Anti-herpesvirus drug treatment may benefit some chronic fatigue syndrome patients

Main Category: Infectious Diseases / Bacteria / Viruses
Article Date: 30 Jul 2013 - 0:00 PDT Current ratings for:
Anti-herpesvirus drug treatment may benefit some chronic fatigue syndrome patients

Many experts believe that chronic fatigue syndrome (CFS) has several root causes including some viruses. Now, lead scientists Shara Pantry, Maria Medveczky and Peter Medveczky of the University of South Florida's Morsani College of Medicine, along with the help of several collaborating scientists and clinicians, have published an article in the Journal of Medical Virology suggesting that a common virus, Human Herpesvirus 6 (HHV-6), is the possible cause of some CFS cases.

Over 95 percent of the population is infected with HHV-6 by age 3, but in those with normal immune systems the virus remains inactive. HHV-6 causes fever and rash (or roseola) in infants during early childhood, and is spread by saliva. In immunocompromised patients, it can reactivate to cause neurological dysfunction, encephalitis, pneumonia and organ failure.

"The good news reported in our study is that antiviral drugs improve the severe neurological symptoms, including chronic pain and long-term fatigue, suffered by a certain group of patients with CFS," said Medveczky, who is a professor of molecular medicine at USF Health and the study's principal investigator. "An estimated 15,000 to 20,000 patients with this CFS-like disease in the United States alone may ultimately benefit from the application of this research including antiviral drug therapy."

The link between HHV-6 infection and CFS is quite complex. After the first encounter, or "primary infection," all nine known human herpesviruses become silent, or "latent," but may reactivate and cause diseases upon immunosuppression or during aging. A previous study from the Medveczky laboratory showed that HHV-6 is unique among human herpesviruses; during latency, its DNA integrates into the structures at the end of chromosomes known as telomeres.

Furthermore, this integrated HHV-6 genome can be inherited from parent to child, a condition commonly referred to as "chromosomally integrated HHV-6," or CIHHV-6. By contrast, the "latent" genome of all other human herpesviruses converts to a circular form in the nucleus of the cell, not integrated into the chromosomes, and not inheritable by future generations.

Most studies suggest that around 0.8 percent of the U.S. and U.K. population is CIHHV6 positive, thus carrying a copy of HHV-6 in each cell. While most CIHHV-6 individuals appear healthy, they may be less able to defend themselves against other strains of HHV-6 that they might encounter. Medveczky reports that some of these individuals suffer from a CFS-like illness. In a cohort of CFS patients with serious neurological symptoms, the researchers found that the prevalence of CIHHV-6 was over 2 percent, or more than twice the level found in the general public. In light of this finding, the authors of the study suggest naming this sub-category of CFS "Inherited Human Herpesvirus 6 Syndrome," or IHS.

Medveczky's team discovered that untreated CIHHV-6 patients with CFS showed signs that the HHV-6 virus was actively replicating: determined by the presence of HHV-6 messenger RNA (mRNA), a substance produced only when the virus is active. The team followed these patients during treatment, and discovered that the HHV-6 mRNA disappeared by the sixth week of antiviral therapy with valganciclovir, a drug used to treat closely related cytomegalovirus (HHV-5). Of note, the group also found that short-term treatment regimens, even up to three weeks, had little or no impact on the HHV-6 mRNA level.

The investigators assumed that the integrated virus had become reactivated in these patients; however, to their surprise, they found that these IHS patients were infected by a second unrelated strain of HHV-6.

Further studies are needed to confirm that immune dysregulation, along with subsequent chronic persistence of the HHV-6 virus, is the root cause of the IHS patients' clinical symptoms, the researchers report.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our infectious diseases / bacteria / viruses section for the latest news on this subject.

The USF-led study was supported by the HHV-6 Foundation and the National Institutes of Health.

Article citation: “Persistent human herpesvirus-6 infection in patients with an inherited form of the virus; ” Shara N. Pantry, Maria M. Medveczky, Jesse H. Arbuckle, Janos Luka,Jose G. Montoya, Jianhong Hu, Rolf Renne, Daniel Peterson, Joshua C. Pritchett, Dharam V. Ablashi, andPeter G. Medveczky; Journal of Medical Virology; published online July 25, 2013; DOI: 10.1002/jmv.23685

University of South Florida (USF Health)

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Has the NHS contracted change fatigue from political interference?

Many working in the NHS have contracted change fatigue and weariness from political interference, argues Harrison Carter. Photograph: Getty Images

Frederick Douglass, the American social reformer and orator, said: "If there is no struggle, there is no progress." This is an experience felt by many working in the NHS, the struggle bit at least. Particularly, when they're used as objects for political point scoring or accidental own goals by successive governments. Some of the struggle that the NHS has experienced has been worth it. At the end of the last century and then on into this one, people fought successfully to give patients more choice, freedom and opportunity. However, it is not surprising that many working in the NHS have contracted a bit of change fatigue and weariness from political interference, especially when they don't understand the need for some things to be altered, or why they should act as scapegoats for faltering ideas in the political sphere – as was the case when Anne McIntosh, Conservative MP, blamed female doctors for burdening the NHS.

Labour party members have cried until they're blue in the face that the Health and Social Care Reform Act is a top-down re-organisation of the NHS. The coalition has retorted that its plans for how the health service is managed will offer better patient care at the same time as being cost-effective.

With the government's policy now on the statute book, it will be very difficult for the Labour party to repeal the changes in their entirety. The cost of abolishing all the new organisations sprouting up across the country is too drastic to justify to health professionals and the general public.

A group of such institutions are the clinical commissioning groups that take responsibility for local health care budgets from the defunct primary care trusts. The argument is that GPs are best equipped to determine which services need to be commissioned.

This is where the Labour party can make its move. It believes that the commissioning groups' budget could be managed by local councillors instead. Labour argues that the merger of health, social care and mental health budgets would de-fragment the NHS, ergo, giving people better results. They see it as whole person care.

This philosophy is not too unreasonable. Jeremy Hunt recently declared a return to family doctoring: GPs were to be responsible for their patients' care out of practice hours. For Labour, the GPs on the commissioning groups could be released to deal more directly with patient requests at home.

The population is ageing, and so the need to incorporate all aspects of clinical and non-clinical care is growing. Locally elected councillors, by virtue of a political term, have to answer directly to the public. If they're not up to scratch, then they're given the boot. As representatives of the people, they can spend their time giving the government an earful when things aren't working well. Some commissioning groups have already been having difficulties with local hospital department closures instigated by central government diktat that went over their heads.

People question whether this could be avoided under Labour's proposals.

If Labour is elected in 2015, the successful implementation of the its ideas will be complex and drawn out. Will commissioning groups be content acting as advisory boards instead of making the decisions? Some people would say that they don't think there is anybody better placed to target NHS resources than those who see real patients with real diseases in real adversity every working day. They question whether the humanity might be lost on local councillors who haven't sat in a GP's surgery and listened to patients.

What is obvious is that if the pooling of the £104bn NHS budget with the £15bn social care budget were to take place, elections would truly be centred on healthcare provision. The increased risk of further political meddling with our national treasure, as a result of this, is pertinent. The BMA, the trade union and professional body for doctors, called a vote of no confidence in the health secretary. Mistrust about the management of healthcare in this country is already dangerously high.

Any further political interference in how healthcare is provided would make it an even greater political hot potato that might negatively affect the ability of practitioners to discharge their duties in the future.

Harrison Carter is the director of policy and advocacy at MedsinUK, a charity that takes action against global health inequity. He also works with the primary care and health sciences research institute at Keele University

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