Very interesting points. I have comments on some of them.
Have there been any studies on herpesvirus titers in healthy people? I tried to do a quick literature search and didn't find anything super relevant.
I know not, but 1:32,000 is definitely a very high level, though my doctor has told me of one patient who doesn't have any apparent illness and had a HSV-1 titer of 1:18,000 I believe. That makes her sceptical that it's actually herpes simplex.
I think any immune-mediated disease could be likely to upregulate production of antibodies.
Theoretically yes, but in my case, only HSV-1 is (massively) upregulated. All other titers, both bacteria (Mycoplasma pneumonia) and viruses (EBV, Influenza, HHV6) all have rather low titers. A dozen autoantibodies were also tested and they are absent.
So if anything else is upregulating antibody production, it would be hard to explain why only HSV-1 is upregulated.
Even if people with, say, ME/CFS produce more EBV/HSV antibodies than healthy controls, how does that show anything about what's causing symptoms? Most people don't have viremia by PCR?
I think Drs Lerner and Montoya have shown a (not entirely convincing) connection between high herpes virus titers and some response to antivirals against exactly these viruses. On the other hand, there is the Naviaux memo that as I read it pretty much rejects any connection between high herpesvirus titers and CFS.
Either way, because, as you say, viremia is absent, you need something like abortive or nonproductive intracellular infection to make the connection to the titers. This theory has never been proven, but as far as I know, it has also not been refuted.
Perhaps antiviral therapy has a role to play in this but I think that for induction of remission we can all see that it's not very effective for most people.
This is correct, but on the other hand if we take autoimmunity or an overactive immune system as a theory, we know how to suppress significant parts of the immune system quite effectively (corticosteroids, B-cell depletion, Methotrexate etc.) and the record seems as bleak as with antivirals. I do not think that route is more promising at this time.