this comes up a lot

but bear in mind - most people think this is happening because of a test showing EBV antibodies

but what is less well known is that its well documented that borrelia and EBV antibodies cross react - so in persons with lyme disease - the "EBV antibodies" may well simply be cross reactive antibodies caused by borrelia ( false positive).

since most testing for both lyme disease and EBV are serologic based ( antibodies ) its not possible to tell if its
-lyme disease only
-Lyme and EBV
-EBV only
from the serologic tests alone

in addition 95% of the population have had EBV by adulthood and once infected the virus never leaves the body -
as a result serologic testing is a very poor way of diagnosing the disease as essentially everyone has some level of antibodies to it.

in these circumstances - test houses simply draw a line above which they say the test is positive and below its not - but this is arbitrary - and in a population like Lyme patients - where immune dysregulation is the norm - even less reliable

to make matters more confusing - some LLMDs do treat lyme patients with antivirals - believing viruses to be reactivated - but we also know that some antivirals are active against borrelia and co-infections - so while a positive response could be interpreted to mean the patient as reactivated viruses - its just as likely the antivirals had off target effects on other bacterial infections

sometimes there are clues - for instance - super high levels of one or two EBV antibodies - but not others - eg an unusual antibody presentation pattern - is suggestive of this type of cross reactivity

overall i would be wary of over diagnosing this as an issue

if in doubt - a PCR test for EBV is available - and should be a clear positive if one does indeed have EBV replicating at a level that caused illness

i hope its of some help

Not EBV specifically, but I have had problems with other herpesviruses.

Be careful with nucleoside analogues, especially acyclovir/valacyclovir/ganciclovir/valganciclovir. Borrelia DNA polymerase is vulnerable to these drugs, and this can cause a severe herx.

If you're going to use nucleoside analogues, I'd recommend starting with just once a week and see if you have a reaction.