A Mechanistic Model of Primary Progressive Multiple Sclerosis Pathogenesis: Integrating Genetics, Epstein-Barr Virus, and Potential Tenofovir Intervention

Primary Progressive Multiple Sclerosis (PPMS), is an aggressive form of Multiple Sclerosis which affects up to 10-15 percent of MS cases. There is a sustained decline in neurological functions with rare inflammatory relapses. This paper addresses the role of shared MS immune - risk genes (HLA-DRB1*15:01 and non- HLS loci), (2) PPMS based CNS - intrinsic variants affecting neuronal resilience) and Epstein -Barr virus (EBV) infection which induces compartmentalized B- cell inflammation within the CNS (1-4) and the potential of halting (PPMS) progression with use of Tenofovir disoproxil/ alafenamide fumarate (TDF/TAF).