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There is no medical intervention currently licensed for the prevention or treatment of EBV infection.
There are many EBV treatments in development or in clinical trials, including in MS, and several EBV vaccines are in development.
The ability of EBV to lie dormant in the body during latent infection makes it more complicated to treat EBV infection. At certain times during latency, the virus is effectively hidden from the immune system.
Current experimental treatments for EBV infection do not completely remove the infection. Â
Vaccines and T cell therapy help the body to control the EBV infection more effectively.
Antiviral therapy prevents the virus from multiplying in the lytic phase and does not directly treat latent infection. Â Â
In addition, some of the current MS treatments may exert their effect in part because of their influence on EBV infection.
In 2007, a Phase 2 clinical trial showed that an early EBV vaccine successfully prevented the development of glandular fever but was not able to prevent infection.
Clinical trials of newer EBV vaccines are in progress or soon to commence internationally. Read more here.
Next-generation EBV vaccines are in development, including an innovative vaccine designed by an Australian team, that is highly effective in laboratory models.
Given that EBV is a major risk factor for developing MS, an effective vaccine that prevents EBV infection in humans may also have an important role in preventing the onset of MS.
A vaccine that prevents glandular fever, but not EBV infection, might not be enough to prevent MS, because not everyone with MS has had glandular fever.
If an EBV vaccine is developed that can prevent infection, it would take a very large study over many years to a determine whether this can prevent MS later in life.
EBV is a very common infection that has evolved with the human immune system. It is not clear whether preventing EBV infection may have more wide-ranging effects, possibly including negative effects, on the immune system or other body systems.Â
Although we don’t yet know whether EBV is involved in ongoing disease activity in MS, the pursuit of therapeutic vaccines to treat MS is also an area of active investigation.
MS Australia and MS Queensland supported the very early work of Professor Michael Pender to develop a cellular therapy for EBV in MS.
This therapy is based on an immune cell called a cytotoxic CD8 T cell, which is primarily responsible for killing EBV-infected B cells in the body.
For this therapy, CD8 T cells are purified from the blood, treated in the laboratory to enhance their EBV-killing capacity, and then returned to the body.
While the first clinical trial (using the person’s own cells) showed promising results, a larger trial (using donor cells) unfortunately did not show a treatment effect.
There is no antiviral treatment currently approved in Australia to treat EBV.
Several antiviral therapies that are approved for use in other viral infections are effective against EBV in laboratory experiments.
In humans, various antivirals have been shown to impact EBV infection (eg reducing viral levels in saliva; curing/improving glandular fever) in some settings but not others.
Although we don’t yet know whether EBV is involved in ongoing disease in MS, the pursuit of antivirals to treat MS is another area of active investigation.
Antiviral medications work by stopping EBV from multiplying during its lytic phase. They cannot kill EBV in its latent (inactive) phase.
The effect of suppressing EBV activation in MS is not well understood.
In older studies (1996, 2002 and 2005), the antivirals aciclovir and valaciclovir did not show significant benefit in MS, including on relapses, MRI lesions or disease progression.
In a recent small study, famciclovir did not reduce EBV lytic infection in people with MS (measured by how often EBV could be detected in saliva), but this may have been influenced by the participants also being treated with natalizumab (Tysabri).
Cases have recently been reported of improvements in MS patients treated with the antivirals tenofovir alafenamide and tenofovir disoproxil fumarate, which are known to suppress EBV in the laboratory.
There are two international clinical trials currently underway to test antivirals in MS.
One is testing if Truvada (tenofovir/emtricitabine) can reduce EBV levels in saliva and blood in people with MS; and if it is safe and tolerable in people with MS.
The second is investigating whether antiviral treatment can reduce EBV levels, improve disease course or stop disease progression in relapsing-remitting MS.
In 2025, the STOP-MS and FIRMS-EBV clinical trials of anti-EBV antivirals in MS will commence recruitment in Australia. You can read more here.
Some of the currently approved disease-modifying therapies for MS may exert some of their influence through effects on EBV.
Ocrelizumab (Ocrevus) is a highly effective MS therapy and depletes B cells. Similarly, alemtuzumab (Lemtrada) depletes several immune cell types including B cells.
In so doing, these therapies are potentially depleting the pool of EBV-infected B cells in the body.
