HIV drugs, EBV and multiple sclerosis: what we know
Could HIV drugs help explain the link between Epstein-Barr virus (EBV) and multiple sclerosis? Case reports suggest some people with MS taking antiretroviral therapy (ART), including tenofovir, experienced long periods of disease stability. Researchers are investigating whether these drugs may work partly by interfering with EBV — but much remains unknown.
From 2014 to 2016, I worked in HIV medicine.
Not as a doctor, but in communications. Still, you pick up a few things along the way.
When COVID emerged, I saw old colleagues on TV and remember thinking, thank God it’s not a retrovirus. So when I recently came across some unusual MS case reports involving HIV drugs, they caught my attention.
People with MS who were taking HIV drugs have had some remarkable results.
One woman had both HIV and highly active MS. She started HIV treatment containing a drug called tenofovir.
Her MS became quiet.
She went almost five years without an MS relapse, despite taking no MS disease-modifying drug (DMT).
Then her HIV medication changed.
The new drugs didn’t have the same known effect on Epstein-Barr virus (EBV).
Her MS activity gradually returned.
Another person with HIV and MS remained stable for more than nine years while taking HIV treatment containing tenofovir.
There’s even a published case of an HIV-negative woman with MS who took two HIV drugs. Her ongoing fatigue and tingling disappeared and her MRI lesions improved.
These are only individual cases. They do not prove that HIV drugs treat MS.
But they give us a fascinating clue.
What does HIV treatment have to do with EBV?
Some HIV drugs, including forms of tenofovir, can also interfere with Epstein-Barr virus (EBV).
And EBV has become a very big deal in MS research.
Most 90-90 percent of people around the world have this EBV.
Once we catch it, it stays in our bodies for life.
And it’s a nasty little virus. It causes mononucleosis, also called mono, the kissing disease, and glandular fever.
I caught glandular fever at 17, right in the middle of my HSC year. Impeccable timing.
Most of the time it is latent — basically, asleep. It hides mainly inside some of our B cells.
Our immune system keeps watch.
Like MS, and HIV, EBV has no known cure.
We can’t eliminate EBV. We control it.
One of the key controllers are our T cells. They patrol for signs that EBV-infected cells are becoming active and help bring them under control.
Sometimes EBV wakes up. This is known as reactivation.
Here’s the intriguing possibility.
Perhaps these HIV drugs weren’t directly treating MS.
Perhaps they were helping by interfering with EBV.
What helps keep EBV asleep?
That’s the question that really interests me.
We know that psychological stress can affect the immune system and has been linked with greater EBV activity.
We also know that sleep, exercise, and good nutrition help support normal immune function.
What we don’t know is whether living a healthy lifestyle actually helps keep EBV asleep — or whether that could affect MS.
That’s still a research question.
Don’t rush out looking for HIV drugs
These case reports are exciting, but they aren’t clinical trials.
We don’t yet know whether HIV drugs such as tenofovir are a safe and effective treatment for MS in people who don’t have HIV.
They can also have side effects and interact with other medications.
So this research is a clue. That’s all.
None of this means getting HIV would somehow be helpful for MS. Absolutely not.
In less scientific language: HIV is a bastard of a virus and you don’t want it.
And you certainly don’t want it just to get access to ART.
Perhaps researchers should look harder at Epstein-Barr Virus.
Last thought
There’s a personal reason this interests me.
I spent nine years with no evidence of MS disease activity (NEDA) while taking no MS drug and no antivirals.
Lifestyle was the main thing I was actively doing for my MS. Food was my medicine. I did loads of exercise, relished my nine hours of sleep, and was right into meditation, bushwalking, creative writing and photography. I found my joys.
Did lifestyle help my immune system keep EBV quiet?
I feel that it did, but I don’t know.
But perhaps the HIV drug cases are pointing us towards a bigger question:
What helps our own immune system keep EBV dormant?
I’d really like researchers to answer that one.
FAQ: HIV drugs, EBV, and multiple sclerosis: what we know
Can HIV drugs treat multiple sclerosis?
We don’t know. A small number of case reports describe people with MS experiencing long periods of disease stability while taking HIV antiretroviral drugs. These reports are intriguing, but they are not clinical trials. HIV medications are not currently established treatments for MS.
What does Epstein-Barr virus have to do with MS?
EBV is a very common virus that causes glandular fever in some people and then remains in the body for life. Strong evidence now links EBV infection with the development of MS. It’s necessary but not enough by itself to cause MS. Researchers are still investigating exactly how EBV contributes to MS and whether targeting the virus could help treat or prevent the disease.
Can lifestyle help keep EBV dormant?
We don’t know yet. Psychological stress has been associated with changes in immune control of EBV, while sleep, exercise and good nutrition support healthy immune function more broadly. There’s no conclusive evidence that lifestyle alone can keep EBV dormant or replace effective MS disease-modifying treatment. But it sure doesn’t hurt to stay healthy.
References
- Bjornevik K, Cortese M, Healy BC, et al. Longitudinal analysis reveals high prevalence of Epstein-Barr virus associated with multiple sclerosis. Science. 2022;375(6578):296–301
- Drosu NC, Bjornevik K, Bilodeau P, Levy M. Long-term MRI and clinical stability in an HIV-positive patient with multiple sclerosis on tenofovir: a case report. Multiple Sclerosis and Related Disorders. 2024;83:105397
- Drosu NC, Edelman ER, Housman DE. Tenofovir prodrugs potently inhibit Epstein-Barr virus lytic DNA replication by targeting the viral DNA polymerase. Proceedings of the National Academy of Sciences. 2020;117(22):12368–12374
- Drosu NC, Edelman ER, Housman DE. Could antiretrovirals be treating EBV in MS? A case report. Multiple Sclerosis and Related Disorders. 2018;22:19–21
- Sausen DG, Bhutta MS, Gallo ES, Dahari H, Borenstein R. Stress-induced Epstein-Barr virus reactivation. Biomolecules. 2021;11(9):1380
This article is general information, not medical advice. HIV medications are not currently established treatments for MS. Never start, stop or change medication without talking to your healthcare team.
