Epstein-Barr Virus Infections: Biology, Pathogenesis, and Management

Epstein-Barr virus (EBV) encodes genes that ensure its persistence in human B lymphocytes. Some of the genes encourage B-cell proliferation; others are poised to evade or defeat immune recognition. Immune restraints on the virus, however, are typically so effective that most infections are never symptomatic. In contrast, acute infectious mononucleosis, a self-limited lymphoproliferative illness, is common in adolescents and young adults. Unbridled proliferative illnesses arise when cellular immunity is grossly defective. Treatment of EBV-associated syndromes is largely supportive. Antiviral drugs have no proven role except in patients with oral hairy leukoplakia. Vaccine development is technically feasible but is not considered a high priority for developed nations.