The Potential of Serology in Early Diagnosis of EBV Related Disease During HIV Infection

1Institute of Tropical Medicine and Infectious Diseases, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya. 2Centre for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya. 3School of Dentistry and Oral Health, Griffith University, Southport, Queensland, Australia

Objective: Molecular methods are important for early diagnosis of Epstein Barr Virus (EBV) related diseases. Human immune deficiency virus (HIV-infection) alters the immune regulation of EBV resulting in the development of a variety of clinical manifestations. These range from benign conditions to aggressive malignancies. This cross sectional study compared serum EBV antibody expression at various clinical stages of HIV disease and the relationship between different stages of HIV-infection and EBV-disease progression.

Methods: A total of 63 male and 38 female subjects, aged above 18 years, were randomly selected from HIV+ male and female outpatients at the Mbagathi District Hospital, Nairobi. Clinical and sociodemographic data were captured using a clinical oral examination and detailed questionnaire. Samples of venous blood underwent EBV solid phase ELISA using EBV Profile 2TM (Medizinische Labordiagnostika AG, Lubeck, Germany). EBV infection stages at various HIV clinical stages were characterized by antibody profiles.

Results: The distribution of EBV-infection stages across the study patients was 66% in late infection, 18% in early infection,11% in reactivated infection and 5% were negative. The Odds Ratio for late stage EBV-infection status by Fishers exact test in HIV Stage 3 was 0.60(95% CI = 0.19 – 1.76) p = 0.34. The Odds Ratio for reactivated stage EBV infection status by Fishers exact test, in HIV clinical Stage 3 was 0.1(95% CI = 0.03 – 1.00) p = 0.03.

Discussion: No significant risk of reactivation of EBV-infection in HIV clinical stage 3 was demonstrated possibly because this was a preliminary study. EBV reactivation stage proteins are a proxy for host cell oncogenic expression. Serology to elicit EBV-infection status in HIV+ patients has a place in early diagnosis of oral hairy leukoplakia, lymphomas and other EBV-related diseases in AIDS. This will translate to early intervention and better prognosis of these conditions.