Ask the Doctor: Do Antivirals Work for ME/CFS?

Q: I hear about treating with antivirals like Valcyte, Valtrex and Famvir. My doctor says there’s no evidence that these help. Others claim great results? I don’t know what to think.
A: The term “no evidence” means specifically that there aren’t high quality published studies showing evidence or proof – and unfortunately, this is true for antivirals and ME/CFS. From my perspective, there are some people who respond, at least temporarily, to antiviral regimens, but the majority of people do not, at least using the commonly available and affordable antiviral drugs. That likely explains the varied claims. 
Even as an experienced clinician, I’m not sure how to predict who will benefit and who will not. In my own clinic, I may try an antiviral regimen when there is substantial clinical evidence of reactivating herpes-virus infections.  For example, if the patient has frequent outbreaks of oral or genital herpes simplex, a history of shingles, and/or onset of their post-viral syndrome (ME/CFS) associated with EBV mono, I certainly wouldn’t hesitate to give antivirals a try. We do not have solid scientific evidence behind any specific viral pathogen or any antiviral regimen.

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