FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 319:1692-1698 December 29, 1988 Number 26 Next

	Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

Abstract

Twenty-seven adults with a diagnosis of the chronic fatigue syndrome were enrolled in a double-blind, placebo-controlled study of acyclovir therapy. The patients had had debilitating fatigue for an average of 6.8 years, accompanied by persisting antibodies to Epstein-Barr virus early antigens (titers greater than or equal to 1:40) or undetectable levels of antibodies to Epstein-Barr virus nuclear antigens (titers less than 1:2) or both. Each course of treatment consisted of intravenous placebo or acyclovir (500 mg per square meter of body-surface area) administered every eight hours for seven days. The same drug was then given orally for 30 days (acyclovir, 800 mg four times daily). There were six-week observation periods before, between, and after the treatments. Three patients had acyclovir-induced nephrotoxicity and were withdrawn from the study. Of the 24 patients who completed the trial, similar numbers improved with acyclovir therapy and with placebo (11 and 10, respectively). Neither acyclovir treatment nor clinical improvement correlated with alterations in laboratory findings, including titers of antibody to Epstein-Barr virus or levels of circulating immune complexes or of leukocyte 2',5'-oligoadenylate synthetase. Subjective improvement correlated with various measures of mood. We conclude that acyclovir, as used in this study, does not ameliorate the chronic fatigue syndrome. We believe that the clinical improvement observed in most patients reflected either spontaneous remission of the syndrome or a placebo effect.

Source Information

Medical Virology Section, National Institute of Allergy and Infectious Diseases, Bethesda, Md 20892.

This article has been cited by other articles:

• Chambers, D., Bagnall, A.-M., Hempel, S., Forbes, C. (2006). Interventions for the treatment, management and rehabilitation of patients with chronic fatigue syndrome/myalgic encephalomyelitis: an updated systematic review.. JRSM 99: 506-520 [Abstract] [Full Text]  
• Cho, H. J., Hotopf, M., Wessely, S. (2005). The Placebo Response in the Treatment of Chronic Fatigue Syndrome: A Systematic Review and Meta-Analysis. Psychosom. Med. 67: 301-313 [Abstract] [Full Text]  
• Viner, R, Gregorowski, A, Wine, C, Bladen, M, Fisher, D, Miller, M, El Neil, S (2004). Outpatient rehabilitative treatment of chronic fatigue syndrome (CFS/ME). Arch. Dis. Child. 89: 615-619 [Abstract] [Full Text]  
• Afari, N., Buchwald, D. (2003). Chronic Fatigue Syndrome: A Review. Am. J. Psychiatry 160: 221-236 [Abstract] [Full Text]  
• Bagnall, A-M, Whiting, P, Richardson, R, Sowden, A J (2002). Interventions for the treatment and management of chronic fatigue syndrome/myalgic encephalomyelitis. Qual Saf Health Care 11: 284-288 [Abstract] [Full Text]  
• Spiegel, D., Kraemer, H., Carlson, R. W., McDonald, C. J., Miller, F. G., Kaptchuk, T. J., Einarson, T. E., Hemels, M., Stolk, P., Lilford, R. J., Braunholtz, D. A., Kupers, R., Shrier, I., DiNubile, M. J., Beldoch, M., Hrobjartsson, A., Gotzsche, P. C. (2001). Is the Placebo Powerless?. NEJM 345: 1276-1279 [Full Text]  
• Whiting, P., Bagnall, A.-M., Sowden, A. J., Cornell, J. E., Mulrow, C. D., Ramirez, G. (2001). Interventions for the Treatment and Management of Chronic Fatigue Syndrome: A Systematic Review. JAMA 286: 1360-1368 [Abstract] [Full Text]  
• Rowe, P. C., Calkins, H., DeBusk, K., McKenzie, R., Anand, R., Sharma, G., Cuccherini, B. A., Soto, N., Hohman, P., Snader, S., Lucas, K. E., Wolff, M., Straus, S. E. (2001). Fludrocortisone Acetate to Treat Neurally Mediated Hypotension in Chronic Fatigue Syndrome: A Randomized Controlled Trial. JAMA 285: 52-59 [Abstract] [Full Text]  
• Wright, J B, Beverley, D W (1998). Chronic fatigue syndrome. Arch. Dis. Child. 79: 368-374 [Full Text]  
• McKenzie, R., O'Fallon, A., Dale, J., Demitrack, M., Sharma, G., Deloria, M., Garcia-Borreguero, D., Blackwelder, W., Straus, S. E. (1998). Low-Dose Hydrocortisone for Treatment of Chronic Fatigue Syndrome: A Randomized Controlled Trial. JAMA 280: 1061-1066 [Abstract] [Full Text]  
• Peterson, P. K., Pheley, A., Schroeppel, J., Schenck, C., Marshall, P., Kind, A., Haugland, J. M., Lambrecht, L. J., Swan, S., Goldsmith, S. (1998). A Preliminary Placebo-Controlled Crossover Trial of Fludrocortisone for Chronic Fatigue Syndrome. Arch Intern Med 158: 908-914 [Abstract] [Full Text]  
• Bou-Holaigah, I., Rowe, P. C., Kan, J., Calkins, H. (1995). The Relationship Between Neurally Mediated Hypotension and the Chronic Fatigue Syndrome. JAMA 274: 961-967 [Abstract]  
• Feder, H. M. Jr, Dworkin, P. H., Orkin, C. (1994). Outcome of 48 Pediatric Patients With Chronic Fatigue: A Clinical Experience. Arch Fam Med 3: 1049-1055 [Abstract]  
• Wachsmuth, J.R., MacMillan, H. L. (1991). Effective Treatment for an Adolescent with Chronic Fatigue Syndrome. CLIN PEDIATR 30: 488-490  
• Gold, D., Bowden, R., Sixbey, J., Riggs, R., Katon, W. J., Ashley, R., Obrigewitch, R., Corey, L. (1990). Chronic Fatigue: A Prospective Clinical and Virologic Study. JAMA 264: 48-53 [Abstract]  
• Kaslow, J. E., Rucker, L., Onishi, R. (1989). Liver Extract-Folic Acid-Cyanocobalamin vs Placebo for Chronic Fatigue Syndrome. Arch Intern Med 149: 2501-2503 [Abstract]  
• (1989). ACYCLOVIR INEFFECTIVE IN THE CHRONIC FATIGUE SYNDROME. JWatch General 1989: 6-6 [Full Text]