title: High Epstein-Barr virus (EBV) DNA loads in HIV-infected patients: correlation with antiretroviral therapy and quantitative EBV serology.
abstract: OBJECTIVE
  To study Epstein-Barr virus (EBV) DNA loads in peripheral blood of HIV carriers to determine base-line values and diagnostic relevance of viral load in relation to quantitative serology; to compare EBV presence in parallel plasma and unfractionated whole blood samples; and to correlate EBV DNA load to HIV, CD4 T-cell counts and HAART.
  
  
  METHODS
  One-hundred and nine random patients receiving highly active antiretroviral therapy (HAART) during 1999 and 99 patients on anti-HIV monotherapy during 1993-1996 were included.
  
  
  METHODS
  EBV DNA load was determined by quantitative competitive PCR. EBV serology was determined by immunoblot profile and quantitative enzyme-linked immunosorbent assay for responses against VCA-p18 and EBNA-1.
  
  
  RESULTS
  Twenty-two out of 109 patients receiving HAART and 28 out of 99 of patients on anti-HIV monotherapy showed elevated EBV DNA loads in whole blood (> 2000 copies/ml), without elevated loads in parallel plasma. EBV DNA load distribution did not differ between the two groups (P = 0.78) and did not correlate with HIV or CD4 T-cell count. In three patients with high EBV DNA loads EBV RNA was virtually absent. Patients with high EBV DNA loads (3610-89 400 copies/ml) had higher anti-VCA-p18 IgG levels than patients with undetectable EBV DNA (P < 0.0001) but lower anti-EBNA-1 IgG levels (P = 0.005).
  
  
  CONCLUSIONS
  Absolute values of EBV DNA load may have poor diagnostic value for defining HIV patients at risk for developing EBV-associated disease. Elevated EBV DNA loads are cell-associated and are not influenced by HAART. Increased anti-p18-VCA and decreased anti-EBNA-1 IgG levels in patients with high EBV loads indicate impaired latency control and increased lytic replication suggesting disturbed overall immunosurveillance against EBV.
authors.affiliation: Department of Pathology, University Hospital Vrije Universiteit, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands.
authors.forename: Servi J C
authors.initials: SJ
authors.lastname: Stevens
authors.forename: Brian S N
authors.initials: BS
authors.lastname: Blank
authors.forename: Paul H M
authors.initials: PH
authors.lastname: Smits
authors.forename: Pieter L
authors.initials: PL
authors.lastname: Meenhorst
authors.forename: Jaap M
authors.initials: JM
authors.lastname: Middeldorp
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use*; D000914:Antibodies, Viral / Q000097:blood*; D023241:Antiretroviral Therapy, Highly Active; D001773:Blood Cells / Q000821:virology; D018791:CD4 Lymphocyte Count; D004279:DNA, Viral / Q000097:blood* / Q000302:isolation & purification; D020031:Epstein-Barr Virus Infections / Q000097:blood / Q000150:complications / Q000453:epidemiology / Q000821:virology*; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D004854:Herpesvirus 4, Human / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification* / Q000502:physiology; D006801:Humans; D009426:Netherlands / Q000453:epidemiology; D010949:Plasma / Q000821:virology; D016133:Polymerase Chain Reaction; D019562:Viral Load; D014766:Viremia / Q000453:epidemiology / Q000821:virology*; D014775:Virus Activation
chemical_list: D019380:Anti-HIV Agents; D000914:Antibodies, Viral; D004279:DNA, Viral