Monday, December 20, 2010

XMRV Treatment Trials for CFS are Now Justified

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Special Edition







THE NICEGUIDELINES BLOG



Doctor Speedy and ME in search of medical honesty




Sunday, December 19, 2010





XMRV treatment
Trials for CFS are
now justified



Valerie Courgnauda, Jean-Luc Battinia,
Marc Sitbona,1, and Andrew L. Masonb,1


aInstitut de Génétique Moléculaire de Montpellier,
Centre National de la Recherche Scientifique, Unité
Mixte de Recherche 5535, Universite Montpellier 1
and 2, F-34293 Montpellier Cedex 5, France; and
bDepartment of Medicine, University of Alberta,
Edmonton, AB, Canada T6G 2E1




As we currently lack postulates to prove a causal
association with a prevalent agent and a chronic
disease with genetic predisposition, it would also be
appropriate to conduct interventional studies.


Indeed, the Helicobacter pylori hypothesis of peptic
ulcer disease was only accepted after Barry Marshall
showed that bacterial eradication with antibiotics
cured peptic ulcer disease


(21). Studies to gain proof of principle have been
performed with antivirals in other chronic, idiopathic
diseases linked to retroviral infection, such as
primary biliary cirrhosis associated with mouse
mammary tumor virus, another possible murine
zoonosis (22).


Trials using a combination of reverse transcriptase
inhibitors led to significant improvements in clinical,
histological, and biochemical outcomes in these
patients, albeit with some evidence of viral
resistance to therapy (23).


Such studies are now feasible for CFS, because
reverse-transcriptase inhibitors, such as tenofovir
and emtracitabine, and the integrase inhibitor
raltegravir can inhibit XMRV (24).


The caveats for conducting clinical trials in patients
with CFS and MLV infection are that the potential
benefits of treatment should outweigh the risks;
also, studies should be conducted as randomized
controlled trials with meaningful and feasible
endpoints using robust therapies.


At this juncture, studies to establish proof of
principle are justified to determine whether safe
antiviral regimens can impact on CFS and to
determine whether xenotropic or polytropic MLV is
causally associated with this debilitating disease.





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The full PDF file:

Mouse retroviruses and chronic fatigue syndrome:
Does X (or P) mark the spot?

is attached for private members, but can also be
found at: http://bit.ly/hHspa8

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