From the Guidelines
Epstein-Barr virus (EBV) infection is primarily treated with supportive care, focusing on managing symptoms while the body fights the virus, with rituximab being a recommended first-line therapy in certain cases, particularly in post-transplant lymphoproliferative disorders (PTLD) 1.
Treatment Approach
The treatment approach for EBV infection typically involves:
- Managing symptoms such as pain and fever with over-the-counter medications like acetaminophen or ibuprofen
- Ensuring adequate rest, particularly during the first 2-3 weeks when fatigue is most severe
- Staying hydrated by drinking plenty of fluids to combat fever and sore throat
- Gargling with warm salt water to relieve throat discomfort
- Avoiding strenuous physical activity and contact sports for at least 3-4 weeks to prevent spleen rupture
- Avoiding alcohol during recovery since the liver may be affected by the virus
Specific Therapies
In cases of post-transplant lymphoproliferative disorders (PTLD), the following therapies are recommended:
- Rituximab, 375 mg/m², once weekly, as first-line therapy 1
- Reduction of immunosuppressive therapy combined with rituximab, if possible 1
- Cellular therapy as adoptive immunotherapy with in vitro generated donor or third-party EBV-specific CTL, if available 1
- For second-line therapy, cellular therapy (EBV-specific CTLs or DLI) or chemotherapy ± rituximab may be considered 1
Important Considerations
It is essential to note that:
- Antiviral medications are not typically effective against EBV 1
- Antibiotics are not prescribed unless there's a secondary bacterial infection
- Surgery, IVIG, interferon, and antiviral agents are not recommended for therapy of PTLD 1
- Medical attention should be sought immediately if symptoms worsen significantly or include severe abdominal pain, persistent high fever, or extreme weakness.
From the Research
Treatment Options for EBV
- Antiviral drugs have been shown to be effective inhibitors of EBV replication, but have resulted in limited success clinically, and none of them has been approved for treatment of EBV infections 2
- Corticosteroids are the mainstay of treatment for complications of EBV infections, such as impending upper airway obstruction 3
- Antiviral treatment may be considered in severe manifestations of EBV infections in immunocompetent patients as an adjunct to steroid treatment 4
- Steroids have been used for their anti-inflammatory effects, but there is insufficient evidence to support their efficacy for symptom control in infectious mononucleosis 5
Specific Treatment Approaches
- Acyclovir monotherapy has been the most commonly prescribed antiviral regimen for severe EBV infections 4
- Combination therapy with acyclovir and other antivirals, such as ganciclovir and foscarnet, has also been used 4
- Hematopoietic stem cell transplantation (HSCT) is considered the only curative treatment for chronic active Epstein-Barr virus disease (CAEBV) 6
- Chemotherapy can be administered to control disease activity before HSCT 6