Patients suffering with "chronic fatigue syndrome," evidence of immune dysfunction- alterations in CD8/CD4 cells and elevated antibodies to a variety of viruses have shown marked improvement in symptoms after taking the anti-viral drug, Valcyte. Valcyte is only FDA approved for CMV retinitis seen in HIV patients; but it is active against other viruses as well. The recommended course of therapy is six months. The best evidence comes from a pilot study from Stanford University. The symptoms of fatigue and cognitive dysfunction closely parallel those seen in my "chronic Lyme" patients. Specifically, patients with evidence of EBV and HHV6/7 have been studied. Other reports include CMV virus, another potential cause of chronic fatigue, in the subset of responders.
Lyme patients have immune dysregulation. High titers of antibodies directed at these viruses are routinely seen. My working hypothesis has been that Lyme- the gatekeeper germ suppresses the immune system which allows these chronic, generally contained, viruses to flourish. Perhaps a sort of vicious cycle betters describes the process. As the viruses replicate, a increasing burden to the immune system makes elimination of Lyme and other opportunistic pathogens more difficult. The various germs in a sense, conspire to weaken one's defenses to all the problematic germs. Lyme treatment failures may occur because the immune defenses never heal adequately to a level which allows control of Lyme. The same arguments have been marshaled regarding other typical, Lyme associated, co-infections.
This drug is toxic to the bone marrow and requires close supervision. The study at Standford is now providing an evidence based justification for trying this drug.
Of course it is used widely in California where medical boards are prohibited from censuring physicians who treat diseases based on alternate hypotheses. Not here.
The early evidence is favorable.
The paradigm, as always, is in a constant state of flux.