From the Guidelines
Epstein-Barr virus (EBV) infection is primarily treated with supportive care, as there is no specific antiviral therapy approved for routine use, and treatment focuses on managing symptoms through adequate rest, hydration, and over-the-counter pain relievers. The most recent and highest quality study, 1, published in 2016, provides evidence-based recommendations for the diagnosis, prevention, prophylaxis, and therapy of post-transplant lymphoproliferative disorders in stem cell transplant patients. However, for uncomplicated EBV infections, the approach remains supportive care.
Key Components of Supportive Care
- Adequate rest and hydration to manage symptoms
- Over-the-counter pain relievers like acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) to reduce fever and alleviate sore throat and body aches
- Avoidance of aspirin in children and teenagers due to the risk of Reye's syndrome
- Gargling with salt water to relieve throat discomfort
- Limitation of physical activities and avoidance of contact sports for at least 3-4 weeks to prevent splenic rupture
Role of Corticosteroids and Antiviral Medications
- Corticosteroids like prednisone may be prescribed short-term in severe cases with significant throat swelling
- Antiviral medications like acyclovir are generally not recommended for uncomplicated EBV infections due to limited effectiveness, as noted in 1
Considerations for Specific Patient Groups
- Patients undergoing hematopoietic stem cell transplantation may require prophylaxis, pre-emptive therapy, or treatment for EBV-related post-transplant lymphoproliferative disorders, as discussed in 1 and 1
- The use of rituximab, reduction of immunosuppression, and EBV-specific cytotoxic T-cell therapy are recommended as first-line therapy for post-transplant lymphoproliferative disorders, whilst unselected donor lymphocyte infusions or chemotherapy are options as second-line therapy, as per 1 and 1
From the Research
Treatment Options for Epstein-Barr Virus (EBV) Infection
- There are various therapeutic approaches for severe EBV infection, although no definite treatment has been established 2.
- Strategies for prophylaxis and treatment of EBV infection in immunocompromised patients have advanced, including immunological-based approaches and improvement in the treatment of underlying diseases 3.
- In immunocompromised individuals, EBV infection can lead to malignancies, and while there are no approved antivirals, novel therapies against EBV have been described 4.
Specific Treatment Approaches
- Corticosteroids, such as methylprednisolone, have been used to treat severe thrombocytopenia as a complication of acute EBV infection 5.
- Antiviral drugs, including acyclic nucleoside and nucleotide analogues, have been shown to inhibit EBV replication in cell culture, but their use in vivo is limited 6.
- Novel anti-EBV compounds, such as maribavir, are being explored for the treatment of acute EBV infections 6.