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Learning CFS: The Lerner Antiviral Trial Succeeds
Tuesday 1 June 2010
It's rare to get good news on the treatment end but Dr. Lerner's latest paper is full of it. The paper analyzes the progress of his patients over the past 10 years who have undergone long-term antiviral treatments for herpesviruses. The results were surprising; Dr. Lerner reported that about 30% of his patients had near or full recoveries, many others returned to normal functioning (ie they were able to work in a sedentary job full time) and about 25% did not respond. Treatment effectiveness was a function of illness duration (yes, it does matter, at least somewhat, how long you been ill) and treatment duration (when he says longterm he does mean longterm – probably at least a year for many patients). The paper also suggested that a significant number CFS patients also have another infection such as Lyme disease that need to be treated for that infection as well.
It's an exciting paper – we don't know what percent of patients these therapies apply to – and a rigorously controlled treatment trial is needed to fully assess their effectiveness – but this paper is very good news for CFS patients in a treatment arena that is often dominated by CBT/GET etc. It should spur more research and, hopefully, federally funded treatment trials.
And the article begins:
Learning CFS: Dr. Lerner on his Longterm Antiviral Treatment Study (05/10)
By Cort Johnson
Our clinic has treated hundreds of people who are now leading normal lives
Background: Dr. Lerner had quite a career before CFS. A check of his research record revealed over five decades of infectious disease work focusing on Coxsackie virus, herpes simplex virus, pseudomonas, interferon, Staphylococcus, Mycoplasma, enteroviruses, myocarditis, etc. A contributing author to one of the seminal works in the medical field – “Harrison’s Principal’s of Internal Medicine” – he’s published over 150 papers over the past fifty years.
In 1986 he began having troubles with dizziness and severe fatigue. A visit to the Cleveland Clinic found his heart was found to be grossly dilated. 10 years later he’d figured out how to treat himself recovered. In the meantime he did a 180 degree career turn and plunged, largely working alone, into wilderness of ME/CFS research. His first post-CFS paper in 1989 “A new continuing fatigue syndrome following mild viral illness” proposed that mild heart abnormalities involving T-waves in a group of post viral patients would be amplified greatly upon exercise and recommended that these patients not exercise vigorously. A 1993 paper cinched the T-wave problem and documented what he called a ‘subtle cardiac dysfunction’ that showed up response to normal everyday tasks. In a 1997 paper he proclaimed that “CFS is a persistent nonpermissive herpes virus infection of the heart”. A small 2001 study finding that antiviral therapy was indeed effective in CFS provided still more evidence for his theory.
In 2002 he documented a finding that would lay the foundation for his subsequent work – the presence of early gene products (for cytomegalovirus) in a subset of patients with CFS. 2002 would bring another successful small antiviral trial – this time using valacyclovir for 6 months in patients with Epstein-Barr virus infection. In 2004 he again documented the presence of early gene products in ME/CFS; this time to Epstein-Barr virus. He cemented his non-permissive infection hypothesis later that year when he demonstrated that abnormal heart wall motion and other problems were associated with incomplete replication of both viruses in CFS.
A 36 month followup of his patients in 2007 indicated further progress on all fronts; the heart problems continued to decline, antibody levels felland he reported that many patients resumed normal activities. A 2008 paper validated the effectiveness of his Energy Point Index Score in measuring fatigue in ME/CFS.
Now Dr. Lerner has published his largest and most comprehensive study to date. While Dr. Lerner is an acknowledged pioneer in the antiviral field on CFS his theory’s have yet to gain acceptance outside of the immediate CFS community. Attempts to gets grants – not a problem at all in his pre-CFS career – have failed. Will this paper finally translate into federal dollars for funding antiviral trials? Will it result in increased funding in this area? Only time will tell.
Did he regret turning his back on such a fertile career and journeying into the ‘desert’ of CFS research? With no funding publications came much less frequently post-CFS but Dr Lerner had no regrets at all saying ‘the work has been so fascinating that I just couldn’t stop”. He is clearly very excited about the possibilities present in the field.
The Study: Dr. Lerner’s study presents a culmination of his work with patients over the last ten years. This is not your typical 25 or 50 patient treatment trial. Virtually everyone he saw in his clinic over the past 10 years is in it. The study involved examining patient records every three months for the past 10 years – that’s ten years of replicated data. Ultimately it involved 7,000 patient visits that generated 35,000 fields of data.
While this is not the placebo controlled, double blinded treatment trial the research community loves it’s clearly dense with replicated data.
Findings: the paper presents some startling findings
The article continues with an extended interview with Dr Lerner.
The full article can be found here.
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