Thoughts on Antivirals and M

[Davsey27]

I came across this from Robert Navieux

I'm curious about this as I am starting up on Famvir and have heard on these forums that despite titers going down to viral numbers patients still mention no changes in fatigue and wonder if it ties into this.Possibly the inhibition of mitochondria and other epigenetic changes below.

I have also heard of some cases of significant improvement from antivirals like Famvir,Valcyte

But is it worth starting something in the short run knowing that it may cause epigenetic changes mentioned below?


Do you find Naxieuex's ideas to be credible?

Thank You


"In addition, all antivirals have metabolic effects that have nothing to do with inhibiting viral DNA or RNA synthesis directly. Many antiviral drugs inhibit the key metabolic enzyme SAdenosylhomocysteine Hydrolase (SAHH). Inhibition of SAHH causes an increase in intracellular SAH levels. SAH is a potent inhibitor of DNA, RNA, protein, and small molecule methylation. This affects both viral and host cell epigenetics, gene expression, mRNA translation, and protein stability.
The inhibition of methylation reactions in the cell also affects neurotransmitter (dopamine, norepinephrine, and serotonin) and phosphatidylcholine membrane lipid synthesis, folate and B12 metabolism, and many other reactions. So by giving antivirals, doctors are not just inhibiting viruses, they are also inhibiting many host cell metabolic functions.
Sometimes the inhibition of host cell functions can attenuate ME / CFS symptoms for a time, but in other cases, using potent antiviral drugs inhibits mitochondrial and methylation reactions and can delay a full recovery from ME / CFS."

 

[halcyon]

Sometimes the inhibition of host cell functions can attenuate ME / CFS symptoms for a time, but in other cases, using potent antiviral drugs inhibits mitochondrial and methylation reactions and can delay a full recovery from ME / CFS.

I don't know enough to judge his ideas credible or not, but to my knowledge, nobody knows how one does or does not achieve "full recovery from ME/CFS", or whether or not such a thing is even possible, so I don't believe there is any evidence to support this apparent statement of fact.

One anecdote I can provide is that the only time I tried stopping my antiviral I ended up hospitalized for over a week, so personally I'm not convinced by his logic.

 

[Shanti1]

Famvir has its mechanism of action as a guanosine analog, interfering with viral DNA polymerase. It is not a SAHH enzyme inhibitor, so does not mess with the methylation cycle. This isn't to say it can't have some toxicity to our own mitochondria, but as far as antivirals go, famvir and valtrex are generally thought to be the most well-tolerated of the bunch.

I have been on valacyclovir (generic of valtrex) for 8 months now. It eliminated my lymphadenopathy and improved my brain fog. I was hopeful that it would be the answer for me, but my improvement plateaued. Even so, I think that clearing out my active EBV may clear the road for future improvements as my body no longer has the burden of that particular infection.

When I first started taking it, I had a worsening of some of my symptoms and a low-grade fever, in fact, I wondered if I would be able to tolerate the medication. I have since learned that this is common and that some doctors, such as doctor Myhill, consider it a good prognostic factor for an antiviral response. When the virus can no longer replicate, it stops suppressing the immune system and virally infected cells can be identified, and an immune response ensues which causes symptoms.

After a few weeks I was able to increase from 1g to2g and finally to 3g tid. Now I can take 3g or more with no problem and I am one of those people who tend to be really sensitive to medications. This isn't to say everyone will do ok with these meds as PWME have notoriously sensitive and unpredictable systems. However, if you have what you/your doc believes is an active virus based on labs / symptoms, I think an antiviral is worth trying.

 

[vision blue]

@Shanti1 That's awesome. I wish i could do that. I get really sick on valtrex and acylovir and have tried multiple times. Also has lasting effects on my GI track and indeed think my esophagus was ruined so i can't really try again. At first i had thought it was having direct irritating effect on gi system but realized it wsn't that. The effect was delayed- so first 24 hours always fine - plus i then adapted acylovir for intranasal absorption (coudln't do valacyclovir/valtrex because supposedly that is converted in the liver to active ingreident though i have reason to doubt that) but got the same reaction. at first thought i must be swallowing it- going down back of my throat. but wasn't the case no matter how careful i am. I've been reluctant to try famvir - i've tried a bit intranasally and does seem better, but the smell of famvir (no smell to acyclovir or valtrex) is tough on me and it starts my lips swelling; also feel vaguely ill with it- though can't rule out what you say that may be responding- though with valtrex, despite the esophagus problem- it worked on my recurrent virus right away though i had taken it in the beginning that first time. Is it really a guinine analogue though or does it inhibit guinine?

maybe i'd do better with the antivirals @davesy27 mentions since i think i'm an overmethylator. No one wants to prescribe anything other than the 3 typical ones since the other antivirals are known for having more side effects and may need to be monitered. In your case, why not try to see if it (famvir or valtrex) agrees with you and how you do with it. You can always look for long term use into whether it caused decrease in methylation (if it does that) by doing something like a homocysteine level baseline then again after the antiviral. if it goes up, your methylation may have gotten to low.

 

[Shanti1]

@vision blue Sorry to hear you weren't able to tolerate valtex, even though you were getting some positive response from it. When I started it my lymph node swelling went down within a week, but it took a couple of months before I no longer had herx type side effects and the intermittent low-grade fevers subsided. Somehow, I could sense that it was helping me despite the aggravations. I never had GI symptoms from it. Lip swelling sounds more like an allergic IgE response than the type of response the body has to exposed viral antigen.

I was just reading about valaciclovir/acyclovir and found this from up-to-date:

"After intracellular uptake, acyclovir is converted to acyclovir monophosphate by virally-encoded thymidine kinase. This step does not occur to any significant degree in uninfected cells and thereby lends specificity to the drug's activity. The monophosphate derivative is subsequently converted to acyclovir triphosphate by cellular enzymes."​

​

So maybe I also stopped reacting to it because it is only made into the active compound in the presence of active virus. When my viral count dropped, the drug was no longer made active to where it could mess with my own mitochondria. This must also be why this class of antivirals is considered to have low toxicity.

Valacyclovir/acyclovir really is guanine nucleotide analog (technically a deoxyguanosine triphosphate analog), so the virus tries to use it like it would guanine, but since the structure is slightly different, it halts the DNA replication. I'm not sure how effective SAHH inhibitor antivirals are against the human herpes viruses, I couldn't find much on a quick search. Not sure if that is because they aren't effective or no one has studied it since there are effective options that are considered less toxic. I wonder if something like Foscarnet would be worth trying for you?

 

[Dude]

https://www.reddit.com/r/covidlonghaulers/comments/1521s58

 

[Tammy]

@Shanti1 do you still take valacyclovir? Did you ever have to get periodic blood tests while on it? If so, which ones?

 

[gbells]

His comments make sense. Basically he's saying that the antiviral drugs are too downstream. The unmethylated RNA could be the trigger for the mitochondral fragmentation which would explain why the drugs don't work. Bhupesh Prusty said all that needs to be done is to create a micro RNA inhibitor and the mitochondral fragmentation will stop. We need to push for that as it is our best shot at the first effective drug maintenance therapy for CFS due to HHV6 and HHV7. From there we can work on gene editing the virus directly through CART-T to go after the B cells and T cells.

 

[Shanti1]

do you still take valacyclovir? Did you ever have to get periodic blood tests while on it? If so, which ones?

Yes, I still take valacyclovir and will have been on it for two years in Aug. At first I had to take 1g 3x/day to keep symptoms from returning, but was able decrease to 1g 2x day as a maintenance dose after starting high dose B1 and nystatin as they seem to have improved my function.

If I dose less than 1g 2x/day, I get a return of lymph swelling, brain fog, slight sore throat, drop in energy, etc. Valacyclovir is the most benign of the antivirals, in my opinion, but is is important to monitor kidney function, which I do with a chem screen. So far there have been no signs of concern and I have no side effects.

 

[Dude]

https://www.healthrising.org/blog/2023/08/08/pridgen-antiviral-combo-long-covid-fibromyalgia/

I'm wondering what the synergy is between celecoxib and valaciclovir. Anyone know or have a guess? Valacyclovir is definitely at the top of my list of drugs i still want to test. Maybe I'll take celecoxib as well. The whole thing definitely sounds too good to be true.

 

[godlovesatrier]

I've been on it every day since Dec 2022, with one or two breaks for kidney stones. Valtrex that is. 1g per day.

I'm still trying to figure out exactly how it has helped but it seems to have slowly healed my hpa axis dysfunction and improved mental stamina and clarity. However I am still trying to figure out exactly whether it is the reason for improvements now and earlier in the year or whether it is related to work I have done on my microbiome.

 

[Ema]

https://www.healthrising.org/blog/2023/08/08/pridgen-antiviral-combo-long-covid-fibromyalgia/

I'm wondering what the synergy is between celecoxib and valaciclovir. Anyone know or have a guess? Valacyclovir is definitely at the top of my list of drugs i still want to test. Maybe I'll take celecoxib as well. The whole thing definitely sounds too good to be true.

“The therapeutic regimen tested in this study was designed to suppress tissue-resident herpes viruses. The famciclovir + celecoxib combination (IMC-1) was intended to provide aggressive antiviral activity against herpes simplex virus 1 (HSV-1), interrupting the cyclical process of virus reactivation and lytic infection hypothesized to trigger and/or perpetuate the symptoms of FM.

The mechanism of action of anti-herpes virus nucleoside analogs such as acyclovir, valacyclovir, and famciclovir is well understood. It is perhaps less well known that COX-2 inhibitors also exhibit anti-herpes virus activity. Several herpes viruses, including HSV-1, are known to significantly upregulate COX-2, and virally induced upregulation of COX enzymes is important for efficient HSV-1 replication.12–17 In addition, researchers have found COX inhibitors are effective in reducing the severity of primary herpes virus lesions and inhibiting reactivation of latent infections.18–21

Whereas other treatments, such as serotonin/norepinephrine reuptake inhibitors and antiepileptic agents, are oriented toward the treatment of downstream abnormalities in central pain processing,22 we hypothesized that the IMC-1 regimen would intervene further upstream in the cascade of events leading to the symptoms of FM.”

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5328426/

FWIW, the studies thus far have been completely underwhelming, failing to meet primary endpoints. Pridgen’ s company, Virios, was on its last legs according to an email sent out to patients until it decided to trial valacyclovir/celecoxib in long COVID.

 

[Hoosierfans]

“The therapeutic regimen tested in this study was designed to suppress tissue-resident herpes viruses. The famciclovir + celecoxib combination (IMC-1) was intended to provide aggressive antiviral activity against herpes simplex virus 1 (HSV-1), interrupting the cyclical process of virus reactivation and lytic infection hypothesized to trigger and/or perpetuate the symptoms of FM.

The mechanism of action of anti-herpes virus nucleoside analogs such as acyclovir, valacyclovir, and famciclovir is well understood. It is perhaps less well known that COX-2 inhibitors also exhibit anti-herpes virus activity. Several herpes viruses, including HSV-1, are known to significantly upregulate COX-2, and virally induced upregulation of COX enzymes is important for efficient HSV-1 replication.12–17 In addition, researchers have found COX inhibitors are effective in reducing the severity of primary herpes virus lesions and inhibiting reactivation of latent infections.18–21

Whereas other treatments, such as serotonin/norepinephrine reuptake inhibitors and antiepileptic agents, are oriented toward the treatment of downstream abnormalities in central pain processing,22 we hypothesized that the IMC-1 regimen would intervene further upstream in the cascade of events leading to the symptoms of FM.”

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5328426/

FWIW, the studies thus far have been completely underwhelming, failing to meet primary endpoints. Pridgen’ s company, Virios, was on its last legs according to an email sent out to patients until it decided to trial valacyclovir/celecoxib in long COVID.

Thanks for the explanation.

I’m considering the Pridgen protocol because I have severe sunburn like pain all over my body — as I describe it to my docs it’s like the shingles commercials but without the rash!! Unfortunately it comes with neuro symptoms as well (dizziness, memory loss, anxiety).

A perusal of Reddit in the fibro and chronic pain subreddits provides a bunch of stories of folks successfully using it for pain…and improving brain fog and energy at the same time. Interestingly there are stories of people who tried *just* Celebrex or other pain killers on their own with no success — add in the Famvir (that’s what most are using) and it all starts to work.

Dosing is a bit all over the place: on the low end Famvir 250 mg 2 x day (high end 500 mg 3 x day) and Celebrex at 200 2 x day.

 

[Hoosierfans]

A question that I’ve been considering as I read these studies / clinical trials / research ideas. More often than not, I don’t see it mentioned that “patient selection” as including folks who are IGM positive (or some threshold high titer of IGG) as a test for whether they are carrying a particular virus or virus load.

5 - 10 years ago my interactions with most docs was if you don’t have IGM, you don’t have an active infection so I won’t treat you with antivirals. Of course, many ME / CFS experts disagreed but presenting this info to my docs at the time wouldn’t convince them.

Has the research community / practitioners moved beyond that dogma and accepted the fact that these viruses lay in a latent state in the tissues, nerves, epithelium / endothelium’s but still cause significant illness in this latent state?

My question is partially self interested — I have a great new PCP and we have just discussed whether it’s even worth paying for expensive viral tests if, in the end, the outcome is the same — these tests aren’t going to pick up viruses in the tissues but my symptoms are enough to suspect they are hiding in their wreaking havoc. That decision to treat, and potentially treat aggressively, of course depends on whether it’s accepted science that latent viruses can cause significant illness.

 

[Rufous McKinney]

of course depends on whether it’s accepted science that latent viruses can cause significant illness.

there seems to be potential for that to be a problem; examples below

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3142679/

 

[Hoosierfans]

Interesting article. Do you think most researchers / me/CFS docs are coming around to the view that latent infections…or maybe it could even be characterized as infections that dip in and out of the lyric / latent phase (but do so quickly enough we don’t capture the IGM)…cause disease?

There seems to be more and more evidence that that is the case — Prusty’s work on the “cascade of horribles” that happen and persist post infection, patients who recover with antivirals after years of having the initial infection, the success of Klimas with COVID monoclonal antibodies in long haul patients. The original infection has long since passed, but treat these patients with antivirals, or monoclonal antibodies, or some sort of -pheresis and they get better. 🤔

Patients who are using Pridgen’s protocol in the chronic pain/ fibro world have been sick w fibro for years and years. It’s not like they are breaking out w cold sores or genital outbreaks at the time of treatment. Yet give them Famvir and Celebrex and their symptoms resolve. Not everybody, but there’s a good cohort.

 

[Davsey27]

Interesting article. Do you think most researchers / me/CFS docs are coming around to the view that latent infections…or maybe it could even be characterized as infections that dip in and out of the lyric / latent phase (but do so quickly enough we don’t capture the IGM)…cause disease?

There seems to be more and more evidence that that is the case — Prusty’s work on the “cascade of horribles” that happen and persist post infection, patients who recover with antivirals after years of having the initial infection, the success of Klimas with COVID monoclonal antibodies in long haul patients. The original infection has long since passed, but treat these patients with antivirals, or monoclonal antibodies, or some sort of -pheresis and they get better. 🤔

Patients who are using Pridgen’s protocol in the chronic pain/ fibro world have been sick w fibro for years and years. It’s not like they are breaking out w cold sores or genital outbreaks at the time of treatment. Yet give them Famvir and Celebrex and their symptoms resolve. Not everybody, but there’s a good cohort.

It seems for some mold can reactivate viruses