perinatologyРоссийский вестник перинатологии и педиатрииRossiyskiy Vestnik Perinatologii i Pediatrii (Russian Bulletin of Perinatology and Pediatrics)1027-40652500-2228Ltd. “The National Academy of Pediatric Science and Innovation”10.21508/1027-4065-2019-64-2-38-46perinatology-854Research ArticleОБЗОР ЛИТЕРАТУРЫREVIEWSПринципы терапии хронической Эпштейна–Барр вирусной инфекции и ассоциированных заболеванийPrinciples of the treatment of chronic Epstein–Barr virus infection and associated diseaseshttps://orcid.org/0000-0003-0507-0174ЯкушинаС. А.YakushynaS. A.

Якушина Софья Александровна – аспирант.

123098 Москва, ул. Гамалеи, д. 18.

https://orcid.org/0000-0001-7336-409XКистеневаЛ. Б.KistenevaL. B.

Кистенева Лидия Борисовна – д.м.н., зав. лабораторией хронических вирусных инфекций.

123098 Москва, ул. Гамалеи, д. 18.

Moscow

https://orcid.org/0000-0001-7639-7268ЧешикС. Г.CheshykS. G.

Чешик Святослав Георгиевич – проф. д.м.н., вед. науч. сотр. лаборатории хронических вирусных инфекций.

123098 Москва, ул. Гамалеи, д. 18.

Moscow

ФГБУ «Национальный исследовательский центр эпидемиологии и микробиологии имени почетного академика Н.Ф.Гамалеи»РоссияGamaleya National Research Centre of Epidemiology and MicrobiologyRussian Federation2019140520196423846Copyright © Ltd. “The National Academy of Pediatric Science and Innovation”, 20192019Ltd. “The National Academy of Pediatric Science and Innovation”Ltd. “The National Academy of Pediatric Science and Innovation”https://www.ped-perinatology.ru/jour/about/submissions#copyrightNoticehttps://www.ped-perinatology.ru/jour/article/view/854

Вирус Эпштейна–Барр, относящийся к герпесвирусам, в ряде случаев при первичном инфицировании вызывает инфекционный мононуклеоз; после выздоровления вирус пожизненно персистирует в организме. Сохранение клинической симптоматики и вирусной нагрузки у пациента спустя 6 мес после перенесенного инфекционного мононуклеоза свидетельствуют о формировании хронической активной Эпштейна–Барр вирусной инфекции. С активацией персистирующего вируса Эпштейна–Барр также ассоциированы гемофагоцитарный лимфогистиоцитоз, посттрансплантационное лимфопролиферативное заболевание и синдром хронической усталости, который имеет полиэтиологическую природу. Большинство из этих заболеваний развиваются чаще у детей в связи с их физиологическим иммунодефицитом и сопровождаются высокой летальностью – до 50%. В патогенезе заболеваний помимо самого вируса играют большую, а иногда ведущую роль иммунные механизмы. В представленной работе мы резюмировали все существующие в настоящее время подходы к терапии хронических заболеваний, ассоциированных с вирусом Эпштейна–Барр, и на примере множества опубликованных исследований проанализировали эффективность этих подходов. Для лечения таких заболеваний используются этиотропные противовирусные препараты – аналоги нуклеозидов, неспецифическая иммунотерапия, таргетная терапия препаратами моноклональных антител, иммунная клеточная CD8+-терапия. При неэффективности перечисленных методов альтернативой остается трансплантация костного мозга. В работе отмечены перспективные направления для разработки новых подходов к лечению заболеваний, ассоциированных с вирусом Эпштейна–Барр.

Epstein – Barr virus, related to herpes viruses, causes infectious mononucleosis during the initial infection; after recovery, the virus persists in the body throughout lifetime. The presence of clinical symptoms and viral load in a patient in 6 months after the infectious mononucleosis disease indicates the formation of chronic active Epstein – Barr viral infection. Hemophagocytic lymphohistiocytosis, posttransplantation lymphoproliferative disease and chronic fatigue syndrome, which has a polyetiological nature, are also associated with the activation of the persistent Epstein – Barr virus. Most of these diseases develop in children due to their physiological immunodeficiency and are accompanied by high mortality – up to 50%. Immune mechanisms, in addition to the virus itself, play a leading role in the pathogenesis of the diseases. The article summarizes all existing approaches to the treatment of chronic Epstein – Barr virus-associated diseases. The authors have analyzed the effectiveness of these approaches on the basis of various published studies. These diseases are treated with etiotropic antiviral drugs – nucleoside analogs, nonspecific immunotherapy, targeted therapy with monoclonal antibody preparations, immune cellular CD8+ therapy. In case of ineffectiveness of these methods, the alternative bone marrow transplantation is used. The article highlightes promising areas for the development of new approaches to the treatment of Epstein – Barr virus-associated diseases.

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The authors declare that there are no conflicts of interest present.