Valganciclovir for the Suppression of Epstein-Barr Virus Replication

Abstract

Epstein-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.