Seeing Dr John Chia on Friday, What Questions Should I Ask?

[Learner1]

Azithromycin or rifampin can be used to treat Chlamydia pneumoniae.

Chlamydia pneumoniae is not easy to kill. Oral azithromycin and rifampin did nothing except mess up my gut, and recently, 3 months of IV azithromycin, doxycycline, and rifampin seems to have failed as well.

The cpnhelp website has stories of people on various antibiotics for years.

My renowned specialist uses LabCorp, Quest Diagnostics, and various specialty labs.

 

[pattismith]

Chlamydia pneumoniae is not easy to kill. Oral azithromycin and rifampin did nothing except mess up my gut, and recently, 3 months of IV azithromycin, doxycycline, and rifampin seems to have failed as well.

The cpnhelp website has stories of people on various antibiotics for years.

My renowned specialist uses LabCorp, Quest Diagnostics, and various specialty labs.

How would you know if your Chlam Pneu are killed or not? Do you have a serology follow up? Or à PCR?

 

[Learner1]

Yes. I will be discussing with my ME/CFS doctor soon and will see what he says.

 

[Hip]

Great reporting on Dr Chia's views @Jesse2233.

He said that there are two acute infections that can shift the immune response back into a healthy state: influenza and human respiratory syncytial virus (RSV). He said that he had an ME/CFS patient who was very ill, got an RSV infection and went into full remission (which lasted for at least 5 years, last time they spoke).

That's fascinating!

A quick glance at this study on the immune response to respiratory syncytial virus indicates that RSV induces cathelicidins, which are part of the intracellular immune responses that takes place inside cells, and should help fight the non-cytolytic enterovirus infections found inside ME/CFS patients' cells.

RSV also seems to induce an unusual type of interferon, namely interferon lambda, which was only discovered relatively recently in 2003. This study says that interferon lambda plays an important antiviral role in coxsackievirus B infection.

Interferon lambda also appears to be the predominant interferon induced by influenza A virus infection, according to this study.

I am not sure if interferon lambda therapy is yet available; there are certainly research papers examining the benefits of interferon lambda therapy.

I will have to study the RSV and influenzavirus immune response further.

Chlamydia pneumoniae is not easy to kill. Oral azithromycin and rifampin did nothing except mess up my gut, and recently, 3 months of IV azithromycin, doxycycline, and rifampin seems to have failed as well.

Yes, it does take extended antibiotic treatment; but the problem also is that Chlamydia pneumoniae is hard to diagnose, a bit like Lyme. I have read that the Chlamydia pneumoniae tests results are somewhat equivocal; this may relate to the fact that Cp is an intracellular bacterium that hides inside cells (in studies on intracellular bacteria, these are often notoriously hard to detect).

So even after being tested, you don't really know if you have a Chlamydia pneumoniae problem or not. That's my understanding. So perhaps your negative results from treatment might simply be due to the possibility that you don't have a Chlamydia pneumoniae problem.

 

[used_to_race]

So I saw Dr. Chia yesterday. I was the last patient of the day and we talked for almost two hours. I could go on about my own case but that's not interesting to you guys. The main thing to take away is that he said there's a conference in June at which he expects to hear more about these antivirals for EV. He also said that there are several companies, including a big American one, doing work on antivirals for EV. Apparently none of them have done extensive testing for whether these drugs can cross the BBB, but there may be an update on that in June as well. He thinks the competition among these companies will speed up development, and he plans to tell anyone who will listen what a big market the ME/CFS issue is for these drugs.

He confirmed for me that he does indeed see better responses in males, younger patients, and those who haven't been sick as long. He also reiterated he sees a lot of Jews with this type of infection. Apparently Oxymatrine is very effective against Hepatitis B and there are some papers about this in China.

I'm wondering, and maybe someone here knows: why doesn't he do more tissue biopsies to look for EV? My ARUP titers for all the ones he tests for were 1:10, low as can be. But he reckons there'd be virus found in my throat and heart tissues at least. A heart biopsy sounds scary (plan to talk to a cardiologist about this) but a throat biopsy seems pretty low effort.

The only other things I can remember that haven't been discussed much on this thread: He told me that exercising heavily when you feel a bit better is a terrible idea and I need to stop doing that. I feel bad for my expensive carbon bikes just sitting there, but ok fine. We also talked about Ron Davis and Whitney Dafoe for a bit. This seems like kind of a personal thing so I don't want to go into this much, but I asked him why Whitney hasn't tried Oxymatrine and he says he doesn't know, but he talks to Dr. Davis sometimes in a more or less personal capacity and he may suggest it. Dr. Chia really doesn't like Valcyte, says it's super dangerous and that "certain" doctors (I think we all know who) are giving it out like candy and they don't have the evidence to back up its efficacy like they claim.

I didn't get to ask him about Favipiravir, which is something I'd love to hear his thoughts on. Anyone here know anything about it? @Hip @Jesse2233 @Learner1

How would you know if your Chlam Pneu are killed or not? Do you have a serology follow up? Or à PCR?

Chia had me do a blood test for it so I would assume you can track the serology and see if it's going up or down. I don't know anything about the treatment though.

 

[Aroa]

Thanks for sharing @used_to_race

Did he tell you anything about his collaboration with Maureen Hanson ?

 

[Hip]

I'm wondering, and maybe someone here knows: why doesn't he do more tissue biopsies to look for EV? My ARUP titers for all the ones he tests for were 1:10, low as can be. But he reckons there'd be virus found in my throat and heart tissues at least. A heart biopsy sounds scary (plan to talk to a cardiologist about this) but a throat biopsy seems pretty low effort.

So your antibody tests for coxsackievirus B and echovirus at ARUP Lab were all very low at 1:10, which is well below the threshold titer value of 1:320 at which Dr Chia diagnoses a chronic active enterovirus infection.

Did Dr Chia test you by stomach biopsy for enterovirus? That he says is the most reliable test, as it picks up pretty much all enterovirus infections, whereas the ARUP Lab tests don't cover all enteroviruses.

If he has tested you by stomach biopsy and you are also negative for enterovirus there, is Dr Chia going to look for other viruses or bacteria as the possible cause of your ME/CFS? I know you said you may be positive for EBV. What were your fully EBV results by the way? Were you tested for active infection with HHV-6 and cytomegalovirus? The criteria ME/CFS doctors use for diagnosing active infection are summarized in the mini roadmap.

You said elsewhere that you had adverse effects with Valtrex (some patients don't tolerate this drug very well), but another better tolerated drug for EBV is Famvir, and Valcyte works for EBV, HHV-6 and CMV.


Regarding performing tissue biopsies: in the 1990s, muscle tissue biopsy to test for enterovirus by PCR was the norm in ME/CFS research studies. The problem with muscle biopsies however is that they are painful, invasive and leave a scar. This I believe is one of the reasons why Dr Chia pioneered the use of stomach biopsies instead, as stomach biopsies do not suffer any of these problems. Biopsies of the throat are painful though.

I didn't get to ask him about Favipiravir, which is something I'd love to hear his thoughts on.

Favipiravir (T-705) is one of the many drugs with anti-enterovirus activity which is still in the research and development stage, like many of the other R&D enterovirus drugs listed at the bottom of this post.



By the way, did you ever get any answers to the questions that you were planning to ask Dr Chia. I'd be interested in the answer to your question 15: "Why would tenofovir have any effect in EV infections?" What I'd like to know is whether tenofovir works just for certain types of ME/CFS infections, like just for enteroviruses, or just for herpesviruses, or whether tenofovir works for all forms of ME/CFS.

I think the reason tenofovir may work for enterovirus is because it potently inhibits IL-10, which is linked to enteroviral persistence.

 

[used_to_race]

Thanks for sharing @used_to_race

Did he tell you anything about his collaboration with Maureen Hanson ?

Her name didn't come up during our discussion, and actually I'm unfamiliar with any of her work by name. He did mention Ian Lipkin but nothing really concrete was said about that either, just that he's trying to develop better tests.

@Hip He didn't seem surprised that my blood tests for EV were all that low. My symptoms have all been fairly minor and I don't have any GI or cognitive symptoms at all. As a result he might not think a stomach biopsy would yield much either. Regardless, he didn't suggest one during our appointment. If Equilibrant doesn't work I'd be interested in additional testing. The only two tests that came up at all were Chlamydia Pneumoniae (1:128) and HHV-6 (1:40), both of which he said were about average for a healthy person so they're not an issue. CMV was negative. My EBV story warrants a whole discussion of its own, probably, but the results, briefly:

I was feeling poorly for a long time, almost a year in fact, before I got an EBV panel done. I had a monospot test that was negative, then a few months later a positive. My EBV VCA IgG and IgM were positive on my first EBV panel. This stayed the same for a while, until eventually my IgM went negative (but this took a really long time). Recently I got another panel through a different lab that showed EBNA IgG and VCA IgM were both negative.... super weird. Chia and I discussed this and he said that he thinks my issue for a while was EBV/mono but the irregular immune response was bc of another virus present, he suspects of course an enterovirus. He also said that my bad reaction to Valtrex was telling, and it somehow indicates that EBV isn't the main problem for me. I wish we had more time to go through this.

I didn't get to ask him about Tenofovir or any other antiviral drugs, unfortunately. He talked to me for a while about some Equilibrant case studies and the process of treating his son. One comment I have is this: according to Vince Racaniello, a Virologist at Columbia, most polymerases have similar structures so there is a lot of overlap in effectiveness among polymerase inhibitors. So an anti-herpesvirus drug might work for other viruses, and so on. This probably doesn't even apply to Tenofovir though, because it's a reverse transcriptase inhibitor. Which, btw, isn't even a process undergone by enteroviruses, is it?

 

[halcyon]

This probably doesn't even apply to Tenofovir though, because it's a reverse transcriptase inhibitor

It does apply. All chain terminating nucleoside/nucleotide analogs work by the same principle. It’s the nucleoside/nucleotide with another chemical stuck on the side. It’s this extra bit that interferes with the polymerase/transcriptase when they interact with the chemical integrated in the viral genome. Same principal just applied to different processes depending on the virus. Reverse transcriptase is a polymerase. There are NNRTI drugs which don’t work by this principle but tenofovir is not one of them.

 

[bobbyD]

According to Chia's published letter, he finds enterovirus the most common cause, in 109 out of 200 ME/CFS patients, but in second place surprisingly is Chlamydia pneumoniae, in 18 out of 200 patients. Though I have almost never come across Chlamydia pneumoniae ME/CFS patients on this forum.

I just saw Chia Few weeks ago got tested for the following: these were all considered in the range of infections

C. PNEUMONIAE IGG 1:64

HERPESVIRUS 6 IGG 1:40

ECHOVIRUS 7: 1:80

COXSACKIE B3 & B5: 1:80

IMMUNOGLOBULIN G SUBCLASS 2 2:04

241-700




1:80

 

[Hip]

None of those titers look high, @bobbyD.

 

[bobbyD]

Thanks Hip,

First off, you are the best source I have ever encountered, I appreciate your knowledge, insight and effort to help yourself and others, you are a true gentleman, and have a friend in LA. I Had Mono at 17, now I’m 55. For years, I've had typical low-level CFS internment symptoms, however the last eight months I have more severe issues: lightheadedness, my extremities can get cold, unprovoked anxiety – panic, waking up in the middle of the night, occasional chest soreness, low energy, brain fog, lack of concentration, abdominal soreness. Recently I had picked up the flu that has been around LA, and now I have this never-ending "dry cough" with some post nasal drip from a recent cold. This dry cough issue seems to create some kind of stress that triggers more anxiety, the coughing fits can go on for as long as 2 hours.

I'm use your anti-anxiety protocol and has been helping THANKS.
Last week I saw Chia, the blood work results are listed above, he has me on oxymatrine.
My question to you is, this intermittent dry cough is really wearing me down, not sure what to do.
Also i need to be more proactive with Dr Chia, any suggestions.

Best Regards Bobby

 

[Learner1]

Bobby, what were your EBV titers and PCR? And your full immunoglobulins results? Did he test for HSV 1 and 2, Zoster, and CMV? And a CD57 panel or B cells and T cells? Are your CMP and CBC normal?

 

[Hip]

My question to you is, this intermittent dry cough is really wearing me down, not sure what to do.

For dry cough, dextromethorphan-based cough mixture can treat the symptoms.

Last week I saw Chia, the blood work results are listed above, he has me on oxymatrine.
Also i need to be more proactive with Dr Chia, any suggestions.

I am guessing you must have high titers to some Coxsackie B viruses or echoviruses, as Dr Chia I believe normally uses oxymatrine when patients have these viruses as active infections (though I am not entirely sure).

Oxymatrine usually takes up to 2 or 3 months to start working, so you'd probably want to wait to see if that works for you before trying other treatments from Dr Chia.

 

[bobbyD]

thanks Hip,
my test results are listed below: do you consider these high?
What additional blood work would be helpful?
C. PNEUMONIAE IGG 1:64

HERPESVIRUS 6 IGG 1:40

ECHOVIRUS 7: 1:80

COXSACKIE B3 & B5: 1:80

IMMUNOGLOBULIN G SUBCLASS 2 2:04

241-700

 

[Hip]

Your coxsackievirus B and echovirus titers do not indicate an active infection. Dr Chia says titers of 1:320 and higher indicate active infection in the ARUP Lab tests. Were your other CVB an echovirus titers also low? ARUP Lab tests all six CVB and tests five echoviruses.

 

[frederic83]

@bobbyD

Without the reference range for HHV6 and CP, it is hard to tell. Regarding the enterovirus tests, Chia certainly used the ARUP Lab and that's normal ranges.

I don't understand the IgG 2 result, is it 204 with reference [241-700] ?

What should be helpful if you are into virus are Parvovirus B19, CMV, EBV.

 

[bobbyD]

Hip, here are the actual results...

 

[bobbyD]

Echo Virus 7 is here...

 

[Hip]

@bobbyD, yes those enterovirus titers are all less than 1:320.