Dr. Teitelbaum on When to Use Antivirals in Chronic Fatigue Syndrome and Fibromyalgia

Dr. Teitelbaum on When to Use Antivirals in Chronic Fatigue Syndrome and Fibromyalgia

Dr. Teitelbaum is a well-known author and doctor specializing in ME/CFS and FM

The visitor asked: "I recently read that antivirals for CFS can do more harm than good if there's no evidence of a current infection. I have a high early antigen EBV, but I'm confused if this is relevant since it's not an IgM antibody. My physician says she no longer checks for it because even healthy people can test positive. Can you clear this up for me?"

This is a bit complex, so please bear with me as I go through this...

It's true that IgG elevation reflects old infection, and most healthy people test IgG positive for EBV, CMV, HHV 6 and HSV1. Because of the immune dysfunction in fibromyalgia and CFS, viral reactivation is usually detected. This will not result in the standard IgM test for acute infection being positive, but has been shown to be associated with very high IgG titres in combination with a clinical picture that is suggestive. Though there is no set cutoff for the IgG to confirm viral reactivation, I consider titres of 4 (or 1:640) or higher to raise a suspicion for HHV 6, CMV, and perhaps HSV 1 reactivation.
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