EBV levels in HIV-positive patients are not reduced by HAART

The proportion of HIV-infected patients with high levels of Epstein-Barr virus (EBV) is not affected by highly active antiretroviral therapy (HAART), Dutch investigators report. Thus, clinicians should still test patients for EBV despite the recent decrease in EBV-lymphoma-related morbidity.

In 1999, a research team led by Dr Servi JC Stevens, of the Vrije University Hospital in Amsterdam collected whole blood and parallel plasma samples from 109 patients being treated with HAART. Although all patients had an asymptomatic EBV infection, none developed AIDS-related non-Hodgkin’s lymphoma during follow-up until November of 2001.

The investigators report in the 3 May issue of AIDS that 64 whole-blood samples were polymerase chain reaction (PCR) positive for EBV, and 22 of these had 2,000 or more copies of EBV DNA per mL of blood. However, no cell-free virus was detected in plasma samples. There was no correlation between EBV DNA levels and HIV RNA levels or CD4 counts.

Compared with samples collected between 1993 and 1996 from 99 patients receiving anti-HIV monotherapy, no significant difference in EBV DNA loads was observed. Thus, the authors infer, HAART does not affect EBV burden.

The EBV DNA loads in some HIV-infected individuals “are remarkably higher than those found previously in healthy EBV-seropositive donors, who invariably have <2,000 EBV DNA copies/mL blood,” the investigators note. They suggest that this indicates a partially impaired immune surveillance against EBV in the presence of HIV.

Dr Stevens’ team noted a disparity in IgG responses to EBV VCA-p18 protein and the EBNA-1 protein. In the 14 patients with the highest EBV DNA loads, the anti-VCA-p19 IgG responses were significantly higher than those of patients with undetectable EBV DNA loads (p < 0.0001). However, anti-EBNA-1 IgG responses were significantly lower (p = 0.005). This observation indicates “impaired latency control and increased lytic replication,” the authors write.

Dr Stevens and colleagues suggest that monitoring EBV DNA load and EBV serology may help identify patients at increased risk for lymphomagenesis.

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