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Help with CMV treatment

Discussion in 'Antivirals, Antibiotics and Immune Modulators' started by jstash, Sep 2, 2017.

  1. jstash

    jstash Senior Member

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    Hi there,

    Currently I'm on acyclovir and some antibiotics for some viruses I've tested positively for, as well as mycoplasma pneumoniae.

    My question is: in the same set of tests that elicited the above treatment, I also had an iGg of 200 for CMV, iGm negative.

    As there's so much conflicting information around different lab ranges (the one above was done in central London), my question is twofold:

    1. Are the lab results here a prompt to pursuing some treatment for CMV?

    2. Are there any supplement/dietary alternatives that would be effective here, rather than a prescription antiviral? I'm on my other antiviruals for at least the next 4 months, and reluctant to try Valcyte/Famvir, so if anyone could help on this regard that would be great. I have propolis in my cabinet, which I think I read once may help with this sort of thing, but no idea if that's true.

    Any help appreciated, cheers
     
    merylg likes this.
  2. Hip

    Hip Senior Member

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    Dr A Martin Lerner says that a diagnosis of cytomegalovirus infection is made by examining the CMV IgG antibody titer. Lerner says the IgM titer for cytomegalovirus is inaccurate and insensitive. Ref: 1

    If you look at this roadmap document, I've included (whenever the information was available) the lab ranges for which ME/CFS specialists believe antiviral treatment might be useful.

    Unfortunately in the case of cytomegalovirus, I could not find the threshold at which antiviral treatment is advised (and in any case, that threshold will be different for different labs). However, if on your lab report it states that your results are indicative of a past or latent cytomegalovirus infection, then treatment would likely not help.

    But if it states that the results suggest a recent infection, active infection or reactivated infection, then possibly antiviral treatment might yield results.



    The downside is that antiviral drugs for cytomegalovirus like Valcyte are expensive, and require regular liver monitoring.

    COX-2 inhibitors can inhibit cytomegalovirus replication (ref: here), and propolis in is fact a potent COX-2 inhibitor, at least in vitro (see here), so possibly good doses of propolis might help.



    Unfortunately in the UK, we don't have any commercial labs that I am aware of that can test for chronic coxsackievirus B and echovirus infection, arguably the two most important viruses to test for in ME/CFS. It is only a neutralization-type antibody blood test that is sensitive enough to reliable detect these viruses in chronic infection. In the US, ARUP Lab provides a micro-neutralization antibody test that can detect these viruses, but I don't know of any lab in the UK that has a neutralization test.

    Coxsackievirus B and echovirus are important to test for, because there is a treatment that for some ME/CFS patients works very well to fight these viruses, namely oxymatrine.
     
    Last edited: Sep 2, 2017
  3. heapsreal

    heapsreal iherb 10% discount code OPA989,

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    I understand being reluctant to try valcyte by why famvir?? Its got a better safety profile and more effective than acyclovir.
     
    merylg likes this.
  4. jstash

    jstash Senior Member

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    Ah - what I should have really said is reluctant to try Valcyte, but also unlikely to get a prescription in my country for Famvir.
     
    heapsreal likes this.
  5. Wonkmonk

    Wonkmonk Senior Member

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    @Hip Thanks a lot for the lab ranges document. Very useful!

    I think a threshold for elevated cytomegalovirus might be included in this Lerner et al. study:

    https://www.ncbi.nlm.nih.gov/pubmed/12582420

    It reads "the control group (nine CFS patients) had, additionally, high titers of serum antibodies (IgG) to conformational structural antigens of human cytomegalovirus."

    So I would suspect he defines what high titers are, and probably that would be a threshold for treatment.

    Sadly, I can't access the full text.
     
  6. Learner1

    Learner1 Professional Patient

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    I have CMV and mycoplasma and tried a natural approach first. It helped a fair amount, but I have 4 other infections and low immunoglobulin, so I needed to bring in the big guns.

    What we tried first was:

    - IV artesunate and high dose vitamin C
    - BioPure Nexus artemisinin suppositories
    - 2g oral vitamin C, twice daily
    - 500mg berberine
    - 15 drops Nutramedix Banderol
    - 15 drops Nutamedix Samento
    - 1 scoop Allergy Research NT Factor
    - EDTA/bismuth/alpha lipoic acid biofilms buster or lumbrokinase
    - UVBI and ozone

    Now I'm doing IVIG, IV antibiotics, and Valcyte, working on my gut, and having my liver monitored.:eek: And doing hyperbaric oxygen therapy.

    There are multiple approaches. Depends on how sick you are, as I know others who've gotten better both ways.
     
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  7. Hip

    Hip Senior Member

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    Thanks Wonkmonk. I cannot see to access the full paper either (I can't get it via Sci Hub).
     
  8. Learner1

    Learner1 Professional Patient

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    Will this work? It has some titers from Lerner.
     

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  9. Hip

    Hip Senior Member

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    Thanks @Learner1, though I am not sure if that document helps. What we really need is a statement by Dr Lerner (or by Dr Dan Peterson, who also treats a lot of cytomegalovirus infections in ME/CFS) saying what titers of CMV he considers high enough to treat with antivirals such as Valcyte, and also what lab was used for testing (because I understand that you cannot convert one's lab's titers into another's).
     
    TrixieStix likes this.
  10. Wonkmonk

    Wonkmonk Senior Member

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    Would emailing Dr Montoya perhaps be an option?
     
  11. Learner1

    Learner1 Professional Patient

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    How about this one?
     

    Attached Files:

  12. Hip

    Hip Senior Member

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    It does not have the titer levels, which are often indicated by figures such as 1:320 or 1:160 etc.



    Montoya I don't think treats cytomegalovirus; at least I have not seen mention of cytomegalovirus in his studies.
     
  13. Learner1

    Learner1 Professional Patient

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    It did show what lab he used.

    Both my expert CFS doc and my primary doc use LabCorp, a national lab in the US. Here's what my report said:

    Cytomegalovirus (CMV) Ab, IgG
    >10.00
    Ref Range: 0.00-0.59

    Negative <0.60
    Equivocal 0.60 - 0.69
    Positive >0.69

    Other titers are reported as 1:512, etc. but not this one.
     
  14. Hip

    Hip Senior Member

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    Yes, some labs report antibody results as an index number, as your lab did. My own cytomegalovirus results from some years back were also reported results as an index; my results were:

    Cytomegalovirus IgG Positive: 7.0 IU/ml (Pos = > 0.4)

    This was from TDL Lab in London. So since I was quite high above the 0.4 threshold, this I believe represents an active infection.


    But more often you see antibody titers represented by numbers such as:

    1:10 ... 1:20 ... 1:40 ... 1:80 ... 1:160 ... 1:320 ... 1:640 ... 1:1280 ... etc

    Or:
    1:8 ... 1:16 ... 1:32 ... 1:64 ... 1:128 ... 1:256 ... 1:512 ... 1:1024 ... etc
     
  15. Learner1

    Learner1 Professional Patient

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    Agreed. LabCorp seems to vary depending on which infection the test is for.
     
  16. Wonkmonk

    Wonkmonk Senior Member

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  17. Learner1

    Learner1 Professional Patient

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    I've been on valganciclovir for 3 months for CMV, HHV6, and EBV and it seems to be helping. Liver needs to be monitored closely, though.
     
  18. jstash

    jstash Senior Member

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    Thanks @Hip. My CMV testing was done at TDL as well...the only comment that's on the test is "evidence of previous CMV infection". I may be misunderstanding something here as my grasp of this stuff is very simplistic, but given the reactive parameter is > = 6 au/ml and mine reads 219.8, is this worth pursuing even with the lab comment being nonspecific about reactivation/recent infection?
     
  19. jstash

    jstash Senior Member

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    Thank you for this, really helpful :)
     
  20. Learner1

    Learner1 Professional Patient

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    YES!

    My CFS doc looked at the labs several other docs had dismissed as I didn't have any IgM and said, "I know what we were taught in medical school, but, with these high IgG titers, you have these infections even when they said you didn't"
     
    Gondwanaland likes this.

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