EBV (EPSTEIN-BARR VIRUS) AND HHV-6 REACTIVATED
Updated: 1 day ago
Lyme can reactivate old viruses such as Epstein-Barr virus (EBV) and HHV-6. This post focuses on EBV first, with HHV-6 further down.
Short on time or energy? A quick-view graphic with the key points is at the bottom of this post.
Looking for ideas that may help? See the solutions post:
EBV AND VIRAL - POSSIBLE SOLUTIONS
Which EBV tests to ask for and what the results mean:
EBV TESTING
Other viruses that can reactivate with Lyme (CMV, parvovirus B19 and more):
REACTIVATED VIRUSES
EBV: THE BASICS
- EBV is a herpes-family virus. It often causes no symptoms, but in some people it causes infectious mononucleosis (mono).
- About 95% of adults are infected with EBV at some point.
- After the first infection, EBV stays in the body for life in a resting (latent) state. In some people it can reactivate later.
WHY EBV MATTERS WITH LYME
- ILADS notes that people who have been sick with Lyme for a long time may also have other infections, such as EBV, CMV and HHV-6. ILADS adds that how these infections interact with Lyme is not well understood yet.
- Dr. Richard Horowitz explains that EBV and HHV-6 are among the viruses he screens for most often, and that Lyme and other infections may reactivate viral infections a person already had (doctor view, from his 2013 book).
- Dr. Marty Ross explains that viruses like EBV and HHV-6 are held in check in healthy people, but can become active in chronic Lyme because of immune suppression. He suggests testing for them if a person isn't recovering after 6 to 9 months of Lyme care. He's open that there is limited science on what works for chronic viruses. He uses olive leaf extract or monolaurin, plus reishi mushrooms to support the immune system's antiviral side. Options like these are in the solutions post (doctor view).
- Dr. Joseph Burrascano lists clinical clues that HHV-6, EBV or CMV may be active: ongoing fatigue that gets worse with exercise, sore throat, swollen lymph nodes and other virus-like complaints. Blood work may show raised liver enzymes and a low white blood cell count (doctor view, 2020).
EBV AND LYME: ONE PATIENT'S STORY
- Jennifer Crystal, a longtime Global Lyme Alliance writer, got mono in 2003. Her EBV levels stayed high and she became bedridden. About two years later, a Lyme-literate doctor found Lyme, babesiosis and ehrlichiosis from a tick bite years earlier.
- Her doctor believed the tick-borne infections came out in full force when mono overloaded her immune system.
- Once her tick-borne infections were treated, her EBV symptoms calmed down, though they still flare at times. Because the symptoms overlap (flu-like feelings, fatigue, aches, low-grade fever), it can be hard for her to tell which one is flaring. Sometimes it's both.
- Her takeaway: when symptoms overlap, keep both EBV and Lyme in mind. Treating only one may leave part of the problem behind.
A NOTE ON THE WORDS
- Some doctors use "chronic active EBV" loosely for EBV levels that stay high long after mono, as Jennifer Crystal's doctor did.
- Blood disorder specialists use the name chronic active EBV disease (CAEBV) for something different: an uncommon, serious condition of infected immune cells. If you see CAEBV in your records, ask your doctor which one they mean.
EBV, CHRONIC FATIGUE AND MS
- ME/CFS often starts after an infection. A 2025 review by DePaul University and Northwestern researchers reports that about 30% of ME/CFS cases follow mono caused by EBV. In one study, 11% of adults met the criteria for ME/CFS 6 months after mono, and 9% still did at 1 year.
- A large 2022 Harvard study of over 10 million young adults in the US military found that after EBV infection, the risk of developing multiple sclerosis (MS) was 32 times higher. EBV alone isn't enough to cause MS, and the study wasn't about Lyme. Global Lyme Alliance notes that MS is a Lyme imitator.
TESTING FOR EBV
- In a 2024 report on three of his patients, Dr. Horowitz listed EBV antibody tests (VCA IgG and EBNA IgG) and EBV PCR among their lab results.
- The full testing guide, shared with credit to Toni and the Epstein-Barr Virus Support Group, is in my EBV TESTING post:
HHV-6
- My experience with HHV-6 testing: the problem is that almost everyone has HHV-6 living in their body. Most of us carry a dormant virus, and it will show up on standard testing. This can make people think they have an active infection when they don't. I was told it's best to get IFA testing, to see whether antibodies are high enough to point to an active infection.
- HHV-6 is two closely related herpes viruses, HHV-6A and HHV-6B. HHV-6B infects about 70% of children by age 3 and can cause roseola, a fever and rash in young children.
- Dr. Horowitz often finds high HHV-6 levels in his chronic Lyme patients. He notes it's linked to chronic fatigue syndrome and fibromyalgia, and that it can become active again later in life (doctor view, from his 2013 book).
WHAT THE HHV-6 FOUNDATION SAYS ABOUT TESTING
- Over 95% of people have HHV-6 antibodies. So the question isn't whether you have them, but whether they're unusually high.
- Many labs use an ELISA antibody test, which only answers yes or no. An IFA test shows how high the antibodies are. Quest Diagnostics, Eurofins-Viracor and ARUP Laboratories offer IFA testing.
- IgM antibodies appear while an infection is active, and for 2 to 3 months afterward. A negative IgM doesn't rule out an active infection.
- HHV-6 found by PCR in plasma or serum generally means an active infection. But a negative result doesn't rule out infection hiding in organs such as the brain, thyroid, heart or liver.
- A quantitative PCR on whole blood above 200 copies per mL points to an active infection. A qualitative PCR on whole blood (just "positive") can't tell an active virus from a dormant one.
- About 1% of people are born with HHV-6 built into their chromosomes (chromosomally integrated HHV-6, or ciHHV-6). They test positive by PCR even without symptoms. A special whole blood test (ddPCR) can confirm it.
HHV-6 RESEARCH
- A 2022 review of 17 studies (1,720 patients) in Intervirology found HHV-6 linked to chronic fatigue syndrome. In the pooled results, the odds of CFS were about 3.5 times higher with HHV-6. The HHV-6 Foundation points out this shows a link, not proof of cause. It also notes the review didn't explain how a positive HHV-6 result was decided, which matters because almost everyone carries the virus.
MY EXPERIENCE
- I have dealt with reactivated EBV myself. My doctor has used olive leaf extract in my EBV protocols for years and always goes back to it. When natural support hasn't been enough, my doctor has prescribed Valtrex for me.
- One I personally love: Find Relief, formulated by my doctor, Dr. Thoring.
I invested in Vital Harmony Nutritionals to help bring Find Relief to market, because I wanted a formula that saves people money.
RELATED POSTS
CFS / ME (CHRONIC FATIGUE SYNDROME)
The fatigue illness that often follows infections like mono.
IMMUNE SYSTEM EDUCATION
How the immune system works and why Lyme can weaken it.
SOURCES
ILADS, Lyme Disease Basics for Providers (current page)
Dr. Marty Ross, Chronic Viruses: A Brief Guide, January 2025
Jason and Katz, EBV and ME/CFS risk factors, Microorganisms, March 2025
Horowitz, Fallon and Freeman, three chronic Lyme case reports, Microorganisms, 2024
Global Lyme Alliance, Jennifer Crystal, Epstein-Barr Virus and Lyme Disease: A Patient's Perspective, August 2024
Blood journal review, Chronic active EBV disease, 2026
NIH Research Matters, Study suggests Epstein-Barr virus may cause multiple sclerosis, February 2022
LymeDisease.org, Epstein-Barr virus may be a leading cause of multiple sclerosis, January 2022
Mozhgani et al., HHV-6 and chronic fatigue syndrome meta-analysis, Intervirology, 2022
HHV-6 Foundation, HHV-6 as a trigger for chronic fatigue syndrome: a meta-analysis (no date shown)
HHV-6 Foundation, HHV-6A/B Testing (no date shown)
HHV-6 Foundation, What Is HHV-6? (no date shown)
Dr. Joseph Burrascano, Sorting out Lyme and Associated Coinfections, LymeDisease.org, 2020 (older source, still worth reading)
Dr. Richard Horowitz, The Importance of Looking at Parasites, Viruses, Yeast and Fungal Infections (from Why Can't I Get Better, 2013), LymeDisease.org, 2017 (older source, still worth reading)
Disclaimer: Rise Above Lyme makes no claims about any possible benefit of using any product mentioned within this site. Always consult with your doctor before adding anything. The information shared is based on personal experience, years of accumulated researched resources from Lyme Literate doctors and polls conducted within Lyme groups from actual patient experience using these solution ideas.
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