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Are antivirals right for me?

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I've been reading a lot on using antivirals for EBV, a lot of which is a bit inconsistent. I took a blood test for EBV around 2 years ago, 5 years after my CFS started. My results were as follows:
  • EBV NUCLEAR AG(EBNA)(IGG) 57.90 H (U/mL)
  • EPSTEIN-BARR VCA AB IGG >750.00 H (U/mL)
  • EPSTEIN-BARR VCA AB IGM <36.00 (U/mL)
  • IGG SUBCLASS 4 136.9 H (mg/dL)
(See picture of my blood test in attachments) My IgG levels are very high, but IgM is normal. According to this article by Dr Teitelbaum: https://www.vitality101.com/health-a-z/when-to-use-antivirals-in-fibromyalgia-and-cfs

"For now, when checking for Epstein-Barr antibodies (EBV), the only test we really need is the EBV Early Antigen Ab, IgG. This test is positive in only about 52% of the population, where the other Epstein-Barr tests are positive in about 90 to 95%, making them not very meaningful. If the person wants a little more information, we can add the EBV VCA IgG antibody. The median level (half the population is less than this) is 186 AU/ML for the EBV VCA and 10.7 AU/ML for the EBV Early antigen, which gives us a reference point."

My VCA IgG is over 750 U/mL, a lot higher than the median level of 186 au/mL. I'm not sure if it's referring to the same test or measurement. In another article though, Dr Lerner asks to test EBV serum IgM viral capsid antibodies (VCA) which is at normal levels in my case. Can someone please help me figure out what my blood test meant? I've still yet to get an EBV early antigen diffuse blood test done. Should I be seeking antivirals as a possible treatment?

Thanks a lot
 

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Hip

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Dr Martin Lerner says ME/CFS patients have an active EBV infection if there are high antibody levels in the VCA IgM and/or EA IgG diffuse tests. Ref: 1 2

What do we mean by high antibody levels? Well only ME/CFS doctors know that; but perhaps 16 times the threshold for negative might be a rough figure.
 
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Dr Martin Lerner says ME/CFS patients have an active EBV infection if there are high antibody levels in the VCA IgM and/or EA IgG diffuse tests. Ref: 1 2

What do we mean by high antibody levels? Well only ME/CFS doctors know that; but perhaps 16 times the threshold for negative might be a rough figure.
Thanks. Yes Dr Lerner does say that, but Dr Teitelbaum instead uses EBV VCA IgG and EA IgG diffuse levels. According to my blood test, should I not use antivirals until I see high level of antibodies in EA IgG diffuse test? My VCA IgG antibodies test is over 750 U/mL, a lot higher than the median level of 186 au/mL.
 

Hip

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Yes Dr Lerner does say that, but Dr Teitelbaum instead uses EBV VCA IgG and EA IgG diffuse levels.
Would you have a link to where Dr Teitelbaum says that. I've never seen Teitelbaum's criteria for active infection in ME/CFS, so would like to see it.

Jose Montoya also uses high EBV IgG VCA and/or high EBV IgG EA as indicative of an active EBV infection. Ref: 1
 
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Would you have a link to where Dr Teitelbaum says that. I've never seen Teitelbaum's criteria for active infection in ME/CFS, so would like to see it.

Jose Montoya also uses high EBV IgG VCA and/or high EBV IgG EA as indicative of an active EBV infection. Ref: 1
I included a link in my original post: https://www.vitality101.com/health-a-z/when-to-use-antivirals-in-fibromyalgia-and-cfs

I also included the part where he says it:

"For now, when checking for Epstein-Barr antibodies (EBV), the only test we really need is the EBV Early Antigen Ab, IgG. This test is positive in only about 52% of the population, where the other Epstein-Barr tests are positive in about 90 to 95%, making them not very meaningful. If the person wants a little more information, we can add the EBV VCA IgG antibody. The median level (half the population is less than this) is 186 AU/ML for the EBV VCA and 10.7 AU/ML for the EBV Early antigen, which gives us a reference point."

So it sounds like I did/do have an active infection? I just need to test HCMV and HHV6 still.
 

Hip

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Ah right, I missed that entirely.



So it sounds like I did/do have an active infection? I just need to test HCMV and HHV6 still.
The perennial problem with trying to determine if one's IgG antibody levels are high enough to consider it evidence of active infection is that for most viruses, the exact threshold is not known. ME/CFS doctors may know it, but they may not make the info public.

As a rule of thumb, some ME/CFS doctors use IgG antibody levels which are at least 4 times the population average as the threshold for active infection. Dr Teitelbaum in his article has stated that the population average for the EBV VCA IgG is 186 AU/ml, and 4 times that value would be 744 AU/ml.

However, that value of 744 AU/ml I think will only apply to the particular lab test which Dr Teitelbaum uses.

Furthermore, in you case, your test results are expressed in U/mL = units per milliliter, which I believe may the same as IU/ml = international units per milliliter, but I am not sure.

Whereas AU/ml = absorbance units per milliliter I think may be a different measurement. So I am not sure if you can compare your U/mL test results to Dr Teitelbaum's AU/ml figures.


What I have used myself as a guiding figure for active infection is 16 times the threshold for negative (the threshold for negative should be stated on your lab report). If you antibodies are at least 16 times higher than then threshold for negative, then I argue here that is suggestive of an active infection (but I may be wrong).
 

Tella

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Ah right, I missed that entirely.





The perennial problem with trying to determine if one's IgG antibody levels are high enough to consider it evidence of active infection is that for most viruses, the exact threshold is not known. ME/CFS doctors may know it, but they may not make the info public.

As a rule of thumb, some ME/CFS doctors use IgG antibody levels which are at least 4 times the population average as the threshold for active infection. Dr Teitelbaum in his article has stated that the population average for the EBV VCA IgG is 186 AU/ml, and 4 times that value would be 744 AU/ml.

However, that value of 744 AU/ml I think will only apply to the particular lab test which Dr Teitelbaum uses.

Furthermore, in you case, your test results are expressed in U/mL = units per milliliter, which I believe may the same as IU/ml = international units per milliliter, but I am not sure.

Whereas AU/ml = absorbance units per milliliter I think may be a different measurement. So I am not sure if you can compare your U/mL test results to Dr Teitelbaum's AU/ml figures.


What I have used myself as a guiding figure for active infection is 16 times the threshold for negative (the threshold for negative should be stated on your lab report). If you antibodies are at least 16 times higher than then threshold for negative, then I argue here that is suggestive of an active infection (but I may be wrong).
‘A diagnosis of Epstein-Barr virus(EBV) infection is made with a positive EBV EA antibody diffuse and/or a positive VCA IgM antibody.’- Lerner.
Isn’t that either one or the other being just positive and not a particular number or antibodies etc? Seems that way to me.
 

Hip

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‘A diagnosis of Epstein-Barr virus(EBV) infection is made with a positive EBV EA antibody diffuse and/or a positive VCA IgM antibody.’- Lerner.
Isn’t that either one or the other being just positive and not a particular number or antibodies etc? Seems that way to me.
In his paper, Dr Lerner says:
CFS patients were considered to have active EBV infection if there were elevated ELISA serum antibodies to EBV IgM viral capsid recombinant peptide antigen VCA p18 and/or EBV early antigen EA-D
The word "elevated" I think means that the antibody levels need to be quite high in order to be classed as an active infection.
 

Tella

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In his paper, Dr Lerner says:


The word "elevated" I think means that the antibody levels need to be quite high in order to be classed as an active infection.
It’s all confusing as everyone says different things! I quoted from Dr Lerner’s protocol paper.
What do u think the following results mean then:
Ebv ebna igg positive
Ebv vca igg positive
Ebv vca igm positive ?

only past infection? But some sources indicate it means an active infection :eek:
 

Hip

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If you are negative for antibodies it means you never had that infection, even in the past. If you are positive, it can means different things, depending on which are positive. I wrote an article about all this here.
 

Tella

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If you are negative for antibodies it means you never had that infection, even in the past. If you are positive, it can means different things, depending on which are positive. I wrote an article about all this here.
Thnx. U are always super helpful!
so it seems that result means a latent reactivated infection which makes sense in ME. But in the article u say ‘high antibodies’. The result I have for igg, igm and ebna are all just ‘positive’. Is that not sufficient? Also I’ve read that if ebna is positive too it means the infection in only a past one. Now I’m confused. Is it reactivated or just a past one? As u don’t mention ebna. Sorry for many questoms n sorry u are up at night like me!
 

Davsey27

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Thnx. U are always super helpful!
so it seems that result means a latent reactivated infection which makes sense in ME. But in the article u say ‘high antibodies’. The result I have for igg, igm and ebna are all just ‘positive’. Is that not sufficient? Also I’ve read that if ebna is positive too it means the infection in only a past one. Now I’m confused. Is it reactivated or just a past one? As u don’t mention ebna. Sorry for many questoms n sorry u are up at night like me!

Have you got tested for other herpes viruses [Cmv,varicella,hhv6,etc..] ?
 

Tella

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Have you got tested for other herpes viruses [Cmv,varicella,hhv6,etc..] ?
Cmv past infection. Didn’t test anything else.
reading Dr Lerner’s protocol it seems it’s reasonable to attack the active ebv regardless of any other viruses i may have. And if after months (really a year he says) there’s no improvement other viruses can get tested and if they need another antiviral it can be tried
 

heapsreal

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Cmv past infection. Didn’t test anything else.
reading Dr Lerner’s protocol it seems it’s reasonable to attack the active ebv regardless of any other viruses i may have. And if after months (really a year he says) there’s no improvement other viruses can get tested and if they need another antiviral it can be tried
Id suggest famvir just because anecdotally it seems famvir may have effects on cmv and hhv6????
A common finding in an active herpes infections is a high cd8 T cell count. Might be worth getting if in doubt about titre levels.
The other way to know is to do a treatment trial of antivirals for 3 months. If you notice nothing then consider stopping and looking into other issues.
 

Tella

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Id suggest famvir just because anecdotally it seems famvir may have effects on cmv and hhv6????
A common finding in an active herpes infections is a high cd8 T cell count. Might be worth getting if in doubt about titre levels.
The other way to know is to do a treatment trial of antivirals for 3 months. If you notice nothing then consider stopping and looking into other issues.
Thanks! Have u tried any antivirals and have they worked for any infections? Sorry I think I asked u in another thread but can’t find it :(
 

heapsreal

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If you are negative for antibodies it means you never had that infection, even in the past. If you are positive, it can means different things, depending on which are positive. I wrote an article about all this here.
In Oslers web, that was about the cfs epidemic at lake Tahoe etc. There was a strange finding by the drs where a significant number of people would come down with ebv igm and later igg and i cant recall the time period, maybe 2 years and they had no antibodies, so it was as if they had never been exposed to ebv. I have a similar experience.

When i initially came down with glandular fever i was tested for ebv and cmv but only positive to cmv, i cant recall having sore or swollen glands. I stayed in this post viral state and a couple of months later started feeling worse and started getting the sore and swollen glands but didnt see a dr for a couple of weeks, which i think was long enough to lose the igm antibodies so when i was tested i had igg antibodies to ebv. So it was quite a new infection as several months early i was totally negative. Several years later when i found a dr who treated cfs patients, he tested me for these viruses and i was igg positive for cmv but negative to ebv. I showed him my previous positive tests for ebv. So it can happen that one can lose antibodies to ebv. Maybe this is one reason why some people may have ongoing viral issues?? Another unexplained phenomenon.
 

Hip

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So it can happen that one can lose antibodies to ebv.
Just came across this article which says that measles infection can destroy immune system memory, making the immune system forget how to make antibodies to all the infections it had previously encountered. Which then means you lose your immune protection to these infections.
 

Hip

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As u don’t mention ebna.
I don't fully understand EBV, as this has more antibody tests than other viruses. With other viruses, antibody tests are usually just for IgM and IgG.

IgM are the first antibodies the immune system makes when you first catch an infection. IgG antibodies are made slightly later, and they become the long-term antibodies that stay in your blood, to help protect you from a reactivation of the same virus.