Response to valganciclovir in chronic fatigue syndrome patients with human herpesvirus 6 and Epstein-Barr virus IgG antibody titers.
Valganciclovir has been reported to improve physical and cognitive symptoms in patients with chronic fatigue syndrome (CFS) with elevated human herpesvirus 6 (HHV-6) and Epstein-Barr virus (EBV) IgG antibody titers. This study investigated whether antibody titers against HHV-6 and EBV were associated with clinical response to valganciclovir in a subset of CFS patients. An uncontrolled, unblinded retrospective chart review was performed on 61 CFS patients treated with 900 mg valganciclovir daily (55 of whom took an induction dose of 1,800 mg daily for the first 3 weeks). Antibody titers were considered high if HHV-6 IgG ≥ 1:320, EBV viral capsid antigen (VCA) IgG ≥ 1:640, and EBV early antigen (EA) IgG ≥ 1:160. Patients self-rated physical and cognitive functioning as a percentage of their functioning prior to illness. Patients were categorized as responders if they experienced at least 30% improvement in physical and/or cognitive functioning. Thirty-two patients (52%) were categorized as responders. Among these, 19 patients (59%) responded physically and 26 patients (81%) responded cognitively. Baseline antibody titers showed no significant association with response. After treatment, the average change in physical and cognitive functioning levels for all patients was +19% and +23%, respectively (P < 0.0001). Longer treatment was associated with improved response (P = 0.0002). No significant difference was found between responders and non-responders among other variables analyzed. Valganciclovir treatment, independent of the baseline antibody titers, was associated with self-rated improvement in physical and cognitive functioning for CFS patients who had positive HHV-6 and/or EBV serologies. Longer valganciclovir treatment correlated with an improved response.
Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University Medical Center, Palo Alto, CA, USA.
Tessa
T
Watt
Stephanie
S
Oberfoell
Raymond
R
Balise
Mitchell R
MR
Lunn
Aroop K
AK
Kar
Lindsey
L
Merrihew
Munveer S
MS
Bhangoo
José G
JG
Montoya
D000328:Adult; D000914:Antibodies, Viral / Q000097:blood* / Q000276:immunology; D000956:Antigens, Viral / Q000032:analysis / Q000276:immunology; D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D036022:Capsid Proteins / Q000032:analysis / Q000276:immunology; D003071:Cognition / Q000187:drug effects; D004334:Drug Administration Schedule; D004341:Drug Evaluation; D015673:Fatigue Syndrome, Chronic / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D005260:Female; D015774:Ganciclovir / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D004854:Herpesvirus 4, Human / Q000276:immunology*; D015654:Herpesvirus 6, Human / Q000276:immunology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D057566:Self Report; D016896:Treatment Outcome; D000077562:Valganciclovir
D000914:Antibodies, Viral; D000956:Antigens, Viral; D000998:Antiviral Agents; D036022:Capsid Proteins; C041788:Epstein-Barr viral capsid antigen; C033305:Epstein-Barr virus early antigen; D000077562:Valganciclovir; D015774:Ganciclovir