Subset-directed antiviral treatment of 142 herpesvirus patients with chronic fatigue syndrome

Original Research

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Authors: A Martin Lerner, Safedin Beqaj, James T Fitzgerald, et al

Published Date May 2010 Volume 2010:2 Pages 47 - 57

DOI: http://dx.doi.org/10.2147/VAAT.S10695

A Martin Lerner¹, Safedin Beqaj², James T Fitzgerald³, Ken Gill⁴, Carol Gill⁴, James Edington⁴

¹Department of Medicine, William Beaumont Hospital, Royal Oak; ²Wayne State University School of Medicine, Detroit; ³Department of Medical Education, University of Michigan Medical School, Ann Arbor, Michigan; ⁴The Dr A Martin Lerner Chronic Fatigue Syndrome Foundation, Beverly Hills, Michigan, USA

Purpose: We hypothesized that chronic fatigue syndrome (CFS) may be caused by single or multiple Epstein–Barr virus (EBV), cytomegalovirus (HCMV), or human herpesvirus 6 (HHV6) infection. To determine if CFS life-altering fatigue and associated findings including muscle aches, tachycardia at rest, chest aches, left ventricular dysfunction, syncope, and elevated herpesvirus serum antibody titers are reversed by long-term subset-directed valacyclovir and/or valganciclovir.

Patients and methods: Data were collected at physician visits every 4–6 weeks from 142 CFS patients at one clinic from 2001 to 2007. To be included in this study, patients had to be followed for at least six months. The data captured included over 7000 patient visits and over 35,000 fields of information. Severity of fatigue was monitored by a validated Energy Index Point Score^® (EIPS^®). Baseline and follow-up serum antibody titers to EBV, HCMV, and HHV6, as well as coinfections with Borrelia burgdorferi, Anaplasma phagocytophila, Babesia microti, and antistreptolysin O, 24-hour ECG Holter monitors, 2D echocardiograms, cardiac dynamic studies, symptoms, and toxicity were captured and monitored. International criteria for CFS plus a specifically designed CFS diagnostic panel were used.

Results and conclusions: The Group A herpesvirus CFS patients (no coinfections) returned to a near-normal to normal life (P = 0.0001). The long-term EIPS value increased (primary endpoint, P < 0.0001) with subset-directed long-term valacyclovir and/or valganciclovir therapy. Secondary endpoints (cardiac, immunologic, and neurocognitive abnormalities) improved or disappeared. Group B CFS patients (herpesvirus plus coinfections) continued to have CFS.

Keywords: valacyclovir, valganciclovir, treatment, chronic fatigue syndrome, CFS, Energy Index Point Score^®, EIPS^®

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