Valacyclovir, EBV and CFS

Readers sometime share the list of prescription from their MDs and ask for my comment. My usual comment are notes like this page, citing what we know from PubMed.

Valacyclovir and CFS

Studies have been done only on a subset of CFS that were EBV positive. One for FM and none for IBS.

Diagnostic Line:

EBV testing must be positive, CMV testing must be negative if you expect any benefit. Testing for EBV can result in some tests being negative (see below), so do not rely on a single negative test as being reliable.

EBV and Brain Inflammation

Note: Encephalitis is inflammation of the brain and that the traditional name for CFS is Myalgic Encephalomyelitis.

  • [Encephalitis due to the Epstein-Barr virus: a description of a clinical case and review of the literature]. [2013]
    “oral valaciclovir with clinical resolution and improvement of the liquoral parameters. Polymerase chain reaction in the cerebrospinal fluid was positive for EBV and negative for the other neurotropic viruses. In blood, the serology test for EBV with IgG was positive, while IgM and heterophile antibody tests [for EBV] were negativeEBV infection can give rise to acute disseminated encephalomyelitis or affect several locations in the central nervous system, especially the cerebellum.”
  • Ataxia and Encephalitis in a Young Adult with EBV Mononucleosis: A Case Report.[2013]
    “The patient was clinically diagnosed with EBV-associated cerebellitis and encephalitis, displaying neurological and psychiatric impairment commonly seen in postconcussion syndrome. MRI showed no acute changes. She was started on valacyclovir and a prednisone taper, recovering by the end of twelve weeks.”
  • [Effect of the Epstein-Barr virus on the nervous system]. [2001]
    “it has been shown that this infection can be accompanied by acute and chronic affections of the central and peripheral nervous system. The pathogenesis of chronic EBV-infection involves autoimmune disorders, neurosensitization, a hazard of an injury to the muscular tissue”

Alternative EBV treatment

  • Bosewellia “showed potent inhibitory effects on EBV-EA induction” [2006]
  • Turmeric
    • The effect of curcumin on human B-cell immortalization by Epstein-Barr virus. [1998] “A strongly promote in vitro B-cell immortalization with EBV … and curcumin, an extract of a common spice is an effective inhibitor of this process;”
    • “Seven rhizomes were found to possess inhibitory activity towards EBV activation, induced by TPA; they are:Curcuma domestica, C. xanthorrhiza, Kaempferia galanga, Zingiber cassumunar, Z. officinale, Z. officinale (red variety), and Z. zerumbet.” [1999]
  • White Mugwort (Artemisia lactiflora) ” In addition, AL-1 strongly inhibited tumor promoter-induced Epstein-Barr virus (EBV) activation” [1999]

Bottom Line

This is effective for a subset of CFS patients that are positive for only one Herpes virus, EBV. Multiple virus or no virus are unlikely to benefit according to the studies.