Antivirals in MS: Tenofovir
Posted: Wed Jan 17, 2024 10:32 am
Long-term MRI and clinical stability in an HIV-positive patient with multiple sclerosis on tenofovir: a case report
https://www.sciencedirect.com/science/a ... 4823008969
Introduction
The Epstein-Barr virus (EBV) is the likely leading cause of multiple sclerosis (MS). (Bjornevik et al., 2022) Debates continue regarding the potential benefit of antiviral treatment for EBV after the onset of MS.
Tenofovir prodrugs, used in highly active antiretroviral therapy (HAART) for HIV treatment, have shown potent inhibition of EBV in B-cells in vitro. (Drosu et al., 2020) Intriguingly, several case reports describe people with MS on HAART containing tenofovir with no evidence of MS disease activity, (Chalkley and Berger, 2014, Delgado et al., 2014, Labella et al., 2021, Francesco and Myriam, 2015, Torkildsen et al., 2020, Skarlis et al., 2018) and epidemiological studies have reported a lower incidence of MS in patients with HIV. (Gold et al., 2015, Nexø et al., 2013)
Although these observations could be due to immunosuppression from HIV, patients on HAART often maintain undetectable viral loads and normal CD4 T cell counts.
This raises the question of whether HIV treatment may be reducing MS disease activity by inadvertently treating EBV. Here, we present the case of an MS patient with significant brain and spinal cord disease burden at diagnosis who has remained clinically and radiologically stable for more than nine years while on a HAART regimen containing tenofovir and in the extended absence of disease-modifying therapies (DMTs) for MS.
Discussion
Although speculative, it is intriguing to consider the possibility that the improvement in this patient's MS condition after her HIV diagnosis was a direct effect of HAART on MS. Interestingly, she was maintained on a regimen containing tenofovir prodrugs for the entirety of her HIV treatment course. While the possibility that the HIV infection itself affected her MS disease course by modulating immune responses cannot be ruled out, she experienced amelioration of incoordination, cognition, and ...
Conclusion
Further research into tenofovir-based therapies for MS is warranted. In the future, it is crucial that trial designs incorporate a rational selection of primary endpoints, drawing from cases such as this one which suggest early treatment with evaluation of MRI disease activity and clinical relapses as suitable endpoints. Rigorous, placebo-controlled trials of antivirals used as monotherapy are essential to answer critical questions concerning the role of EBV in MS.
https://www.sciencedirect.com/science/a ... 4823008969
Introduction
The Epstein-Barr virus (EBV) is the likely leading cause of multiple sclerosis (MS). (Bjornevik et al., 2022) Debates continue regarding the potential benefit of antiviral treatment for EBV after the onset of MS.
Tenofovir prodrugs, used in highly active antiretroviral therapy (HAART) for HIV treatment, have shown potent inhibition of EBV in B-cells in vitro. (Drosu et al., 2020) Intriguingly, several case reports describe people with MS on HAART containing tenofovir with no evidence of MS disease activity, (Chalkley and Berger, 2014, Delgado et al., 2014, Labella et al., 2021, Francesco and Myriam, 2015, Torkildsen et al., 2020, Skarlis et al., 2018) and epidemiological studies have reported a lower incidence of MS in patients with HIV. (Gold et al., 2015, Nexø et al., 2013)
Although these observations could be due to immunosuppression from HIV, patients on HAART often maintain undetectable viral loads and normal CD4 T cell counts.
This raises the question of whether HIV treatment may be reducing MS disease activity by inadvertently treating EBV. Here, we present the case of an MS patient with significant brain and spinal cord disease burden at diagnosis who has remained clinically and radiologically stable for more than nine years while on a HAART regimen containing tenofovir and in the extended absence of disease-modifying therapies (DMTs) for MS.
Discussion
Although speculative, it is intriguing to consider the possibility that the improvement in this patient's MS condition after her HIV diagnosis was a direct effect of HAART on MS. Interestingly, she was maintained on a regimen containing tenofovir prodrugs for the entirety of her HIV treatment course. While the possibility that the HIV infection itself affected her MS disease course by modulating immune responses cannot be ruled out, she experienced amelioration of incoordination, cognition, and ...
Conclusion
Further research into tenofovir-based therapies for MS is warranted. In the future, it is crucial that trial designs incorporate a rational selection of primary endpoints, drawing from cases such as this one which suggest early treatment with evaluation of MRI disease activity and clinical relapses as suitable endpoints. Rigorous, placebo-controlled trials of antivirals used as monotherapy are essential to answer critical questions concerning the role of EBV in MS.