 5times daily) + prednisolone (0.7mg/kg
Barr Virus. x first 4 days) vs placebo
• viral shedding was suppressed/inhibited in the
acyclovir + prednisolone group
• However, it was observed that no significant
enhancements were detected in the individual
clinical symptoms overall.
To review antiviral drugs Result
that have been evaluated • acyclovir was shown to significantly reduced EBV
in the clinic to treat EBV shedding in the oropharynx when administered
infections intravenously and orally, virus release resumed at
the initial level within 3 weeks of cessation of the
treatment
https://doi.org/10.3390/mole
cules24050997
Study 3
Yager, J. E., Magaret, A. S.,
Kuntz, S. R., Selke, S.,
Huang, M. L., Corey, L.,
Casper, C., & Wald, A.
(2017). Valganciclovir for
the Suppression of Epstein-
Barr Virus Replication. The
Journal of infectious
diseases, 216(2), 198–202.
https://doi.org/10.1093/infdis
/jix263
Study 4
AlDabbagh, M. A., Gitman,
M. R., Kumar, D., Humar,
A., Rotstein, C., & Husain,
S. (2017). The Role of
Antiviral Prophylaxis for the
Prevention of Epstein-Barr
Virus-Associated
Posttransplant
Lymphoproliferative Disease
in Solid Organ Transplant
• Antivirals in combination with immunomodulatory
drugs (such as corticosteroids, used empirically by
physicians to treat infectious mononucleosis) might
be effective.
• pediatric liver transplant recipients, treatment with
intravenous ganciclovir did not change the
proportion of patients with reduction in EBV load
at 8 weeks and 1 year after detection of EBV
viremia
To evaluate effect of • Randomized Result
valganciclovir on oral • Double-blind • 72% reduction in frequency of EBV shedding on
EBV shedding in a • Placebo- valganciclovir vs placebo
randomized, double-blind, controlled
placebo-controlled study • Crossover trial Discussion (risk for PTLD)
• One study reported a reduction in PTLD (3.9% to
0.5% of SOT recipient) received either acyclovir
(QID dosing) or ganciclovir (IV) – study 4
• Another study evaluating renal-only transplant
found 83% reduction in PTLD (various in between
antiviral therapy)
• Ganciclovir is associated with 38% reduction of
early PTLD
• However, definitive study of ganciclovir or
valganciclovir in PTLD prevention has not been
done
Evaluate the role of • Systematic Result
antiviral prophylaxis for review and meta- • Only Included the studies that had confirmed
the prevention of analysis histopathological diagnosis of PTLD and confirmed
posttransplant evidence of EBV infection
lymphoproliferative • Biological explanation support its use for the
disease (PTLD) remains reduction of PTLD, however despite the biological
controversial for solid plausibility, this meta-analysis failed to
organ transplantation demonstrate a benefit
(SOT) recipients who are • Data were insufficient to analyze the impact of
antiviral use on mortality and efficacy
Recipients: A Systematic seronegative for Epstein–
Review. American journal of Barr virus (EBV)
transplantation : official
journal of the American
Society of Transplantation
and the American Society of
Transplant Surgeons, 17(3),
770–781.
https://doi.org/10.1111/ajt.14
020