Many early human trials of Acyclovir in EBV showed positive effect on viral load reduction but were never run long enough to actually assist the immune system in eradication or marginalizing the virus. Examples such as this one and others prove this point:
[Andersson J, Sköldenberg B, Ernberg I, Britton S, Henle W, Andersson U. Acyclovir treatment in primary Epstein-Barr virus infection. A double-blind placebo-controlled study. Scand J Infect Dis Suppl. 1985;47:107-15. PMID: 3006226]
I believe our lab proven eradication results using immune support plus 60 days minimum of Acyclovir or Valacyclovir are due to the combination approach as mentioned in the webcall. More modern data at least leave the option up to physicians to use this drug class in EBV (and in my opinion best done with immune support):
“The available data derive from case reports and case series and thus the deduction of conclusions regarding the effect, if any, of antiviral treatment is debatable. However, physicians may consider using antiviral agents in severe manifestations of EBV infections in immunocompetent patients as an adjunct to steroid treatment.” [Rafailidis PI, Mavros MN, Kapaskelis A, Falagas ME. Antiviral treatment for severe EBV infections in apparently immunocompetent patients. J Clin Virol. 2010 Nov;49(3):151-7. doi: 10.1016/j.jcv.2010.07.008. Epub 2010 Aug 24. PMID: 20739216]
References:
1. Andersson J, Sköldenberg B, Ernberg I, Britton S, Henle W, Andersson U. Acyclovir treatment in primary Epstein-Barr virus infection. A double-blind placebo-controlled study. Scand J Infect Dis Suppl. 1985;47:107-15. PMID: 3006226
Abstract: Acyclovir (ACV), which effectively inhibits in vitro Epstein-Barr virus (EBV) production, was tested in 31 patients with clinical and laboratory diagnosis of infectious mononucleosis (IM) in a double-blind trial. Patients with symptoms not exceeding 7 days were randomised to intravenous ACV 10 mg/kg or placebo (PLO) treatment every 8 h for 7 days. Clinical, virological and immunological parameters were followed in each patient before, during and after treatment. There were no significant differences (p greater than 0.05) between the treatment groups for any single clinical symptom between the treatment groups. If data concerning duration of fever, weight loss, tonsillar swelling, sore throat and patient self-assessment of general health were combined, a significant effect (p less than or equal to 0.01) favouring ACV treatment was determined. ACV significantly inhibited oropharyngeal EBV shedding (p less than or equal to 0.001), but the salivary EBV titer returned within 3 weeks after cessation of treatment. Specific cellular and humoral immunity was not affected, nor was the development of virus latency.
2. Rafailidis PI, Mavros MN, Kapaskelis A, Falagas ME. Antiviral treatment for severe EBV infections in apparently immunocompetent patients. J Clin Virol. 2010 Nov;49(3):151-7. doi: 10.1016/j.jcv.2010.07.008. Epub 2010 Aug 24. PMID: 20739216
Abstract:
BACKGROUND: Infectious mononucleosis usually runs a mild self-limiting course. Complications arise rarely and when so, corticosteroids are the mainstay of their treatment. The role of antivirals in the management of severe EBV infections is debatable.
METHODS: We sought to review the usage of antivirals for severe EBV infection in apparently immunocompetent patients. For this reason a search in PubMed and Scopus was performed for the time period from 1982 to 2009. RESULTS: 45 patients with severe manifestations of infectious mononucleosis received antivirals (as an adjunct to steroids in 26 of them). Specifically 21 patients with CNS involvement (meningoencephalitis, cerebellitis), 4 with peripheral nervous system involvement (Guillain-Barré, myeloradiculitis, facial nerve palsy), 5 with hepatitis and 15 with other afflictions (including adult respiratory distress syndrome, thrombocytopenia, aplastic anemia, acute renal failure, ulcerations, myocarditis, and frosted branch vasculitis) received antiviral medications. Thirty-nine out of these 45 patients had a favourable outcome (27 were cured and 12 showed clinical improvement) while 6 patients died. The most commonly prescribed antiviral regimen was acyclovir monotherapy (35 patients). Three patients received combinations of acyclovir with other antivirals and 1 received famciclovir. Three patients received ganciclovir monotherapy, 1 ganciclovir plus foscarnet, 1 foscarnet and 1 vidarabine.
CONCLUSION: The available data derive from case reports and case series and thus the deduction of conclusions regarding the effect, if any, of antiviral treatment is debatable. However, physicians may consider using antiviral agents in severe manifestations of EBV infections in immunocompetent patients as an adjunct to steroid treatment.
