Learning CFS: Dr. Lerner on his Longterm Antiviral Treatment Study (05/10) by Cort Johnson

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

Dr. Martin Lerner CFS PhysicianBackground: 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 assocEBV in CFSiated 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

  1. Long term antiviral therapy was effective – very effective – in many of his patients. Many of them, while not completely cured, are able to work and lead normal lives again – an astounding finding in this field. Some are completely cured.
  2. About 25% did not respond- a finding that may be related to the limited duration of their treatment.
  3. While Dr. Lerner’s protocol can and often does work for longer duration patients – duration of illness does make a difference in treatment response
  4. About 30% of his patients had, in addition to herpesvirus infection, another related infections such as Lyme disease, Babesia or Streptococcyus. The fact that these patients improved but not to the extent of herpesvirus only patients has profound implications for how to treat both ME/CFS and Lyme disease and other infected patients.

Interview (any misrepresentations of Dr. Lerner’s thoughts are my own)

The CFS Community is a large and many people think a very varied one. I asked Dr. Lerner what percentage of patients that he saw fit into this herpesvirus/other pathogen infected subset?

Dr. Lerner replied that he thought about 90% of the patients that see him have this kind of pathogen involvement and that the reason the medical community doesn’t get it about the pathogen prevalence in ME/CFS is that they’re basically looking in the wrong place; if they start looking in the right place – that is, if they start looking for signs of ‘non-permissive infection’ he believes these results would show up in spades across the community.

In fact, Dr. Lerner believes that even he may be missing some significant pathogen involvement because we still don’t have a test for early gene products of HHV6. He noted that Dr. Kondo in Japan is trying to develop an antibody test for these. Once that test is developed it’s possible that the rate of HHV-6 infection in his cohort – which is quite low – could jump dramatically.

It’s possible, however, that Dr. Lerner’s reputation as an antiviral specialist has caused a more pathogenic subset of patients to make its way to him so it’s unclear at this point what percentage the CFS community it applies to. That fact demonstrates how desperately the CFS community needs studies that assess the prevalence of early herpesvirus gene products in CFS (as well as Borrelia, Babesia, etc). . Ironically, the one group that’s been in a position to do this – theCDC’s CFS research program in the Rickettsial and Viral Diseases branch, no less -has virtually ignored pathogens in CFS for over the past decade.

Interlude I: ‘A Non-Permissive Infection’

EBV and ME/CFSIn general a virus needs to do four things to spread an infection in the body.

  1. penetrate a cell
  2. use the cells machinery to build more viruses
  3. l eave the cell and move into the bloodstream
  4. find another cell it can infect and start the process all over again.

Problems with the second step of the process – using the cells machinery to create more viruses – are where non-permissive infections show up.

Once they’re inside a cell viruses create a series of gene products or building blocks that are then pieced together to form the complete virus . In a nonpermissive infection the building block process gets stopped leaving the cells littered with bits of viral gene products. Dr. Lerner believes the herpesviruses in people with ME/CFS are able to create about a quarter of the building blocks needed to produce a new virus. He believes these viral gene products interfere with cell metabolism, weakening it and eventually probably causing it to die.

Most viral tests look for antibodies to proteins found on the envelope of the virus. This makes sense in an normal infection because the immune system is usually interacting with the proteins on the outside surface the virus. But if the virus is pumping out hordes of early gene products such tests will miss any evidence of infection.

You must’ve had wide range of responses.The average patient basically went from being out of bed for 4-6 hours a day (ie being in bed from 18-20 hours a day) to been able to maintain a 40 hour work week as well as light housekeeping or social activities. That’s an amazing functional shift.Since responders were classified as anyone who shifted at least one level upwards on the EIPS this suggests that some people must have shifted all the way to nine or 10; not only are they able to work but they are completely well, able to exercise without relapse, etc. Is that true?

Oh absolutely. I’ve got people who are up to 8 or 9 or 10; fully recovered able to exerciseand participate fully in life. I have all kinds of people who are not as well but are living normal lives now, marrying when they couldn’t marry before, working when they couldn’t work before. It’s been extraordinarily satisfying.

This study demonstrated that people who’ve been ill longer are, indeed, more difficult to treat. Do you know what’s going on here? Are their antibody titers not going down – is it more difficult to knock out the virus or are they less likely to heal after the virus has been knocked down? If the antibody titers are not going down does this mean has made its way to parts of the body antivirals have trouble getting at?

Dr. Lerner said that ‘viral load’ is a critical point and he pointed to what he described as a wonderful study showing that total viral load does diminish over time with Valtrex. He stated that ‘viral load’ (the number of viral particles present in the body) may be a function of duration for some patients; ie the longer the patient has been ill the higher their viral load. As a rule of thumb if somebody has been ill for three years or less they generally begin to respond within six months of starting antiviral therapy. Other patients will take longer; at the Clinic they suggest that patients be treated for at least a year before they assess how effective treatment is.

This is not to say that people who have been ill for seven or 10 or 15 years do not respond to this treatment; Dr. Lerner said many long-duration patients do respond to this treatment – but as a group they don’t respond as quickly and, of course, some don’t respond at all. About 25% of his patients were classified as nonresponders.

Another significant finding was that the nonresponders didn’t take the drugs for as long as the responders which suggested that some people simply needed to be on the drugs longer for the treatment effects to show up.

Interlude II: the Necessity of Long Term Drug Therapy

EBV and CFSEBV replicates when the B cells it is found in divide – this is how it spreads from the original cell into the new cell. It reactivates - ie grows inside those cells – using an entirely different procedure.

The primary treatment for EBV (either acyclovir or valtrex) is able to stop EBV reactivation; that is it is able to reach into the cell and stop the process which EBV uses to grow in the cell. Neither are able to stop EBV from replicating when the B cells its infected divide.

This is a problem because patients with high viral loads have many, many of their B cells infected with EBV, each of which is potentially a little time bomb waiting to go off if their immune system gets suppressed again. This could result in the classic get better, relapse, get better, relapse scenario that occurs as their stop EBVreactivation then allow it to reactivate as their systems get overwhelmed. Each time EBV reactivates enough to spread outside the cell the patients viral load increases (Dr. Lerner believes the herpesvirus infections in CFS are a mixture of permissive/nonpermissive infections).

Even if they knock EBV reactivation down are these people doomed to carrying increasingly high loads of EBV? Not necessarily. Because B-cells die off over time EBV is always in a race to keep infecting new cells before the cells it is present in die off. This means that if Valtrex can keep EBV reactivation down then as the infected B-cells die off the number of EBV infected cells should slowly decline over time.

This is what Cohen found in the paper Dr. Lerner liked very much. The decline in infected cells after Valtrex administration was slow, however; after a year only a modest decline has occurred. This ‘modest decline’ could be why really long-termantiviral therapy is sometimes necessary. Cohen estimated that it would take6 years of Valtrex administration every day to eradicate EBV from the B-cells (and 11 years to eradicate it completely from the body). Higher doses would work more quickly. Fortunately it’s more important to reduce EBV activity than to completely eradicate it. Most healthy people are, after all, infected with EBV and most patients should not require such long term treatment.

(Some healthy people do in fact carry high loads of EBV without any problem. These people, however, are able to hold EBV in check; if Dr. Lerner is right many CFS patients cannot).

I wondered about side effects from such long term therapy?

Dr. Lerner said it’s important to be very careful with dosing but with an EBV infection it’s as simple as making sure that the patient is drinking enough water. With HMCV infection he has to be very careful with liver functioning tests since the antiviral can damage the liver but even so he’s had no really serious side effects.

One of the most significant findings was that unless physicians look for the full range of pathogens treatments for anyone pathogen may be not effective. About 30% of his patients had herpesviruses plus either Borrelia or Babesia and the patients with those infections simply did not thrive on a standard antivirals. Of course the same case can be made for Lyme patients; many patients undergo long antibiotic regimes but Dr. Lerner’s results suggest that if they have a herpes virus infection they most likely will not satisfactory results from antibiotic therapy. I asked him if he was surprised to see this subset popout. This finding could have profound implications for both sets of patients.

Dr. Lerner replied that he was ‘very, very surprised’ to see this pathogen+ group stick out. This was not a small subset of CFS patients – about 30% of his patients had ‘parasitic’ as well as ‘opportunistic’ infections. Most of these were Lyme disease (2/3rds Borrelia burgdorfii) with the rest either Babesia and/or Anaplasma (rickettsia) and/or streptococcal infections.These patients tended to be sicker (EIPS 3.1-4.0) and while after two and half years of treatment their EIPS scores were significantly improved (EIPS 5.3) they were still sick enough to be diagnosed with ME/CFS.

Dr. Lerner noted that the data is not so ‘bleak’ as it appears in the paper and that further directed treatment improved their outcomes considerably. Dr. Lerner’s assessment of the ‘bleakness’ of their treatment outcomes surprised me given their progress and surely reflected his high expectations; most physicians would be happy to see a jump from an EPIS score somewhere in the three’s (in bed about 20 hours a day) to the fives (performing with difficulty a sedentary job ). That kind of outcome is rarely seen in CFS treatment trials but Dr. Lerner clearly wanted to see more.

How did ‘parasitic’ infections show up in a disease mostly characterized by ‘opportunistic’ infections? Dr. Lerner could only speculate that the opportunistic infections had weakened the immune system enough to allow parasitic infections to gain entry.

The New Mantra - Data Mining, Data Mining, Data Mining – The ‘pathogen plus’ finding illustrated how important data mining is when you’re dealing with large amounts of data. The ability to tease out the herpesvirus plus patients had huge implications for the outcome of this study; if Dr. Lerner’s crew hadn’t statistically separated the pathogen plus group out the positive effects in the pure herpesvirus group would have partially disappeared. – This is a problem that presumably occurs in many studies. When you treat a ‘wastebasket disorder’ such as CFS as if it was a single disorder then the good responders are washed out by the non-responders which allows lower common denominator treatments like CBT (which would probably be somewhat effective in any chronic illness) to gain prominence.

In any case Dr. Lerner’s paper illustrates just how important ‘data mining’ is in uncovering patterns in complex, poorly characterized diseases like chronic fatigue syndrome and he’s fortunate to have a dedicated crew of volunteers with the skills necessary to do this kind of work. Providing Dr. Bateman with the tools to better mine her data was one reason the Phoenix Rising Fundraiser for the Fatigue Consultation Clinic took place.

It’s not surprising therefore that data mining plays such a key role in large data-rich enterprises such as the CFIDS Associations creation of its BioBank and DataBank and Research Network. Several of the CFIDs Associations current research projects use innovative techniques to mine large amounts data from multiple systems in order to find patterns that explain. Both the CFIDS Association and Whittemore Peterson Institute’s Biobanks should provide researchersopportunities to examine patient samples for factors like Dr Lerner has found.

What about when the responders go off the anti-retrovirals? They seem, on average, to be able to hold a job but exercise still seems to be problematic for many of them. Are they able to maintain their health off the antivirals? At some point do they need to do another round of antivirals? What is their prognosis post viral treatment?

Dr. Lerner stated that when his patients get well they tend to stay well. About 30% of them get up to eight or nine on the EIPS Scale and stay there. There’s another group there needs some ongoing viral suppression. He noted that he was on Valtrex for six years and is now off them entirely.

The Heart of It All?

“CFS is a persistent nonpermissive herpesvirus infection of the heart”

The heart infection Dr. Lerner proposes is present is unusual; in most heart infections the heart is grossly inflamed when dying cells explode into the bloodstream where their fragments attract hordes of immune cells that then touch off the inflammation seen in myocarditis or a typical heart infection.

heart, EBV and CFSIn the nonpermissive infection Dr. Lerner envisions incomplete herpesvirus gene products disturbing heart cell functioning. Many of the infected cells probably do die off when the cell, recognizing that it’s been irrevocably damaged, flips on its suicide program but they do so at a rate that leaves them largely hidden from the immune system and inflammation is low.

The heart replaces these cells with fibrous tissue – which means the damage is permanent. Stopping the infection, however, stops the slide to further damage to the heart and substantial recovery can occur – as evidenced by the improvement on the heart tests Dr. Lerner regularly gives.Patients may or may not fully recover their full extent of physical function – but after a point its not clear how much it matters.Dr. Lerner pointed to himself as an example; after 10 years of illness he probably sustained some permanent damage but it’s hard now to tell where; not many 80+ year olds are running a full-time medical practice, regularly traveling to international conferences, etc.

How do EBV and HCMV get carried to the heart when they’re present in a nonpermissive infection; ie if the herpesviruses are unable to create copies of themselves how are they getting out of the B cells and into the heart cells? In this paper Dr. Lerner stated that he believes that parts of the infection are permissive and that low levels of complete herpesvirus particles that are intermittently being carried to the heart; thus producing a smoldering infection that burns at a low heat.

What percentage of your patients have orthostatic intolerance (problems standing)? Does that clear up as well and if so do you have any idea what herpesviruses are doing to cause that problem? How about low blood volume?

Orthostatic intolerance(OI) – was a key symptom for Dr. Lerner when he became ill as it is for many ME/CFS patients. Some ME/CFS researchers think the autonomic nervous system plays the key role in OI but Dr. Lerner’s focus is on the heart. Over the years he’s documented several heart problems in his patients including aberrant Holter Monitor tests and abnormal cardiac wall motion findings.He believes that a heart weakened by these unusual infections beats more rapidly (the tachycardia in POTS) and ineffectively and this causes many of the problems many CFS patients have in standing up.

He noted that these problems to clear up in the patients who respond to antiviral treatments. He starts patients with these problem but these problems on fludrocortisone acetate, atenolol and/or digoxin – each of which was able to be discontinued as the EIPS values rose.

Low blood volume – Dr. Lerner believes the low blood volume found in ME/CFS patients is an extraordinarily interesting finding but exactly what’s causing it is unclear. He did note that it could be protective in nature as it’s easier for the heart to function if there’s less pressure.

I wondered about other markers? There are lots of interesting immune and endocrine findings in CFS. Where any of these correlated with drops in antibody levels? Can Dr. Lerner see, for instance, the immune system or endocrine system readjusting itself?

Dr. Lerner acknowledged the importance of immune dysfunction in CFS but said he is not following any other immune markers in the illness and this makes sense. He is, after all, primarily a doctor treating his patients – most of whom have to pay for an expensive and long-term treatment regime (@$1,000/month) out of pocket. Without federal funding it’s hard to see how any physician can regularly collect nonessential data. Certainly one would think that immune functioning would be a part of any federally funded pathogen study

The current crop of drugs went a long way but they didn’t work for some people, are expensive and require long treatment regimes; there’s still much work to be done on the antiviral front. I asked Dr. Lerner if he saw promise in any new or upcoming drugs?

He reported that Vistide(brand name)/Cidofiovir (generic) – was effective against HCMV but that he uses it only for the patients who have not responded to the standard protocol after at least 1 year because it can affect the kidneys.

He felt Marabavir is an interesting drug on the horizon. It still needs to be tested further but initial in vitro testing indicated it was effective against both HCMV and EBV and its safety profile looks very promising (which means that it may be able to be given in larger doses. Many drugs are a trade-off between side effects and effectiveness. If given in large enough quantities many drugs can kill off pathogens; the problem is that they can kill if the patient as well. Any ideal drug would be a drug safe enough to be able to give it in large enough quantities to quickly kill off the pathogens without harming the patient.)

Dig Deeper! Discuss the Paper Here

Dig Deeper! Valtrex in ME/CFS

Dig Deeper! The Lerner Antiviral Treatment Paper

Dig Deeper: A Four Part Series on EBV In ME/CFS

Future Work; I didn’t specifically ask Dr. Lerner about his future work but it’s clear that he’s very excited about the progress being made in the field and he’s actively pursuing his ideas. He said he plans to submit studies that will help to solidify the idea that ‘non-permissive’ viruses play a key role in ME/CFS (or as he says it ‘the chronic fatigue syndrome’).He hopes that a multi-center treatment trial will be done

The Martin Lerner Foundation - before the interview got started Dr. Lerner first acknowledged the people who created the Martin Lerner Foundation for the study of Chronic Fatigue Syndrome. It’s absolutely accurate to say that this paper would not have been created without their help. He first acknowledged Kim and Carol Gill, whom, if my notes are correct, created the Foundation in order to promote Dr. Lerner’s work. They and Jim Eddington spent a year and a half in the office developing the study. James Fitgerald at the Department of Medical Education at the University of Michigan Medical School did the statistics. Safadin Beqaj assisted in the creation of the paper . Ann Cavanaugh, the volunteer Communications Director for the Center (another CFS patient), was my liason.

In the end Dr. Lerner saw and treated his patients while a group of skilled volunteers snatched up his data, inputted it and then analyzed it and, in the end, presented it to him and that’s how this paper came about. He was very gratified by their work as should we all be.

Conclusion: This is not the paper that will cause the traditional medical community to turn its standard treatment approach to CFS on its head but it hopefully is the paper that will spur the creation of federally funded treatment trials and more research into the effects herpesvirus have on ME/CFS. This study cries out to put Dr. Lerner’s protocol to the test with double blinded, placebo-controlled, multicenter treatment trials and it is Dr. Lerner’s hope that is just what will happen.

Pamela Stites October 21, 2012 at 2:38 am

I hope Dr Lerner gets this.. I have been ill for 2 years with no explanation as why, except suspected CFS… I became so ill in the last year, I thought I was slowly dying. My Dr was taking shots in the dark running all kinds of different blood work, one of the tests she finally ran was testing me for Epstien Barr, it came back positive with high numbers !! She sent me to an immunologist who did nothing except say I just had to live with it, I thought she was wrong. I found out that EBV is the same virus that causes herpies, I know some people with herpies who take Valtrex, I asked my immunologist if Valtrex may work to lower the viral load in my body. She said no. She would not say anymore about it, except that there is no proven studies that show Valtrex would work on EBV. I then saw an infectious diease Dr who said basicly the same thing. I was very frustrated and almost ready to give up all hope. I then asked my PCP, if she would be willing to give it a try, she said yes since I was so ill, what could it hurt to just try it. I started out on 500mg 3 times per day, finished that bottle, and asked if I could remain on a low dose of 500mg per day once a day, after 4 months I began to feel better, I’m not cured, but the relief from being so ill everyday is remarkable !! I still struggle with some fatiuge, and a few other things, but I am no longer in the grip of being so ill I could not hardly get out of bed, I have horrible back pain, which I’m trying to find help for, it can keep me down from time to time, but I do my best to push through the everyday pain, and am able now to get up and move, because I am not so very sick as I was before I started taking the Valtrex. Then I came across Dr Lerners study and this website, where he was treating people like myself with Valtrex and having success at it !!! I was so excited !!! Just to know there was a Dr who had already been treating people with EBV with Valtrex !! My Dr nor I know if I am on the correct dose for everyday use, but the 500mg seems to be working very well !!! I have allot of health issues, at least I can say from taking the Valtrex, I have found such great relief from an long time illness that had taken all my quality of life away, now I have it back, and something to hope for, that I have a weapon to use that may keep me from ever being that sick with EBV and CFS again. Thank You Dr Lerner !! I am glad to know I was on the right track, and then found this website and all the information in it so helpful so I am trying to get a better understanding of all of it. I know so many who are suffering with EBV, CFS, and other things that Valtrex could be a help to them as it was to me, but their Drs will not prescribe the Valtrex !!! I do not understand this !!! If it can help why not try ?? I thinks it’s a tragedy that Drs are not willing to try Valtrex for EBV, CFS etc.. I wish I could speak to you, or get in touch with you, and somehow maybe change this !! I know from reading as with any medication Valtrex used long term can have side effects and complications, but so far I’ve had none, I plan to have kindney, and Liver function tests done about every three months, and complete blood work up in 2 more months to see if the numbers that were so high when I had my EBV test done have lowered, I suspect that it will show they have. Anyway, I just wanted to share this with you… Thank You, I wasn’t wrong, and it’s working, keep up the work, and maybe one day Drs will use Valtrex for a treatment with people suffering from EBV, and at least give them some relief, maybe even stop all the symptoms, so people like myself can have hope again, and a much better quality of life… Truly Pamela Stites

Belle December 15, 2012 at 10:19 pm

So much of what I scratch down on paper stays hdiden within the pages of my journals, becomes buried in early drafts, or gets lost in multiple files of stories. There’s becoming lost and hdiden and discarded and there’s refining. Everyday before I get to writing in earnest I sit at my scratch pad, a heavy document of misspellings and frantic passion, and write my frustrations through, ask myself questions about the story I’m working on, and talk to myself on the screen. It gets deleted eventually, but my stories wouldn’t exist at all if it weren’t for the chaff. I agree with Pam, for regular life is our most valuable tool. And I’m so glad to have your views of the world, Christi. XO

Anonymous K December 16, 2012 at 6:06 pm

I had become very ill in October 2000. I am a female and was 51 years old at the time. I went to an ENT doctor because my I had very bad pain throughout my body and especially in my ears.
Fatigue and pain consumed me. The ENT doctor advised me to see Dr. Lerner which I did in February 2001. I was given many blood tests and Dr. Lerner advised me I had the epstein-barr virus. At my initial visit I had told him I thought I had lyme disease, but that turned out to be negative. In late spring of 2001 I began to take 1 gram of valtrex four times a day. I had some better days , but mostly bad days for a long time. It was very hard to function on a daily basis with the fatigue and dizziness. However, I continued to take the valtrex which provided some relief and hope for me. Slowly over several months I could participate in life a little better. Then in September of 2003 a lyme test showed up positive and I was treated for it for six weeks with an antibiotic intravenously. At this time I had stopped taking the valtrex. After six weeks I took oral antibiotics and was feeling okay. After several months it was necessary to begin taking the valtrex again. After years of antibiotics and valtrex and never giving up hope or in believing that Dr. Lerner would help me I am now functioning very well at an 8.5 energy level. Along the way it was necessary to start taking 4000 IU of vitamin D because of a low level which has helped bring up my energy level as well. It has been a long journey over the past eleven years, but for the past six years I have enjoyed a sense of well-being and more energy due to the diligence of Dr. A. Martin Lerner and his protocol for the treatment of EBV using valtrex.

anonymous December 17, 2012 at 5:29 pm

I was a 51 year old female in 2001 when I was referred to Dr. Lerner by an ENT doctor whom I had seen regarding severe ear pain. My body was in pain from head to toe as well. I was concerned I had lyme disease, but at the time that test was negative. However, the blood tests revealed I had EBV. Dr. Lerner began treating me with Valtrex in the spring of 2001 with a dosage of a 1000 gram tablet four times a day. After several months I began to feel a little better. In the fall of 2003 I tested positive for lyme disease and began a six week course of intavenous antibiotics. After the treatment I began to feel better. I was no longer taking Valtrex, but after several months found that I needed to start taking Valtrex again because of persistent fatigue and dizziness. I also began taking 4000 IU of vitamin D daily. It has
been a difficult journey, but because of Dr. Lerner’s diligence and commitment in helping me regain a quality of life, I now have a sense of well-being and much more energy since 2006. My energy score was five in 2001, but it is now 8.5.

Stephanie Roth December 20, 2012 at 1:01 pm

Cort. Did I miss it or was there no mention of Valcyte? When I was Dr. Lerner’s patient he had me on high doses of Valcyte in addition to the Valtrex (for me it was famvir since my stomach could not tolerate valtrex). I ended up with some very bad complications from the Valcyte – lost a good bit of my hair, gums receded with subsequent need for a lot of dental work & 30% bone lose during this time (verified by dexa scan). I am still on famvir 500mg 2x day and have some good days but mostly bad days. Overall I am improved but, I went thru this some years ago and had a total remission for 5 years so I it hard to tell what helps and would be normal progression for me.

Kat March 23, 2013 at 7:06 pm

I got sick on March 15,1987 and did not get better until this March, 2013. My family doctor recommended me to Dr. A Martin Lerner in Beverly Hills, Michigan. I had tried many medications, therapy and treatments with no success. I started on Dr. Lerner’s scale at a 4 and I am now close to a 10. Dr. Lerner is slowly reducing my medication of Valcyte and seeing if my body will be able to fight this debilitating illness. When I first got ill, all of my body functions went wrong – heart, digestion, of course FATIGUE, shooting pains, body shakes, eyesight, fibroids throughout my body, memory problems, swelling, temperature extremes, etc., nothing worked correctly. I really did not think what Dr. Lerner had to offer would work. BUT, first he did not tell me that I was doing something wrong OR it was all in my head (I’m a woman you know.) I did get far worse before I started getting better. Dr. Lerner tried other medications with no success, making sure I was safe to use this powerful drug at all times. I followed his instructions,take vitamins daily, eat a well balanced diet and drink plenty of water daily. I am retiring this year and feel like I did when I wasn’t sick. I’m not a 10 yet but I am very close. My EB count was over 480 when a doctor decided to run it. My last count was 20. I truly believe this stuff is a virus and antivirals do help. I am a teacher and have my Masters. However there was a time I could not tell you my phone number or my address. My memory seems to be the last thing to get back BUT I am soooo much better thanks to many prayers and Dr. A Martin Lerner.

AD1210 September 10, 2013 at 7:14 am

I am on Dr. Lerner’s protocol for the second time. The first time was ten years ago when I was newly married and eager to start my life. I believe I stopped sooner than I should have and that that allowed the EBV to replicate once again. I have the awful consequence of moderate to severe panic/depression and severe insomnia. Has anyone here experienced any significant mood issues? If so, did they abate as the virus(es) went into remission? I am afraid right now and I know that everyone around me is extremely concerned.


Kat September 23, 2013 at 6:27 pm

I experienced severe panic/depression because I was sick. My life was, as I saw it, gone. Doctors wanted to put me on antidepressants. I tried many but quit because they were just making me lethargic. All the things that gave me pleasure were taken away by the CFIDS/EBV. I was better off without the antidepressants. The severe insomnia was also a symptom when I was sick. The nightmares were horrible! My mind wouldn’t shut off. As I got better the insomnia got better. I can sleep soundly for 4 to 5 hours in one stretch and my dreams are the ones I had before I got sick. I can also sleep for thru entire night. No nightmares! I am afraid also for my family. How is this disease spread? My husband is not affected. I do not give blood and am very careful not to share any food with anyone. Dr. Lerner’s program works. I too quit too soon but am still recovering. I pray the same for you.

Marie January 16, 2015 at 1:11 am

“how is this spread” This is what i want to know as well… i JUST got the results yesterday that this is whats going on with me, and what has been going on with me for 28 years… yes TWENTY EIGHT YEARS ive been dealing with this… at various times during that period i coul;d be anywhere from completely debilitated, totally bedridden, to almost normal, high functioning, though never as high as before my illness.. my initial bout with mono lasted more than 9 months, though my viral load never went down very low, they just stopped testing once it was appearing to be on a down trend… so finally, after all these years, a young, not set in his ways doctor, Dr. Suzelis, must have seen this research and tested me… my viral load on several of the EBV tests is listed simply as >600. I guess 600 is as high as this lab tests? I dont know, i just know thats what it said on my lovely computerized results… no input from my doc since he was and still is on a mission trip out of the country, but wanted me started on my anti virals and to know i wasnt crazy so bad that he had me called rather than wait till he was back in the country. im not sure what to think or feel, i want to laugh and cry at the same time because FINALLY here is something concrete. Here is something we can TREAT. Im not crazy, im not lazy, im not anything but SICK! and i can get BETTER!!!! But i have a husband and four children, and my husband has been having a lot of trouble with fatigue over the years as has my oldest son…. have i given them this???? i have a brand new grandson, should i stay away from him???? I had to find this info on my own and im concerned, i know its been a long time and part of me says if it could be spread people would be dropping like flies around me, but the grandson is a preemie and that scares me. I wont go near him till someone says this is non communicable. I dont think im processing this all the way yet, but im working on it. Bad thing is all the people it pops into my head to tell are dead. My mom and dad, my grandparents, everyone who either supported me or mocked me is gone. At least i have the family i made myself :) I am truly blessed. Thank God for my doctor.. weird thing is we were at our wits end with this.. and before i left after my last appointment.. he asked to pray with me. And we did. And now we have an answer, and a treatment. God is good.

Kris October 19, 2013 at 8:03 pm

My son will be 25 in November and has been seeing Dr Lerner for almost 5 years.

He suddenly became very ill in the fall before his 13th birthday with many of the same symptoms mentioned above; he saw 2 ENTs and a neurotologist associated with Henry Ford and was diagnosed with both tinnitus and hyperacusis, which lasted for several months. As they improved, the pain (which was always there) became worse, and he was wheelchair bound for a while and was physically debilitated.

Over the course of his illness, we have seen many physicians, most of whom either didn’t know how to help, or thought he had a psychological disorder, including his original primary care doctor. Those were very black years. Imagine the swirl of confusion and other emotions for an elementary school kid! He missed two years of school, then was able to start back/finish 8th grade, but relapsed halfway through his freshman year of high school and was back to square one.

After doing much reading on our own and finding a stronger trail pointing to the viral connection, we finally found an expert in our own state—Dr Lerner, who diagnosed him with a chronic HHV6 infection and no co-infections, thank the Lord.

After giving our son the most thorough physical he has ever had, Dr Lerner started treatment with Valcyte, which our son tolerated well for many months; he was then progressed to Valtrex, which he is still taking. From the beginning, we understood that recovery would be a slow process, and it was difficult for a teenager to rest and avoid all activity, but he stuck with the program. When cleared by Dr Lerner for increasing levels of activity, he was able to gradually start martial arts for his ‘physical therapy’ and he is still attending 3xweek.

His cognition cleared up more slowly, but last fall he started his GED, finished it this spring, and is now taking 2 classes at the local community college. He has been more tired lately due to the adjustment and the many different demands after he missing essentially all of high school, but he continues to progress.

Words cannot expresss how grateful we are to Dr Lerner, his staff and benefactors for giving our son a life worth living.

shirley December 8, 2013 at 8:43 pm

If you live in another part of the country how does Dr. Lerner treat the patient. How often does the patient have to be seen.

Marilynne March 6, 2014 at 3:58 pm

I am currently in treatment with Dr. Lerner. I travel from Louisville, KY every 2 weeks for anti-viral treatment. I am a 2 on Dr. Lerner’s scale. I tested positive for Herpes 5 and 6. I will keep you posted as to my progress.

Gayle June 15, 2015 at 8:23 am

I live in Kentucky and am very interested in speaking with you. Would you contact me via email?

Becky March 27, 2014 at 12:42 pm

I was diagnosed in late 2008. Just came across Dr. Lerner’s info. I live in Ohio so it’s not far. I read it can be $1000/ mo. for treatment out of pocket. Is anyone being treted that has insurance that covers it. If not what are the options? I am concerned about permanent heart damage so would rather not wait. Also my Dad’s wife has had it for 30 years.

Allison April 9, 2014 at 8:20 am

I’ve been seeing Dr Lerner for 5 months, on Valtrex (1 gm 4x/day) for 3 mo & Valcyte (450 mg x 2 pills two times a day) a week. He’s been requiring me to go every 4-6 weeks, which I have to fly to do. My insurance is covering him as an “out of network” physician. The Valtrex is cheap, since there’s a generic I can use (Valtrex is for my EBV infection). Valcyte is very expensive – pharmacist said it is $9000 before insurance for a one month supply (Valcyte is for my HHV-6 infection that’s causing tremors and weakness in my hands). My insurance has an out-of-pocket maximum for the meds, which is the only way I can afford it.

Dr Lerner also has an IV med protocol that requires visits every 2 wks for 3 months, which he’s found works faster, but we couldn’t afford that many trips to see him. He told us that for my infections, either approach would work (IV or oral anti-virals), it was just a matter of how quickly.

I’ve not had any changes yet (I’m about at a 2.5 on his scale), which is exactly what he expects – it’s supposed to be 6-9 months before I notice change. It’s a gamble, and we’re very lucky to have been able to find the $ to try this so far.

Best wishes!

James June 12, 2014 at 5:12 pm

Am still undergoing treatment from Dr Lerner. What a blessing to find him as went through ten doctors who had no clue what the cause was. They would try to treat the symptoms with little improvement. It took a long time for things to get better so hang in there. Have a co-infection so things will take longer but started at a EES of 2 and now up to an 8 so if you have CFS I highly recommend that you give him a try. Not inexpensive as but well worth it.

Rachna January 12, 2015 at 11:29 am

I was admitted for acute follicular tonsilitis in Mar 2014 and administered with antibiotics and antifungal medicines. after 2 weeks of treatment that didn’t resolve anything I was discharged as so much medication wasn’t helping. the infection ate away my left tonsil leaving a gap in my throat and necrosed 75% of the other. a biopsy was done and blood test showed EBV antibody presence( India doesn’t have titre values) .I culdnt eat, breathe or talk as the condition was very painful and I had fever which came with chills. Over time the throat healed automatically for 2 months and relapsed again in Dec 2014. The 25% tonsil got infected again and has now covered the entire throat wall on that side with a white exude. fever and chills with muscle pain is back for last 6 weeks and getting worse. was given a 7 day antibiotic course and a steroid course with wyslone 10 mg thrice a day for a week but no improvement. Today noticed some hard lumps/boils that are painful on my lower limbs. The fever pain stays and pain killers becoming inaeffective. Can you please help me with what to do next. The doctors here are at a loss currently

Paulette April 10, 2015 at 6:52 pm

I too owe so much to Dr Lerner. Three years after a bout of Ross River Virus (a mosquitio-born virus here in Australia that leaves many people with CFS) from which I recovered, but which affected my immune system so that I get RRV symptoms whenever I get a cold or flu, I contracted a herpes virus. My family dr gave me antivirals to treat it, which I did for a week or so. At this time I began to feel ill all the time. I ached all over and could barely get the will to get out of bed. After 2 1/2 years of dragging myself around I finally stumbled upon Dr Lerner’s work. I finally put two and two together, realising that the CFS started when I got the herpes virus, and in my mind the impact of my messed up immune response was triggered 24/7 by this virus that does not go away. I searched for anyone in Australia doing similar work to Dr Lerner. There is no one at this stage. So very sick of ineffective specialists I still had the antivirals in the cupboard and felt that I had nothing to loose by trying it myself. I took 500mg of Valtex twice a day, and to my amazement within three days I felt closer to normal than I had for the preceding 2 1/2 years. I took Dr Lerner’s papers to my GP and ran it past her. She sent me off to an infectious diseases specialist who said that the treatment was not mainstream and he could not support me in this. Thoroughly dejected I stopped taking the antivirals. Within 2 days I was back to my worst. So, I went back to my doctor and begged her to help me. She is. Because I had been diagnosed with herpes I am eligible for one prescription of Valtrex subsidised, so only pay the full price for half of the 1000mg/day. Over one year later, still feeling amazing. I trialled halving the dose a few months ago, but began feeling it come back, so back to 1000mg. I emailed Dr Lerner to thank him. I may not be taking a high enough dose of the antiviral to rid it from my system, no one here can help me with that issue and I can’t afford to up my dose, but I do know that I have my life back doing what I am doing. Slipping into the world of CFS was a nightmare and to all of you who are suffering through it every day, being told that it is in your head, being put on antidepressants, feeling lazy and useless, being told it is associated with menopause, being told that you just need to live with it – I feel your pain, and I wish you well, literally.

JR stockert May 27, 2015 at 8:24 pm

he would like to talk to Pamela stites about Valtrex my cell number is 605 490 9470 I live in north Dakota have cfs with high ebv need encouragement thanks JR or anyone else that could talk would be fine thanks JR

Comments on this entry are closed.