Acyclovir and other antivirals such as famciclovir, valacyclovir, foscarnet and val/ganciclovir can all limit acute phase replication and viral shedding. Can use to treat OHL, but will recur without treatment of immunosuppression. Clinical impact of these drugs on HIV-related lymphomas is uncertain.
Limited data suggestive ganciclovir lowers EBV viral load in vivo, especially for PCNSL, but clinical utility undefined.
Comment: Practical and heavily referenced review addresses questions regrding oral lesions in HIV infected patients. Review includes topical therapies for OHL.
Comment: EBV-related malignancies among the top causes in HIV, along with HHV8 and non-Hodgkin’s lymphoma (NHL). EBV may be the promoter in certain types of Burkitt’s lymphoma (mostly in Africa), NHL (including diffuse large B-cel, extra-nodal natural killer/T-cell nasal type) and nasopharyngeal carcinoma.
Comment: Authors using retrospective data suggest that a cut off of EBV copies of 200/ml predicted CNS lesions (sensitivity 70-73%, specificity 85-93%) with both PCNSL and AIDS-related lymphoma, respectively. Best specificity was acheived using a cut-off of 2,000 copies.
Comment: Because 4 lymphomas developed during a phase II trial of vicriviroc (a CCR5 antagonist), plasma EBV DNA was monitored in 116 pts who did not experience increases in detectable levels, suggesting that CCR5 antagonism by this drug did not lead to EBV reactivation.
Comment: Thorough overview from an oncologic perspective points out that EBV-driven lymphomas often present with plasmablastic differentiation in HIV+ pts, and that ART appears improve outcomes with combined chemotherapy protocols.
Comment: Some have questioned specificity of CSF EBV PCR in Dx of CNS lymphoma in HIV+ pts. This study suggests that addition of quantitative aspect (namely >10,000 c/ml) improves specificity and positive predictive value compared to qualitative result for Dx of PCNSL (96% vs. 66% and 50% vs. 10%, respectively).
Comment: Small study suggests that treatment with ganciclovir, AZT and IL-2 may have been helpful in 2/5 patients.
Comment: Along with Aboulafia ref, data suggesting that active replication of EBV may be playing role in PCNSL.
Comment: EBV PCR was not helpful diagnostically, but higher EBV PCR viral load correlated with poorer outcomes in HIV+ population with NHL.
Comment: Case series describing an association.
Comment: Reviews largely anecdotal experience suggesting that ART is influencing both epidemiology and outcomes of PCNSL.
Comment: Small series refuting claimed high sensitivity/specificity of EBV CSF PCR. Here 26 pts studied with CNS processes, but PCR had only 29% positive predictive value, and specificity 79%. This study more likely reflects real-life statistics in evaluating a diffuse set of CNS conditions in HIV. Authors suggest test useful for ruling out lymphoma, but Dx requires brain Bx.
Comment: Small RCT of 19 HIV+ pts. examining use of valacyclovir (with better bioavailability than acyclovir) in treatment of OHL. Most cases resolved, though in some cases productive EBV replication recurred after discontinuation of treatment. In a few treated cases, treatment failed, which authors attributed to drug-resistant EBV.
Comment: Study of university students in Scotland suggests EBV acquired more frequently in those sexually active. However, since kissing and intercourse are closely related behaviors, it is still unclear whether EBV is commonly acquired by other than salivary shedding.
Comment: Report describes 3 pts suspected of IM with positive heterophile (Monospot) testing who instead had acute HIV infection, with EBV-specific serologies not suggesting acute EBV infection. These cases add to other reports showing that the Monospot can be falsely positive in pts with primary HIV infection.
Comment: Retrospective study examined unselected pts with suspected IM who had negative heterophile antibody tests. 2% had HIV disease by plasma HIV RNA testing. Of those, half had primary HIV infection, and half had chronic HIV disease.
Comment: One of the better papers suggesting diagnostic utility of CSF EBV DNA PCR in patients with PCNSL. In 136 HIV+ pts with brain lesions, examining both EBV DNA or T. gondii-DNA tests, positive predictive value for PCNSL increased to >0.96. Regardless, authors suggested that brain Bx still necessary to establish Dx of PCNSL. However, brain Bx mortality may be ~2%, so this needs to be weighed against risks of inappropriately receiving brain irradiation.
Comment: Report from pre-HAART era suggesting 60-fold increased risk of NHL in HIV+ pts and linking risks to EBV. From CDC-gathered information 1686 cases were immunoblastic lymphoma, 548 primary CNS lymphoma, and 590 Burkitts lymphoma, a condition not normally associated with immunosuppression.
Comment: OHL described on subclinical (histopathological) basis in ~17% of HIV+ pediatric patients, which is higher than prior reports in adult populations.
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