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15 February 2006

Volume 42, Number 4
Clinical Infectious Diseases 2006;42:e21–e25
© 2006 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2006/4204-00E2$15.00
DOI: 10.1086/499956
MAJOR ARTICLE

Ganciclovir Is Associated with Low or Undetectable Epstein‐Barr Virus DNA Load in Cerebrospinal Fluid of Patients with HIV‐Related Primary Central Nervous System Lymphoma

Simona Bossolasco,1

Kerstin I. Falk,3,4

Maurilio Ponzoni,2

Norberto Ceserani,1

Fulvio Crippa,1

Adriano Lazzarin,1

Annika Linde,3,4 and

Paola Cinque1

1Clinic of Infectious Diseases and 2Department of Pathology, San Raffaele Hospital, Milan, Italy; and 3Department of Virology, Swedish Institute for Infectious Disease Control, and 4Microbiology and Tumor Biology Center, Karolinska Institutet, Stockholm, Sweden

Background.Epstein‐Barr virus (EBV) is pathogenically linked to human immunodeficiency virus (HIV)–related primary central nervous system lymphoma (PCNSL) and is found in virtually all HIV‐related PCNSL cases. The objective of this study was to assess the effect of ganciclovir on EBV DNA replication in patients with HIV‐related PCNSL.

Patients and methods.EBV DNA was measured by real‐time polymerase chain reaction in cerebrospinal fluid and plasma samples from 25 patients with HIV‐related PCNSL. Eight of these patients were receiving ganciclovir for concurrent cytomegalovirus infections.

Results.EBV DNA was detected in cerebrospinal fluid samples obtained from 15 (88%) of 17 ganciclovir‐untreated patients and 4 (50%) of 8 ganciclovir‐treated patients ( ). EBV DNA load was significantly lower for treated patients, compared with untreated patients (median value, 2.15 vs. 4.16 log copies/mL; ). Analysis of sequential cerebrospinal fluid samples from 7 patients showed that EBV DNA decreased in samples obtained from 2 patients following the start of ganciclovir administration but did not decrease in samples obtained from the 5 untreated patients. In addition, patients who received ganciclovir survived longer than the untreated patients (median duration of survival, 181 vs. 72 days; ).

Conclusion.The effect of ganciclovir on EBV DNA load in cerebrospinal fluid supports the hypothesis that EBV is replicating in patients with PCNSL. This observation, together with the effect of ganciclovir therapy on patient survival, suggests that this drug might be useful for the management of PCNSL.

Received 19 September 2005; accepted 11 November 2005; electronically published 11 January 2006.

Reprints or correspondence: Dr. Simona Bossolasco, Clinic of Infectious Diseases, San Raffaele Hospital, Via Stamira d’Ancona, 20, 20127 Milano, Italy ().

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