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Epstein–Barr virus viral load in human immunodeficiency virus-positive patients with reactive hemophagocytic syndrome

Abstract Because human immunodeficiency virus (HIV)-infected patients control Epstein–Barr virus (EBV) replication poorly, we hypothesized that reactive hemophagocytic syndrome (HS) in these patients may be associated with poor control of EBV. The files of 314 patients with a suspected diagnosis of HS were retrospectively reviewed. EBV viral load at the time of HS was compared between HIV-positive and -negative patients. A confirmed diagnosis of HS was made in 162 patients [109 males, median age 48 (35–62) years]. Among them, 61 (38%) were HIV positive [median HIV viral load 3.2 (1.6–5.5) log/ml, median CD4 count 94 (28–190)/mm3]. The median EBV viral load was significantly higher in HIV-positive than in HIV-negative patients [4.0 (2.9–4.6) vs 2.5 (0–4.2) log/ml, p = 0.002]. It was higher both in patients with hematological malignancy-associated HS [4.0 (2.9–4.4) vs 2.9 (0–4.9) log/ml, p = 0.03] and in patients with infection-associated HS [3.9 (0–4.9) vs 0 (0–4.1) log/ml, p = 0.14]. However, EBV viral load was not significantly higher in HIV-infected patients with confirmed HS than in HIV-infected patients for whom HS was unlikely [4.0 (2.9–4.6) vs 3.9 (2.6–4.1) log/ml, p = 0.48].The high EBV viral load observed in HIV-infected patients with HS may be more likely to reflect the chronic HIV infection than to be the direct trigger of HS.