Abstract
OBJECTIVE: Epstein-Barr virus (EBV) is linked to both AIDS-defining and non-AIDS-defining malignancies. This study investigated the variation and trajectory of blood EBV DNA load after antiretroviral treatment (ART) among a prospective cohort of people with HIV (PWH). DESIGN: Prospective, observational, noninterventional study. METHODS: Newly diagnosed PWH in Taizhou, China (2012-2014) received ART and were followed until December 2022. Whole blood samples were periodically collected for EBV DNA quantification. We used a nonlinear mixed-effects (NLME) model to analyze EBV DNA dynamics, K-means clustering to categorize EBV load patterns, and Cox regression to determine hazard ratios for shifts in EBV DNA detection. RESULTS: Six hundred and fifty-eight PWH were enrolled at baseline, with 609 (2439 samples) included in cohort analysis. Detectable EBV DNA decreased from 86% at baseline (TP0) to 60% 7-10 years post-ART (TP4). Three hundred and eleven (51%) patients consistently maintained detectable EBV DNA. Among the 238 patients with detectable EBV DNA at TP4, 82.8% achieved suppressed HIV. EBV DNA load initially declined rapidly, then slowed post-ART. Two EBV DNA patterns were identified. Higher baseline CD4 + T-cell count was associated with detectable EBV DNA at baseline but with decreased EBV viral load and undetectable EBV DNA post-ART. Older age was associated with detectable EBV DNA and increased EBV viral load. CONCLUSIONS: Although EBV DNA load significantly declined, it remained detectable in most PWH, even those with suppressed HIV, which highlights the need for ongoing EBV monitoring in PWH. The predictive values of CD4 + T-cell count and age underscore the importance of early diagnosis and ART initiation.