QUESTION: Viral testing for CFS/fibromyalgia interpretation
- HHV6 IgG 1:160 H
- CMV IgG > 5.00 H
- EBV EA IgG EBV VCA IgM negative
- EBV VCA IgG 4.77 H
- EBV EBNA IgG >5.00 H
Are the positive HHV6 and EBV results just indicating past infection (and not significant) but the CMV considered active and requiring tx? Is anyone using Valcyte? I was told by another doctor: “NO, the CMV is only active if the IgM is reactive. These test results have nothing to do with her fibro/CFS.”
ANSWER: Trouble is that with these test results you may have no viral activity, and then again you might. There is data (which is too much to summarize here but that I’ll do in the webinar hosted on this site) showing that as the Sensitivity is reasonable but Specificity is low for these tests and the Viri they represent (and the cross reactivity among HHV strains [and others] is high) which shows that in many cases the velocity of IgG can tell an active infection better than an IgM as an example.
Another issue is the overall load of HHV series as well as other viral IgG in a “sick user” type patient. (“well” users for these tests are asymptomatic and have no SnSx which may indicate HHV activity. “sick” users are those who have SnSx that indicate HHV or other viri should be considered – a smaller group than well folks (for whom the standard IgG and IgM assessment is more sensitive and specific). In a sick user there are a couple of things to consider:
1- How many viri tested show high IgG (this is a marker of overall exposure and propensity to reactivation in the family or in viral immunity.)
2- How high the IgG titers are.
So: When one sees a lot of IgG to a lot of viri, even in the face of no acute phase reactant (such as IgM) as the IgM has such a narrow window and low sensitivity one can often assume some viral activity in the SICK user. Additionally in the papers I have read and more importantly in the over 2000 patients I have tested and followed (sick users) with viral illnesses when you have Sn/Sx and high IgG you often have one or more active viri regardless of acute reactant status. This is based on things like follow up PCR testing, and interventions that target viri (and those things confirming this idea.) there are many other factors like Mitochondrial and Endocrine effects etc – but this gives you a brief idea.
As for Valcyte: I see and manage HHV series viri pretty much daily in cancer and non-cancer patients and you actually don’t need it as much as we pharmacology teachers tell you… I’d consider an aggressive NatMed antiviral approach and run down the other things that mess up these folks and see how the person reacts. Listen to my webcall about EBV, and stay tuned for a full webinar.