I've been on 10mg hydrocoritzone now for five years. I've not done a blood test for XMRV and I know there is still much to be researched about the role of the virus in CFS/ME. However, I have read some posts that say cortisol can increase XMRV. Would hydrocortizone possibly increase the XMRV?
I am pretty ill at the mo, mainly confined to bed and don't feel well enough to try and come off the hydrocortizone, but the posts about XMRv and cortisol are worrying me a bit.
Any opinions most gratefully received. Thank you
This is a complicated question, for at least two reasons:
1) If you're cortisol (or cortisone, should I say? Does the difference matter?) level is too low - it's might be a question of what's making you feel worse - XMRV's replication or the low level of cortisone? Perhaps the only way right now to figure that out is to drop the cortisone - but I don't know if that would be a good idea. Anyway, if you do drop the cortisone, this should be done with instructions from your physician, because when people are getting of cortisone supplementation they should do it slowly (for example - you take now 10 mgs a day - he might tell you to take for 4 weeks 9 mgs a day, and then 8 mgs, etc. - although I can really be wrong about the dosages or the time, as I've never took cortisone in this dosage for five years).
2) It's really tricky: On the one hand, cortisol does induce XMRV replication. On the other hand - inflammation also induces XMRV replication - and it was shown in a recent study that inflammation with TNF-alpha or something that EBV does, are causing XMRV replication, and if I remember correctly that replication was induced to the level that androgen were shown to induce XMRV replication. Now, for example, both testosterone and cortisol induce XMRV replication - but testosterone helps XMRV to replicate much more that cortisol does. Anyway, the last paper said that it's probably the NF-kappa-B pathway that TNF-alpha and EBV induces, and which in turn induces XMRV replication. And this is the interesting part: Cortisone is anti-inflammatory - so while cortosine by itself can help XMRV replicate, if you have an inflammation its anti-inflammatory abilities might be more efficacious against XMRV replication than the ability of cortisol to induce XMRV replication. It's a question - what is stronger. As I've said, since it seems that the importance of the TNF-alpha-EBV-NF-kappa-B (inflammatory) efficacy seems as important of the efficacy of androgen (IF I'M NOT MISTAKEN - the paper should be read again in order to make such a conclusion, it might be that I'm making a mistake), and since testosterone is more important for XMRV replication than cortisol - it would seem that TNF-alpha/EBV/NF-kappa-B are more important to XMRV replication than cortisol. However - the question is: How much inflammation do you have? I mean, cortisone is a great anti-inflammatory, but what if your inflammation level is low or non-existent? Or, what if it was high, but now it's non-existent because of the cortisone, and the cortisone is now just helping XMRV to replicate, and it can't act against it since it has no inflammation to reduce? And then the question would be: If you'd stop the cortisone, would the inflammation come back? And to what degree?
So I think there are a lot of questions not enough answers - but at least we know some things that might lead us in the correct way - and the decision what to do, I believe, should be taken by you, as there seem to be risks, but it's possible that there would be gains.