Which drugs are effective against herpesviruses HSV, EBV, CMV, VZV, HHV6, HHV8?

Pyrrhus

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Which drugs are effective against herpesviruses HSV, EBV, CMV, VZV, HHV6, HHV8?

This thread is intended to collect information from other threads regarding which drugs are effective against the various common herpesviruses:
  1. Herpes Simplex Virus (HSV)
  2. Epstein-Barr Virus (EBV) (also known as mononucleosis, glandular fever, or simply "mono")
  3. Cytomegalovirus (CMV)
  4. Varicella-Zoster Virus (VZV) (also known as shingles, chickenpox, or herpes zoster)
  5. Human Herpesvirus 6 (HHV6)
  6. Human Herpesvirus 8 (HHV8) (also known as Kaposi's sarcoma-associated herpesvirus or simply KSHV)
 
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Pyrrhus

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In vitro testing gives us some hints:

According to a 2019 review:
  • Valtrex/Valacyclovir (active ingredient is acyclovir) should work best for HSV and VZV, and is only partially effective against EBV and CMV.
  • Valcyte/Valganciclovir (active ingredient is ganciclovir) should work best for HSV, VZV, EBV, CMV, but is only partially effective against HHV6 or HHV8.
  • Famvir/Famciclovir (active ingredient is penciclovir) was not included in this 2019 review for some reason.
However, this 2019 review was mainly based on in vitro studies, and does not take into account dosage and dosing frequency.

In the below graph, Valtrex/Valacyclovir is represented by "ACV" (an abbreviation of acyclovir) and Valcyte/Valganciclovir is represented by "GCV" (an abbreviation of ganciclovir). ("BCV" stands for Brincidofovir, a drug approved only for smallpox.)

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Reference:
https://www.sciencedirect.com/science/article/pii/S0166354218306570?via=ihub
 
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Pyrrhus

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In vivo testing also provides some clues:

The section of the below 2019 paper titled, "Antivirals Against EBV Evaluated in the clinic" goes through the evidence for valganciclovir [ganciclovir] and valacyclovir [acyclovir]. In the human trials, they both appear to be effective. While it is possible that valganciclovir may be more effective than valacyclovir, based on the in vitro data, this was not called out in the clinical trials reviewed in this paper.
Novel Therapeutics for Epstein–Barr Virus - MDPI
Valacyclovir (or similar meds) does not eliminate the virus, the viral [genome] in the cell remains intact. It only stops the replication ie the production of additional viruses. [...] I've been on valacyclovir for 8 months now and pushing and getting PEM sets me back, it does not help me clear viruses and improve.

An example is mono. While acyclovir may reduce viral shedding during Mono, it doesn't eliminate the virus from cells (just the replication), alleviate symptoms, or shorten the course of the disease. This is because the symptoms are an immune response to EBV-infected B-Cells.

EBV infection can be latent, abortive lytic, and lytic reactivation. It has been proposed that abortive lytic may be a common finding in ME/CFS, [where] the virus still produces immuno-suppressive proteins, and symptoms, but is not susceptible to antivirals.
 

Pyrrhus

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sunshine44

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No, the drugs described above are direct-acting antivirals (DAA) which act directly on the virus, whereas the link you provide talks about immunotherapy which acts by killing infected cells.

I hope this helps.
This does help. Thank you for clarifying.
 

Pyrrhus

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Brincidofovir seems like the greatest hope for treating many, many viruses.
I agree, brincidofovir is definitely the best broad-spectrum direct-acting antiviral (DAA) for treating DNA viruses. (But it does NOT work for RNA viruses.)

Unfortunately, there is a very long and very sad story regarding the pharmaceutical development of this drug. The drug company was nearing phase III trials when it had money problems and decided to stop development of the drug completely. Apparently, the US government then intervened to get it approved for smallpox, which the US government considered a "national security threat".

But good luck trying to get your hands on it, since it's only approved for smallpox!
 

katabasis

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While they aren't as reliable as pharmaceutical antivirals, I think it's worth mentioning there are a lot of supplements for which there is some evidence of efficacy against these viruses. To start things off, here's a selfhack.com article which has a list of supplements effective against EBV (including links to substantiating research, so you can evaluate yourself whether these supplements are worth trying). Some of these supplements, I remember reading, are also effective against some of the other viruses this thread focuses on, though I don't have the energy to do a full write-up.
 

MartinK

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doubts about Valacyclovir (Valtrex) effectiveness for EBV and VZV
hey hey, I compared my EBV and VZV results before and after nearly 6 months of Valacyclovir (3x1g daily)(this treatment is without any succes for me)

10-2021

a-EBNA IgG 12.56 >> S/CO (0.00 - 0.50)
a-EBV VCA IgG 67.30 >> S/CO (0.00 - 0.75)
a-EBV VCA IgM 0.05 S/CO (0.00 - 0.50)
a-EBV EA IgG <5 U/mL (0 - 40)

4-2022

a-EBNA IgG 12.32 >> S/CO (0.00 - 0.50)
a-EBV VCA IgG 52.42 >> S/CO (0.00 - 0.75)
a-EBV VCA IgM 0.03 S/CO (0.00 - 0.50)
a-EBV EA IgG 5 U/mL (0 - 40)

10-2021

a-VZV IgA 0.06 IP (0.00 - 0.90)
a-VZV IgG 3.87 >> IP (0.00 - 0.90)
a-VZV IgM 0.10 IP (0.00 - 0.90)

4-2022

a-VZV IgM 0.20 IP (0.00 - 0.99)
a-VZV IgG 1998.0 >> IU/L (0.0 - 150.0)
a-VZV IgA 0.11 IP (0.00 - 0.90)

*You can see that there is almost no noticeable difference - I remember Dr. Lerner talking that clear changes (not full cure) should be visible within 3-5 months with Valtrex - I gave this a chance and now I will probably stop treatment. But, hard to know, if this viruses are really active in my case... I know reading results of me/cfs patients can be difficult to interpret.

This is my experience with this antiviral.
 

Pyrrhus

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You can see that there is almost no noticeable difference. [...] But, hard to know, if this viruses are really active in my case...
Doctors interpret the serology in different ways, but personally I don't see evidence that you have a re-activation of either EBV or VZV:

10-2021
a-EBV EA IgG <5 U/mL (0 - 40)
4-2022
a-EBV EA IgG 5 U/mL (0 - 40)
EBV Early Antigen (EA) is probably the most relevant IgG antibody in determining whether there may be a reactivation. Your EA antibodies are within the stated reference range.

10-2021
a-VZV IgM 0.10 IP (0.00 - 0.90)
4-2022
a-VZV IgM 0.20 IP (0.00 - 0.99)
VZV IgM antibody is probably the most relevant antibody in determining whether there may be a reactivation. Your IgM antibodies are within the stated reference range.

Of course, serology is never a perfect guide as to whether a re-activation of a herpesvirus truly exists.

Related discussion:

Labs for Epstein-Barr Virus (EBV)
https://forums.phoenixrising.me/threads/labs-for-epstein-barr-virus-ebv.87383/
 
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I agree, brincidofovir is definitely the best broad-spectrum direct-acting antiviral (DAA) for treating DNA viruses. (But it does NOT work for RNA viruses.)

Unfortunately, there is a very long and very sad story regarding the pharmaceutical development of this drug. The drug company was nearing phase III trials when it had money problems and decided to stop development of the drug completely. Apparently, the US government then intervened to get it approved for smallpox, which the US government considered a "national security threat".

But good luck trying to get your hands on it, since it's only approved for smallpox!
The group is organising a synthesis and group buy of this. There are concerns regarding carcinogenicity though.
 

Pyrrhus

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The group is organising a synthesis and group buy of this. There are concerns regarding carcinogenicity though.
Please do let us know how it goes.

It would be helpful if the people trying it monitored their kidney function with a microalbumin urine test (AKA albumin-creatinine ratio test) in case the drug attacks any BK virus or JC virus hiding in the kidneys, triggering kidney inflammation.

There may also be some neurological start-up symptoms due to any JC virus hiding in the brain. My guess is that these neurological start-up symptoms would be short-lived (1-2 weeks). But that's just a guess.

And of course, it would be helpful if they also monitor immune function with a Complete Blood Count (CBC). A temporary drop in immune cells lasting a few weeks may be expected, especially if there is a hidden parvovirus infection. I would think that a drop in immune cells that lasts for more than 4-8 weeks is cause for immediate concern. Again, that's just an estimate.

And of course, it would also be helpful if they monitor liver function with a Comprehensive Metabolic Panel (CMP). A temporary elevation in liver enzymes (roughly 2-4 weeks) might be expected if there is any adenovirus hiding in the liver, but a longer-term elevation in liver enzymes is cause for immediate concern.

Patients who have previously had warts might also experience some tingling in the area where they had the warts if the drug attacks the HPV hiding in the skin.

And to minimize any gastrointestinal upset or other toxicity, they might find it better to dose it as 30mg daily (maybe take with whole milk to suspend the lipophilic drug) instead of dosing it 100mg twice a week. It's not clear if the reported gastrointestinal upset/toxicity is due directly to the drug or if it is a side-effect of attacking viruses hiding in the intestines.

I hope this helps. None of the above should be interpreted as medical advice, of course.
 

godlovesatrier

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In my case the antivirals did seem to work but as soon as I did something while taking them I'd go backwards. Then after that taking the antivirals made me feel worse, of course that could just have been a reactivation of viral load.

For me as well valtrex specifically caused kidney stones, but I also experienced kidney pain, felt like someone had kicked me in my back just below the kidney in both flanks. Kidney function tests were fine, I even ahd the hospital do a ct scan but they could only one one very tiny stone in my kidney. I think by that point the stones had passed but the swelling was still present.

After just 1g of valtrex, I get very dull sometimes sharp pain in my lower right and left flank. I drink tons of water and I have tried with and without supplements to no avail. It's frustrating and I don't get how the stones can be forming with me drinking so much. I did wonder if it could be blood flow related. I also thought maybe my body is having a reaction to valtrex as I did experience some allergic symptoms when I took more than 500mg a day which I thought was odd.

As for Famvir that made my heart race but I did notice the same dull ache in my flanks even taking that. The first 15 days I took famvir I didn't notice this though at all, so I think in my case the valtrex must have been the cause.

--

I also found valtrex at 500mg would stop the pain of a crash in its tracks. However 500mg of famvir while it seemed to dent the pain didn't stop it. I think I took two split doses of 500mg famvir in my last (push) crash and that didn't work that well.

I probably took it for about 4 to 6 weeks in total. I may try 250mg Famvir twice a day but taking a break for now.
 
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Don't you mean kidneys? I'd be more bothered about valgans effect on kidneys of aloyvirs stone producing traits.

Famvir is extremely safe but I just found out last night I can't get any European famvir its way way too expensive.

A lot of the other drugs outside of valac and famvir are pretty toxic it seems. Then again many to in via IV.