Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
To the Editor: Dr Levin and colleagues1 found that infection with Epstein-Barr virus (EBV)
was a risk factor for later development of multiple sclerosis (MS). Although
the authors pointed out that levels of IgG against EBV nuclear antigen 1 (EBNA-1)
were correlated with the risk of developing MS, I disagree with their analogy
to similar associations between EBV and Burkitt lymphoma and nasopharyngeal
carcinoma. In those cases, neoplastic cells reexpress EBV antigens, which
leads to an increase in the levels of serologic markers.2 Thus,
it is uncertain whether EBV has any causal role in the etiology of these cancers.
There is no evidence, for instance, of persisting EBNA-1 antigen expression
by central nervous system cells in patients with MS. Similarly, there is no
evidence that EBV causes the lesions of MS, and the serologic picture of chronic
or reactivated EBV infection in otherwise healthy persons is different than
that found in patients with MS.
Lily O. Epstein-Barr Virus and Risk of Multiple Sclerosis. JAMA. 2003;290(2):192. doi:10.1001/jama.290.2.192-a