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Multiple sclerosis (MS) is a complex disease in which genetic and environmental factors act together to cause disease.1 Genetic studies consistently point to human leukocyte antigen (HLA) haplotype DR15 as a risk factor for MS2; data regarding environmental risk factors are less consistent. Among putative environmental risk factors Epstein-Barr virus (EBV) is frequently studied. In adult and pediatric populations, patients with MS show increased EBV antibody seroprevalence, increased serum titers, or both.3,4 A systematic review of eight case-control studies comparing EBV seropositivity in patients with MS and controls found increased odds of MS in EBV seropositive persons (OR 13.5; 95% CI: 6.3, 31.4).3 Seroepidemiologic studies indicate that HLA type may influence antibody responses.5,6 Thus differences in HLA type may be associated with differences in immune responses, and differences in EBV titers among patients with MS may reflect genetic risk, rather than reflecting …
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