EPSTEIN-BARR-VIRUS INFECTION OF HIV-SEROPOSITIVE INDIVIDUALS IS TRANSIENTLY SUPPRESSED BY HIGH-DOSE ACYCLOVIR TREATMENT

Objective: To assess whether oral acyclovir can eliminate persistent E pstein-Barr virus (EBV) infection and thereby prevent EBV-associated l ymphoma development in HIV-seropositive homosexual men. Method: Persis tent EBV infection was examined in a group of 21 HIV-seropositive homo sexual men before, during and after treatment with oral acyclovir at a dose of 800 mg every 6 h (10 individuals) or with a placebo (11 indiv iduals). Results: In 13 individuals, EBV was isolated from the orophar ynx before and after treatment (seven cases from the acyclovir-treated group and six from the placebo-treated group). A significant reductio n in virus isolation occurred during treatment in the acyclovir-treate d group, but not in the placebo-treated group. In seven cases in whom EBV shedding was detected before and after treatment, the EBV strain i solated was identical throughout the study, even when acyclovir had ab olished detectable shedding for the duration of the treatment. In two other cases more than one strain was detected. On examination of the E BV type present, 89% of a group of 18 patients consistently shed type A virus, 5.5% type B virus and 5.5% showed evidence of co-infection wi th both virus types. This compares with figures of 100, 0 and 0%, resp ectively, in a control group of HIV-seronegative individuals. Conclusi ons: High-dose acyclovir therapy does not eliminate persistent EBV inf ection from the oropharynx of healthy HIV-seropositive individuals and therefore would not necessarily prevent lymphoma development. Our res ults suggest that infection by type B EBV, and co-infections of both A and B type, are more common in HIV-seropositives than HIV-seronegativ es.