Very tender and a little swollen lymph nodes after starting Valtrex?

Shanti1

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I had a slight flair in my chronic lymph node swelling for 1-2 days after starting valaciclovir and then it subsided, along with my chronic sore throat, completely disappearing within a month or so. I also had a low-grade fever most of the time during my first month on valacyclovier.

When the valtrex kills the replicating viruses, you may get some immune recognition of the EBV, leading to some lymph node swelling and symptoms. That is my thought, but of course, it is important to rule out an infection caused by something else.
 

ljimbo423

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When the valtrex kills the replicating viruses, you may get some immune recognition of the EBV, leading to some lymph node swelling and symptoms.
Getting "die-off" symptoms or "herxing" from valtrex or other herpes antivirals, doesn't make sense to me. Because valtrex works by stopping viruses from multiplying, by inhibiting viral DNA polymerase, it doesn't kill them

So there can't be die-off because the viruses live their normal life-span, they just are unable to replicate and multiply, therefore lowering the viral load. This is one reason why I think antivirals work in some other way to help some us, rather than lowering viral loads.

At least this is how I understand how herpes antivirals work.

The inhibitors of protease (ritonavir, atazanavir and darunavir), viral DNA polymerase (acyclovir, tenofovir, valganciclovir and valacyclovir) and of integrase (raltegravir) are listed among the Top 200 Drugs by sales during 2010s.
https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC7975490/
 

Shanti1

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Getting "die-off" symptoms or "herxing" from valtrex or other herpes antivirals, doesn't make sense to me. Because valtrex works by stopping viruses from multiplying, by inhibiting viral DNA polymerase, it doesn't kill them

So there can't be die-off because the viruses live their normal life-span, they just are unable to replicate and multiply, therefore lowering the viral load. This is one reason why I think antivirals work in some other way to help some us, rather than lowering viral loads.

At least this is how I understand how herpes antivirals work.
It is true that the valacyclovir doesn't kill the latent EBV virus, and the same sentiments you express went through my mind as I tried to make sense of my first 3 months on valacyclovir. However, as my symptoms were so reminiscent of a herx, I began to wonder if those who have very actively replicating EBV virus may not display some sort of immune reaction on initiation of a DNA polymerase inhibitor.

My thought is that, if you have viral DNA in a cell in various stages of replication, along with the viral proteins in various stages of completion and assembly, and you use a DNA polymerase inhibitor to halt that process, inclusive of a halt on the viral proteins that inhibit immune activation and B-cell apoptosis, you may get some immune recognition, B-cell apoptosis, and immune-mediated cell destruction. This would result in immune activation from enhanced immune recognition and spillage of viral proteins into the extracellular space, leading to symptoms.

My theory is not provable (I don't think, although I haven't done a deep dive), but it is my working theory based on my experience. Prior to valacyclovir, I had chronic lympnode swelling and sore throat and my PEM events were very flu-like. At first I could only tollerate 1 valacyclovir each day due to fever and exacerbated fatigue symptoms. Over a period of 3 months, I built up to 3 per day, but would still have some medication related fatigue. Now I take it like it is nothing. My doctor said this is a common experience.
 
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Pyrrhus

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My thought is that, if you have viral DNA in a cell in various stages of replication, along with the viral proteins in various stages of completion and assembly, and you use a DNA polymerase inhibitor to halt that process, inclusive of a halt on the viral proteins that inhibit immune activation and B-cell apoptosis, you may get some immune recognition, B-cell apoptosis, and immune-mediated cell destruction.
That's exactly right. Once the antiviral is initiated, the active herpesvirus can no longer replicate its DNA, which means it can no longer produce viral RNA or viral proteins from the DNA, which means it can no longer use viral proteins to evade and suppress the immune system.

The immune system can then identify cells with active herpesvirus, kill them, and transport the killed cells to the lymph nodes where immune cells process the killed cells and multiply accordingly, leading to lymph node swelling.

My doctor said this is a common experience.
Yes, this is well documented in the clinical setting.
 
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ChookityPop

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I had a slight flair in my chronic lymph node swelling for 1-2 days after starting valaciclovir and then it subsided, along with my chronic sore throat, completely disappearing within a month or so. I also had a low-grade fever most of the time during my first month on valacyclovier.
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Thanks for Sharing. This is Very interesting. Did you measure your temperature confirming fever?
 
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It's probably your bodys reaction to the drug, which could also cause your body to generate enough gunk that it ends up in your lymph nodes. But if you persevere for 6 months you should know whether your baseline is higher or not.