Authors: Peluso MJ, Deveau TM, Munter SE, Ryder D, Buck A, Lu S et al.



Epstein-Barr virus (EBV) reactivation has been proposed as a driver of Long COVID (LC), but studies in well- characterized post-acute COVID-19 cohorts of individuals with and without Long COVID symptoms over a time course consistent with current case definitions of LC are limited. In a cohort of 294 hundred adults with a history of SARS-CoV-2 infection, we observed that LC symptoms such as fatigue and neurocognitive dysfunction at a median of 4 months following initial diagnosis were associated with serological evidence of recent EBV reactivation (early antigen-D IgG positivity or nuclear antigen IgG levels >600 U/mL), but not with ongoing EBV viremia.. Importantly, Long COVID was also observed in the small proportion without evidence of prior or recent EBV infection, suggesting that EBV reactivation is not a prerequisite for this condition. Overall, these findings expand our knowledge of the relationships between EBV reactivation and LC and suggest that further assessment during the acute phase of COVID-19 is warranted.

SUMMARY The authors found that Long COVID symptoms in a post-acute cohort were associated with serological evidence of recent EBV reactivation when adjusted for participant factors, sample timing, comorbid conditions and prior hospitalization, but not with ongoing presence of EBV viremia.

Keywords: Epstein-Barr Virus, EBV, long COVID, COVID-19