The Epstein-Barr virus, or EBV for short, often causes confusion in connection with multiple sclerosis. Therefore, this is the start of the first of three parts with facts and considerations about EBV and MS.
In the relevant MS chats, the topic of whether MS can’t “simply” be treated with antiviral therapies comes up again and again. The discussion is based on the assumption that MS – contrary to the generally scientifically accepted view – is not an autoimmune disease, but an infectious disease mediated by viruses.
MS is not a viral disease
One argument is the observation that the incidence of MS in individuals infected with HIV is lower than in the general population (Gold J et al. HIV and lower risk of multiple sclerosis: beginning to unravel a mystery using a record-linked database study. J Neurol Neurosurg Psychiatry. 2015; 86(1):9-12). Supporters of the infection hypothesis use this to justify, among other things, the effectiveness of a highly active antiviral therapy (so-called HAART = therapy for HIV) against a supposed (viral) “MS pathogen”. Therefore, the use of antiretroviral therapies for the treatment of MS is sometimes advocated in forums.
Discussions are often very emotional and occasionally drift towards conspiracy theories (“The pharmaceutical industry is withholding this important knowledge in order to continue selling expensive immunotherapeutics”). It is concealed that retroviral therapies have indeed been investigated in clinical studies in the past, but no effect on the activity of MS could be demonstrated (Gold J et al. A phase II baseline versus treatment study to determine the efficacy of raltegravir (Isentress) in preventing progression of relapsing remitting multiple sclerosis as determined by gadolinium-enhanced MRI: The INSPIRE study. Mult Scler Relat Disord. 2018; 24:123-128). There is therefore currently (especially for the industry) no convincing evidence to pursue this approach – and therefore self-medication of any kind should be discouraged.
EBV can promote autoimmunity
The discussion on antiviral therapies has recently gained momentum again after a much-noticed work was published in the prestigious scientific journal SCIENCE at the beginning of 2022, which clearly demonstrated the importance of the Epstein-Barr virus (EBV) in the development of MS. I had already commented on this work in a post in January 2022 (see DocBlog „Cause of Multiple Sclerosis – new study on the role of the Epstein-Barr virus (EBV)„). And also pointed out that this work did not prove that MS is directly caused by EBV, but that the mechanisms of disease development are much more complex. Accordingly, this work is not an argument for treating MS with antiviral therapies (which keeps happening in chat groups).
Since the topic of EBV and MS is of such great interest, it makes sense to collect some facts about EBV at this point. If you consider the complexity of the interaction of EBV with the human organism, it quickly becomes clear that the mechanisms by which EBV contributes to the development of autoimmunity are not yet fully understood and therefore no sensible strategies can be derived from the current knowledge. Antiviral therapy alone is certainly not the solution – and certainly not with drugs that were developed to treat HIV. EBV, which belongs to the family of herpes viruses, is a so-called DNA virus, while HIV is a human retrovirus that initially has to transcribe its genetic material, which is in the form of RNA, into DNA. Most HIV therapies aim to prevent this process, which plays no role in an EBV infection.
Therefore, in the next two posts, I will explain
- the EBV infection and
- take a position on a possible vaccination against EBV.
This should better enable my readers to classify the current discussion contributions on EBV, antiviral therapy, and MS.
