ME/CFS in the Department of Medicine

Herpes Viruses

Treatment

A. martin Lerner, MDPhysician Perspective: A. Martin Lerner, MD

In a controlled, randomized, and blinded pilot study the antiviral drug valacyclovir (Valtrex) was shown to be effective in reducing the fatigue of CFS patients who had only Epstein-Barr virus (EBV).  A blinded trial of valacyclovir has been completed and confirms the original study.  Initial studies involving subsets including Human Cytomegalovirus (HCMV) and Human Herpesvirus-6 (HHV-6), utilizing the antiviral drug valgancyclovir (Valcyte), are also successful and exciting.  When patients are treated with appropriate antiviral medicines after specific proof of EBV, HCMV and/or HHV-6 virus active infection, research has shown significant improvement in cardiac and CFS symptoms.1,2,3,4

Information on treatment options from the Treatment Center for CFS

Jose Montoya, MDPhysician Perspective: Jose G. Montoya, MD

Valganciclovir has been shown to successfully resolve acute and life-threatening HHV-6-related neurological syndromes.5,6 Valganciclovir and other anti-herpesvirus therapies (e.g. foscarnet) have also been effective in treating patients with chronic and severe neurological syndromes who have high peripheral blood HHV-6 viral loads (e.g. >2,000,000 copies/mL) and whose HHV-6 has been confirmed by fluorescence in situ hybridization to be chromosomally integrated. Treatment resulted in a reduction in HHV-6 viral load and dramatic clinical improvement.7,8 Valganciclovir has also been shown to be effective in treating CFS patients with positive serologies for HHV-6, EBV, and/or HCMV. Seventy-five percent of patients positive for these viruses who were treated with valacyclovir and/or valgancyclovir for at least six months improved by >1 point on the Energy Index Point Score, representing a significant change in functioning.9

Previously, our group reported on 12 patients who were chronically infected with HHV-6 and EBV and had elevated HHV-6 and EBV antibody titers (median titers: EBV VCA IgG 1:2,560, HHV-6 IgG 1:1,280), suffered from debilitating fatigue for at least one year, and experienced significant improvement in their fatigue and cognitive symptoms following the open-label administration of valganciclovir for 24 weeks.10 We postulated that high titers were indicative of active viral replication and possibly an abnormal immune response. We found a dramatic recovery of physical functioning in these patients after valganciclovir therapy.10

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The information and opinions contained in this portion of the website are intended for educational and research purposes only. It is not intended for the medical management of patients and does not necessarily reflect the views of Stanford University or Stanford Hospital and Clinics.

Only a physician familiar with a patient's individual medical history can make medical judgments and give that patient specific medical advice.


CITATIONS:

1 Lerner AM, Beqaj SH, Fitzgerald JT. Validation of the Energy Index Point Score to Serially Measure the Degree of Disability in Patients with Chronic Fatigue Syndrome In Vivo, 2008:22:799-802.

2 Lerner AM, Zervos M and Dworkin HJ et al. New cardiomyopathy: A pilot study of intravenous ganciclovir in a subset of the chronic fatigue syndrome. Infectious Diseases In Clinical Practice 1997;6:110-117.

3 Lerner AM, Beqaj SH, Deeter RG, Fitzgerald JT. Valacyclovir treatment in Epstein-Barr virus subset chronic fatigue syndrome: thirty-six months follow-up. In Vivo. 2007 Sep-Oct;21(5):707-13.

4 Lerner AM, Zervos M and Chang CH et al. A small, randomized, placebo-controlled trial of the use of antiviral therapy for patients with chronic fatigue syndrome. Clinical Infectious Diseases. 2001; 32:1657-58.

5 Karam C, Revuelta M, Macgowan D. Human herpesvirus 6 meningoradiculitis treated with intravenous immunoglobulin and valganciclovir. J Neurovirol 2009 Jan;15(1):108-9.

6 Troy SB, Blackburn BG, Yeom K, Caulfield AK, Bhangoo MS, Montoya JG. Severe encephalomyelitis in an immunocompetent adult with chromosomally integrated human herpesvirus 6 and clinical response to treatment with foscarnet plus ganciclovir. Clin Infect Dis 2008 Dec 15;47(12):e93-6.

7 Lunn MR, Kar A, Ambros P, Neely M, Troy S, Montoya JG. Antiviral Therapy Induces Viral and Clinical Response in Patients with Central Nervous System Dysfunction and Chromosomally Integrated Human Herpesvirus 6.  submitted, 2009.

8 Arbuckle JH, Medveczky MM, Luka J, et al. The latent human herpesvirus-6A genome specifically integrates in telomeres of human chromosomes in vivo and in vitro. Proc Natl Acad Sci U S A 2010 Mar 23;107(12):5563-8.

9 Lerner MA, Beqaj S, Fitzgerald JT, Gill K, Gill C, Edington J. Subset-directed antiviral treatment of 142 herpesvirus patients with chronic fatigue syndrome. Virus Adaptation and Treatment 2010;2:11.

10 Kogelnik AM, Loomis, K., Hoegh-Petersen, M., Rosso, F, Hirschier, C, Montoya, J.G. Use of valganciclovir in patients with elevated antibody titers against Human Herpesvirus-6 (HHV-6) and Epstein-Barr Virus (EBV) who were experiencing central nervous system dysfuntion including long-standing fatigue. Journal of Clinical Virology 2006;37(1):S33-S8.

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