Free fulltext: https://www.jacc.org/doi/full/10.1016/S0735-1097(23)02228-3 https://www.jacc.org/doi/epdf/10.1016/S0735-1097(23)02228-3 IS EXPOSURE TO EPSTEIN-BARR VIRUS A RISK FACTOR FOR LONG-COVID?OPEN ACCESS Prevention And Health Promotion Benjamin Davies Horne Kirk U. Knowlton Viet T. Le Tami L. Bair Heidi Thomas May Stacey Knight and Jeffrey L. Anderson J Am Coll Cardiol. 2023 Mar, 81 (8_Supplement) 1784 Background A viral etiology to chronic fatigue syndrome (CFS) has long been postulated, and Epstein-Barr Virus (EBV) was the first CFSassociated virus. CFS and Long-COVID share features, potentially implicating a similar etiology. This study evaluated if EBV exposure is associated with post-COVID syndrome (Long-COVID). Methods Intermountain Healthcare electronic health records were queried to identify patients diagnosed with COVID-19 and tested for EBV between March 6, 2020 and April 13, 2022. A subsequent diagnosis of Long-COVID (ICD-10 U09.9) was evaluated using survival methods. Results Overall, 296,959 patients had COVID-19 and 590 had concurrent EBV test results [207 (35.1%) were EBV positive]. Subjects averaged 27.4±18.4 years of age (range: 0-86); 57.6% were female. Hospitalization occurred in 61 subjects (10.3%) within 30 days of COVID-19 diagnosis, with 17 (2.9%) requiring intensive care. Long-COVID was found in 29 (4.9%) subjects (just 10 were among the 61 hospitalized for COVID-19), with 15 (7.2%) EBV positive (Figure) and 14 (3.7%) EBV negative (HR=2.09, 95% CI=1.01, 4.34; p=0.042). EBV risk remained in multivariable analyses. Race, hyperlipidemia, and tobacco use also predicted Long-COVID, with histories of anticoagulant and vitamin D use were protective. Conclusion In a large prospectively-collected registry, EBV positivity was associated with an elevated risk of Long-COVID. This suggests that EBV may be a predisposing risk factor for or co-precipitant of Long-COVID. Download FigureDownload PowerPoint
Only EBV considered ( perhaps due to recent research with MS ) ? HHV virus statuses would also be interesting given Prusty' s work. General viral panel ?
I am not with it enough this morning to think the methodology through logically, but is’t there a risk that by looking at just data from those that a previous clinical decision had been made to test for EBV exposure that they are looking at a skewed sample for some reason. Sad that the opportunity to do a full work up on a population early on in the pandemic and then followed them up over several years, seeing if there were any predictors for who developed an active Covid-19 infection and who subsequently developed Long Covid and who developed Long Covid that met the criteria for an ME/CFS diagnosis, was missed. However it may be the only people advocating the need for such studies back then were ME patients. Establishing an association is a very valuable result, but we are still left not knowing if a previous EBV exposure was a necessary factor for subsequent development of Long Covid or if for some reason given the individuals genetics or physiology whatever predisposes them to develop Long Covid had also independently predisposed them to previously react to EBV a pretty ubiquitous virus. Looking at other very common viruses, as suggested by @Amw66 for HHV, might give some suggestions on how to distinguish association from a possibly necessary precursor. [added - sorry they did look at other viruses too, see below]
Reminds me of the suggestion (by others on this site) to use the US Army samples, which identified the link between EBV & MS, i.e. to examine whether there's a link between EBV & ME/CFS.
Hopefully, this leads to more expanded studies that go far wider. The technology is ready to do this at scale and low-cost, so let's effing go. Even if EBV is significant, this hopium-based belief that most pathogens are harmless until proven otherwise may finally receive the challenge it deserves, a model that basically fails at object permanence. Ugh.
