Thursday, July 10, 2008
What role do viruses play?
In the past my attitude had been that I wasn't going to test for viruses because A) I don't know if they make any difference and B) you can't treat them anyway. Perhaps I was wrong. HHV-6 has recieved a lot of attention. This is Human Herpes Virus 6. This is virus that everyone has been exposed to in early childhood. It is the cause for a common childhood disease called roseola. The CDC considers it an emerging disease. It has two strains, called A and B. The CDC states: "HHV-6 is probably the most neurotropic virus known." HHV-6B has been associated with multiple sclerosis in numerous studies. It has been associated with a host of other disorders, especially in patients with suppressed immunity. This virus has also been associated with chronic fatigue syndrome. The HHV-6 foundation and others report that the oral anti-viral drug Valcyte may be helpful. The disease is hard to diagnosis. A decision to treat is based on high antibody levels and a clinical response to therapy. This drug has the potential for serious toxicity and needs to be monitored carefully. Certainly the use of the medication for CFS, MS and other related syndromes needs to be considered experimental. Of interest is the fact that amantadine, a relatively benign drug used for influenza and parkinson's disease may be effective. And Lamictal, an anticonvulsant commonly used for bipolar disorder may be effective against HHV-6B. If a patient suffers with mood disorders as part of a Lyme disease complex and high titers of HHV-6 are present then the use of this drug might be considered. This medicine is generally safe but needs to be monitored carefully because it has been associated with a dangerous rash. The role of this virus and others needs to be considered, especially when patients do not repsond to therapy. We physcians need to keep in mind the dictum: "First do no harm." But this may be an exciting area of further research and cautious treatment.