Valganciclovir for the Suppression of Epstein-Barr Virus Replication

Abstract

Valganciclovir for the Suppression of Epstein-Barr Virus Replication Jessica Eve YagerChair of the Supervisory Committee:Professor Anna Wald Department of EpidemiologyEpstein-Barr virus (EBV), a common herpesvirus, is the main causative agent of infectious mononucleosis.Following primary infection, EBV persists in host cells and can cause B cell transformation, leading to the development of EBV-associated malignancies. The role for antiviral therapy in treating and preventing EBV-associated disease remains unclear. Using oral swabs collected from a randomized, double-blind, placebo-controlled crossover study that our group had previously conducted, we sought to determine the impact of valganciclovir on both the rate and quantity of oral EBV shedding. Twenty-six men were randomly assigned to receive either oral valganciclovir, 900mg daily, or oral placebo once daily for eight weeks. Participants then received no study drug for a two week "washout period," followed by the alternate treatment (valganciclovir or placebo) for a second eight-week period. Valganciclovir reduced the proportion of days on which EBV was detected by 72% (relative risk 0.28, 95% confidence interval 0.08-0.55; p=0.003), and reduced the quantity of virus detected by 0.77 logs (95% confidence interval 0.62-0.91 logs; p<0.001). These results were consistent regardless of participants' HIV status and use of antiretroviral therapy. These findings could have significant clinical applications in both the treatment and prevention of EBV-associated disease. 4Background and Significance:

Quantification of Torque Teno Virus and Epstein-Barr Virus Is of Limited Value for Predicting the Net State of Immunosuppression After Lung Transplantation

“…One possible caveat when determining EBV DNA load is the use of valgangciclovir for preventing reactivation or primary infection of CMV. All patients received 3 months of valgangciclovir treatment initially after LTx; there are a few studies showing that valgangciclovir treatment reduces EBV load, which may have affected the results in this study [45,46].…”

A new therapy in Epstein-Barr virus-associated lymphoproliferative disease: a case report and a revision of the literature

“…Yager et al [20] found that oral valganciclovir could inhibit EBV replication. In our patient, long-term oral ganciclovir therapy could inhibit EBV replication in the gastrointestinal tract; corticosteroids offered symptomatic relief.…”

Bilateral granulomatous panuveitis in two patients with T-cell type of chronic active Epstein-Barr virus infection

“…The only promising treatment for resolving the EBV-infected neoplastic cells in CAEBV has been HSCT [19]. Although recent studies suggest some degree of effectiveness of valganciclovir for replication of EBV [20–22], there have been no studies which found the effectiveness of valganciclovir or ganciclovir for CAEBV. In the present 2 cases, EBV-infected cells could not be eradicated, but the disease activities: inflammatory symptoms including uveitis were resolved after HSCT.…”