From the Guidelines
Treatment for post-Epstein-Barr virus (EBV) issues should focus on managing symptoms and considering immunomodulative therapy, as antiviral agents have shown no obvious effect on morbidity and outcome. When considering treatment options, it's essential to weigh the potential benefits and risks of each approach.
- For patients with chronic active EBV infection, therapies such as interferon gamma, IL-2, corticosteroids, cyclosporin A, or immunoglobulins have been tried, but their effectiveness is still uncertain 1.
- A more promising approach may be the use of autologous EBV-CTL, which has shown success in a series of patients with CAEBV, with 4 out of 5 patients not experiencing a relapse of their disease during the observation period 1.
- In severe cases, allogeneic peripheral blood or bone marrow stem-cell transplantation may be considered as a treatment of choice, given the recently reported successful results in patients with severe disease 1.
- It's crucial to note that further clinical studies are needed to evaluate and improve these approaches, and treatment should be individualized under specialist care.
- Additionally, supportive care measures such as maintaining proper hydration, a balanced diet, and stress reduction techniques may also be beneficial in managing symptoms and supporting immune function.
From the Research
Treatment Options for Post-EBV Issues
- Nonsteroidal anti-inflammatory drugs (NSAIDs) have been shown to quickly resolve symptoms associated with EBV-induced infectious mononucleosis in patients with atopic predispositions 2.
- Inhibitors of EBV reactivation and replication, including drugs licensed for treatment of other herpesviruses, licensed or experimental drugs for various other indications, compounds at an early stage of drug development, and nutritional constituents such as vitamins and dietary supplements, may be used to detect and treat EBV reactivation 3.
- For hemolytic anemia linked to EBV infectious mononucleosis, treatment options include steroids, blood transfusions, plasma exchange, intravenous polyclonal immunoglobulin, rituximab, and splenectomy, with observation alone being the chosen approach in some cases 4.
- Pre-emptive rituximab has been shown to reduce PTLD-related mortality in patients experiencing EBV infection following allo-SCT 5.
- Antiviral drugs, although effective inhibitors of EBV replication, have resulted in limited success clinically and none have been approved for treatment of EBV infections 6.
Specific Treatment Approaches
- NSAIDs, such as tiaramide or loxoprofen, may be used to improve symptoms quickly after initiation in patients with atopic predispositions 2.
- Rituximab may be used pre-emptively to reduce PTLD-related mortality in patients experiencing EBV infection following allo-SCT 5.
- Steroids and blood transfusions are commonly used to treat hemolytic anemia linked to EBV infectious mononucleosis 4.