Nephrology Dialysis Transplantation, Vol 12, Issue 10 2099-2104, Copyright © 1997 by Oxford University Press
B Winkelspecht, N Mueller-Lantzsch and H Kohler
Background: Reactivation of EBV infection is a common
finding in immunocompromised individuals. The influence of 'uraemic
immunodeficiency' on EBV infection is so far not well defined.
Methods: We determined specific antibodies to EBV
nuclear antigens (EBNA) 1 and 2 in sera of 286 patients with
immunodeficiency due to progressive chronic renal failure and of 51 healthy
controls. We used the baculovirus vector expression system for recombinant
production of EBNA1 and EBNA2. Results: Serological
evidence of reactivated or chronic persistent EBV infection, i.e. an
anti-EBNA1/antiEBNA2 ratio (E1/E2)<1, was found in 18% of patients
with chronic renal failure not yet receiving renal replacement therapy
(CRF), 11% of peritoneal dialysis patients (CAPD), 25% of haemodialysis
patients (HD), 24% of renal transplant recipients (TX), and in 6% of
healthy controls. Rate of EBV reactivation was significantly increased in
HD (P=0.004) and TX (P=0.006) patients compared to healthy controls.
Moreover, the difference between HD and CAPD patients was statistically
significant (P <0.05). This finding may reflect additional effects
modulating the function of the immunosystem, probably through activation of
immunologically competent cells by contact with the artificial surfaces of
dialysis membranes. Although the rate of EBV reactivations is expected to
increase further under conditions of therapeutic immunosuppression, our
serological approach did not detect an additional effect of
immunosuppressive therapy following renal transplantation. However this
finding may reflect an impaired endogenous synthesis of antibodies caused
by immunosuppressive agents. Conclusion: We conclude
that determination of E1/E2 is useful for assessment of EBV infection in
patients with chronic renal failure and 'uraemic immunodeficiency'. In
patients with immunsuppressive therapy following renal transplantation
additional testing including direct estimation of viral load, is necessary
to correctly assess the state of EBV infection.
Keywords: EBV infection; EBV reactivation;
immunodeficiency; serology; uraemia; transplantation
ORIGINAL ARTICLES
Serological evidence for reactivation of EBV infection due to uraemic immunodeficiency
Department of Internal Medicine IV, Nephrology, and Department of Virology, University Homburg/Saar, Germany; Corresponding author at: Nephrology, Dept Internal Medicine IV, Gebaude 40, University of the Saarland, D-66421 Homburg/Saar, Germany
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