Ruiz-Pablos, Manuel, Paiva, Bruno, Zabaleta, Aintzane · Journal of translational medicine · 2023 · DOI
This study proposes that a virus called Epstein-Barr virus (EBV) may play a central role in both ME/CFS and long COVID by gradually weakening the immune system. The researchers suggest that in people with certain genetic traits, EBV can hide in various body tissues and repeatedly reactivate, causing ongoing inflammation and exhaustion of the immune system. They hypothesize that long COVID may follow a similar pattern, possibly starting with a COVID-19 infection in people whose immune systems struggle to control EBV.
This study is important because it offers a unifying immunological explanation for why ME/CFS and long COVID share so many characteristics, potentially opening new avenues for treatment targeting EBV control and immune recovery. If the proposed mechanism is validated, it could lead to diagnostic tests based on immune markers and therapeutic interventions that benefit both patient populations. Understanding the role of EBV in disease persistence may also explain why some patients develop chronic illness after viral infections while others recover completely.
This study does not prove that EBV actually causes ME/CFS or long COVID, as it is a theoretical model based on literature review rather than direct experimental evidence. It does not demonstrate that 'weak' HLA-II haplotypes are the actual genetic factor responsible, nor does it establish causation versus correlation in the observed immunological similarities between the two conditions. The hypothesis remains to be tested through prospective studies comparing immune function and genetic markers in affected versus unaffected individuals.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Ruiz-Pablos, Manuel, Paiva, Bruno, & Zabaleta, Aintzane (2023). Epstein-Barr virus-acquired immunodeficiency in myalgic encephalomyelitis-Is it present in long COVID?. Journal of translational medicine. https://doi.org/10.1186/s12967-023-04515-7
BibTeX
@article{mecfsatlas-ruiz-pablos-2023-epstein-barr,
author = {Ruiz-Pablos, Manuel and Paiva, Bruno and Zabaleta, Aintzane},
title = {Epstein-Barr virus-acquired immunodeficiency in myalgic encephalomyelitis-Is it present in long COVID?},
journal = {Journal of translational medicine},
year = {2023},
doi = {10.1186/s12967-023-04515-7},
note = {PubMed: 37718435},
url = {https://www.mecfsatlas.com/evidence/ruiz-pablos-2023-epstein-barr},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-27. https://www.mecfsatlas.com/evidence/ruiz-pablos-2023-epstein-barr
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