Epstein-Barr virus

The Epstein-Barr virus (EBV) or HHV4 is a herpesvirus. It infects 90% of adults worldwide.

Age of infection
Typically child who acquire EBV are symptomatic. In adolescents and young adults, EBV can cause the symptoms of mononucleosis.

Latency
In most adults, the virus remains latent for life in B cells. It is estimated that 1 in every one hundred thousand to one million circulating B cells carry EBV. In healthy hosts, EBV populations are kept in check by CD4+ and CD8+ T-cell responses.

The equilibrium can be disrupted in individuals with compromised immune systems such as patients with AIDS or transplant patients taking immune system suppressing drugs. It has been observed that these patients are more susceptible to EBV-related cancers, such as certain lymphomas and carcinomas.

Chronic fatigue syndrome
A prospective study of 250 primary care patients revealed a higher prevalence of chronic fatigue syndrome after infectious mononucleosis (glandular fever) when compared to an ordinary upper respiratory tract infection. Anti-early antigen titers to EBV were elevated in CFS patients and associated with worse symptoms.

Treatment
Epstein-barr is thought to persistent harmlessly in immunocompetent individuals but in those with compromised immune systems has been associated with certain cancers and possibly autoimmune disease.

Several antivirals are active against EBV including valganciclovir.

A theoretical treatment...