Antiviral Therapy 101

At the request of several people, I’m going to give an overview of antiviral therapy as I understand it. I’m not a doctor. This is all based on my own research, helpful people and learning from doctors that are in the know on viruses. I’m doing this so you may talk to your own doctor about it and discuss how you would choose to proceed. And selfishly, I’m also doing this so I don’t have to answer the same questions over and over.


Feel free to print it out and take it with you if you need a guide for your discussion. Also, leave any questions you have in the comments and I will try to clarify any areas of confusion. The more questions you ask, the better I can make this post.  It’s quite a long post and I considered breaking it up into parts. I decided against it.

Now on to the therapy.

The first question I get is: “How do I know if I have a viral kid?” The answer to that isn’t cut and dry. In my son, he got random fevers with no other symptoms; he was always sick, though, when he didn’t have random fevers. For the first year of life, he was in the peds office every month. By the time the year was over, I had quit taking him to the ped because the answer was always the same: it’s just a cold. He was constantly battling bronchitis, although I must say, we never got antibiotics for it because it was always explained away through the cold.  That was, at least, one positive that came of it.  He also had roseola, which is common in children. It starts as a fever for a day or two, followed by a rash and no fever. It is a herpes virus, HHV6, which is in the family of viruses that antiviral therapy usually targets. If your child has had EBV, CMV or chicken pox, you might want to consider antivirals as a possible avenue.

On the flip side, kids that never get sick.  Kids should get sick. That’s part of how the immune system works and grow.  If your child hardly ever gets sick and you can count on one hand how many times it has happened, then that’s a pretty strong indication that there is immune dysfunction.

Frequent cold sores/canker (or if you prefer the ancient spelling, chancre) sores.

Random rashes.

Visual stims.

History of miscarriage (for the mom, of course).  You’d be amazed at how many miscarriages are immune related.

There are a few other signs that I can’t remember off the top of my head right now as I write this but I will add them as I remember.  Right now, I’m just trying to get this in ink (pixels?).

“What about tests?” you ask.  There is no reliable test.  You should definitely pull titers, though.  You should pull HHV1-6.  This will not get you a 100% answer (let’s be honest, how often do we get that anyway?) unless it comes up high.  Most mainstream doctors will tell you that these are pointless because it just means they have been exposed.  Yes, I’ve heard that before. Sounds pretty similar to the vaccine titer draw answer. Like the ones my son had a reaction to and 3 years later still had 50x+ over reference range (Hep B).

And the good news about these labs: no specialty labs needed. Your local lab will do. And while you’re at it, you might as well pull T&B Lymphocytes/NK Cells, a full immune panel w/ subclasses and a CBC+Chem (although that one is likely a given). And also, whatever vaccine titers you want.  You could also pull ANA and AntiDnase to check for PANDAS and pull Mycoplasma — and if you’re feeling really investigative, Toxoplasmosis, on the off chance it’s positive (it happens).

Sorry.  I can’t help it. I have a compulsive need to start listing labs to run at any opportunity.  I shall restrain myself from continuing now, I swear.

Here is a list of studies showing what these viruses can do just in case you might consider that these mainstream docs are right (and who knows, maybe they are.  Again, I’m not a doctor but I’m certainly able to look at my son and see what he’s responding to.  I have two eyes and like to think I’m fairly intelligent):


And that’s just from a quick PubMed search. Imagine what it would be with a lot more digging. Decide for yourself if titers only mean “exposure.”

What happens if you come up negative/normal on titers?  Well, I’m glad you asked. Many kids come up negative but start antivirals anyway because they are sure there’s a viral problem. And many of them are right. What they find is that the titers shoot up after 3-6 months of antiviral use. I’ve heard the rare occasion where it took 9 months. The viruses are in hiding and the body isn’t recognizing it until you make it with the antivirals. I’m no scientist. I can’t explain why or how this works. I can only tell you that this happens with relative frequency in the pool of parents I’m in contact with.This is one reason why pulling titers every couple of months is important. Google “stealth virus” and you’ll likely get a much better explanation than I can currently offer.

Another reason why pulling titers is important:  you need to know what is happening. If the titers aren’t moving, you may need to switch antivirals. If the titers are moving, then you know you are okay and it’s doing its job. If the titers start to climb after going down, you then might want to switch antivirals. If the titers stall, you may want to switch antivirals (or not). There’s a whole lot of finessing and working with the information you have that needs to be done. Too many people quit too early because they haven’t done enough investigation.  It’s never as simple as just taking a pill.  Knowing what’s going on inside is as important as knowing what’s happening outside. And Valtrex is not the only antiviral and yet I still get a lot of people thinking that somehow, if Valtrex doesn’t produce a result, they should just give up on it.

First, antivirals are very rarely short term. There’s a lot of work to do to get the immune system where it can tolerate having these viruses on its own. Second, trials are not 2-3 months.  See the above paragraph to understand why. At minimum, you’re looking at a 6 month trial but it’s likely going to be longer if you’re doing all the titer pulling, monitoring, switching (if necessary), etc.

“But HHV-6 Foundation says Gancyclovir is the best to treat the herpes virus!”  Well, yeah, if you’re an adult and understand the risks and is willing to take them. Gancyclovir is pretty toxic and best only used when absolutely necessary – like active infections that necessitate its use.  We don’t use it because of safety concerns.  You don’t want to get rid of HHV6 only to have a blind child because of retinal detachment. Or worse.

Much of what we do to help our kids is considered fringe medicine. Why, I’m not sure, but that’s another soapbox. My point is, you don’t want to make antiviral therapy dangerous. While mainstream doctors think it’s “quackery,” they generally don’t feel like any of the antivirals we use are particularly dangerous. My former ped (that has zero belief in any kind of biomed) had this to say when I told him our autism specialist put my son on Valtrex:  “Well, it’s harmless. I don’t care.” Gancyclovir would have garnered a much different response, and with good reason. Try to balance the “accepted” with the “unaccepted” methods because while you want to do all you can, it’s always better to be safe than sorry. Keep some common sense in all of this (at least, that’s my opinion). The others might not be as effective but they do the job and with a lot more safety.

When your kids are old enough to make a choice of their own, they can decide if it’s worth the risk.  It’s not up to you to choose something like this for them. Your first priority is safety because, however the severity, autism isn’t going to kill them.

The next question is: “Why do I need an antifungal?” The answer is fairly simple. Antivirals shift the immune system from TH1 to TH2 cytokines. What does this mean? TH1 is where the bulk of the fungus fight lays in the body. So when you shift to TH2, you need support to fight off fungal infection.  Here are some studies:


And remember that when using systemic antifungals (you want to use Diflucan or Nizoral, basically an azole), you must monitor liver function. These clear through the liver and can raise liver enzymes, which you don’t want – read that as: it’s very bad (Valtrex, Famvir and Acyclovir clear through the kidneys, in case you’re wondering).  Should you have high enzymes, your doctor can tell you how to proceed. It usually involves stopping the antifungal altogether until the enzymes return to normal and possibly trying a different one or a lower dose or both. If they still rise again, it’s possible this isn’t an option, which will leave you in a position of having to stop antivirals because of the antifungals or trying to go through antivirals with no systemic antifungal. This typically doesn’t work out so well but I’ve heard of a very few cases where it did with lots of natural antifungals, non-systemic antifungals and strict diet. Long term high liver enzymes can cause liver damage. As long as you monitor liver function, you shouldn’t need to be concerned with it because you won’t make it to long term high enzymes.  You’ll catch it right away.  I can’t stress the importance of monitoring these.  My son, in the years he’s been doing antivirals, has not had a problem with liver enzymes, but it does happen to others so make sure you monitor.

So now you ask how to start.  These dosages should most definitely be discussed with your doctor.  I have to remind you of this because I am not a doctor. Again, this is all based on my experiences and what I know of other families and where the best results have been found.  I have nothing to offer in the way of scientific evidence of this, only that this is true for those I’ve spoken to.  Completely anecdotal, as they say.

A word on dosages before we get to them:  There are no guidelines. There is no “normal” or agreed upon therapeutic dose for our purposes. Here’s what I’ve been told by doctors and the like:  There is no dosage information.  You look at the pediatric dosages and work within those parameters.  The dose changes with age.  You go from pediatric dosage to adult dosage at the appropriate time based on the drug’s dosage information.

Valtrex:  Younger kids under 35lbs usually use 250 mg 3x/day.  Some say up to 50 lbs others, don’t.  (My son was around 35 pounds when we went up to 500mg and it was awesome, he’s still on that amount now at 7-years-old.) Then you go up to 500 mg 3x/day.  Now here’s where the disagreement comes in, some prefer only 2x a day.  I can tell you that everyone that I know that has gone up from 2 to 3x a day has had better results.  But I’m also not a walking encyclopedia of everyone that has ever used Valtrex.  Some doctors simply don’t think 3x a day is any more beneficial.  I would say look at my son but hey, they might have 50 kids that did better on 2x day than 3, for all I know.

Famvir:  The dosage is equivalent to Valtrex.  Your doc should know how to do this.  (Update:  When I say equivalent, I do not mean that the actual dose is the same, only that the determination of dose is the same.  The actual mgs should be appropriate for the drug. Ditto for Acyclovir.)

Acyclovir: The biggest problem I see here is that this needs to be dosed more frequently (5x a day).  I can see your shock.  Yes, I know, 5x a day is hard with school and such.  But your doc can write a note and you can have the school dose it.  Others think 4x a day is sufficient. Others even go so far as to say 3x a day is sufficient because they only dose Valtrex at 2x a day.  I can’t tell you who is right.  I can only tell you that 5x a day was the bomb in this house.

What not to do on antivirals:  Skip doses!  Do not skip doses if you can, in any way, avoid it.  Skipping doses leads to viral mutation.  Antivirals work by inhibiting replication.  Once you start taking it erratically, the virus starts replicating and mutation can occur.  Once mutation happens, you get resistance.  Same concept as antibiotics and we all know that antibiotics lose their effectiveness because of mutation.  DON’T DO THIS.  If you have trouble believing me, just google “viral mutation antivirals.”

You can only use one of these at a time.  You can add Immunovir (Dr. Cheney’s protocol) to any of these at the same time. Dosing of Immunovir is very specific as it is based on a pulsing system, where the dosage changes as you are on it. Sometiems you are x dose, sometimes, y dose and sometimes none at all.  We’ve not done Immunovir but the dosages can be found here:


You should discuss this with your doctor because I don’t know if this amount is the same for peds. It’s not technically an antiviral but an immune modulator.

One thing to note, Immunovir is very expensive and is not sold in the US. You have to buy it from Canada or overseas.

There’s also LDN (Low Dose Naltrexone) which helps to balance TH1/TH2 cytokines and it is also not an antiviral.  Dr. McCandless has been the spearhead in this therapy.  It’s typically given at night as a TD cream and no more than 4.5 mg as anything over loses it’s immune benefits and starts to become what it was originally intended to do, which you don’t want.  My son was accidentally given too much by a babysitter and went bonkers for a month.  It’s not toxic but Naltrexone was developed for a completely different purpose so make sure you stay within her guidelines.  Along with the immune benefits, people typically find social gains (which makes sense: if you feel better, you’re more functional).

And there you have it. This is the gist of the prescription antiviral therapy. Naturals will be another day and I must admit to being less versed there (naturals have never done much in my house).  But since we are on the subject, a good thing to note is that herpes viruses tend to thrive in an arginine-rich environment and poorly in a lysine-rich environment.  Limit arginine and increase lysine, either through food or supplementation.  Here are some links but there are many, many more on PubMed.  Search “lysine arginine herpes.”


Hope it all helps and feel free to comment.  Let me know if there are any dead links.  I’m pretty sure I checked them all but I’m a bit cross-eyed right now. Now it’s time for me to rest my poor eyes after such a long post!
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28 Comments (+add yours?)

  1. Stan Bates
    Jan 04, 2011 @ 16:58:52

    Many thanks, Cheryl. Well explained. You preety much covered all the pertinent points.Stan

    Reply

  2. Jen Stevens
    Jan 05, 2011 @ 05:47:18

    Very nice. Can you comment on which anti-virals go with specific viruses ie. measles, herpes/chicken pox, flu, etc. Probably in the links, but just a general comment for those of us that do not have time to check each link.Also, the mechanism is to suppress the virus while LDN supppresses the hyperimmune response, so can they be used together or no?One last question. Some doctors claim you can not have PANDAS without a strep (bacteria) infection gone wrong somewhere in your history. Is it possible PANDAS can be triggered by a virus, and if so, are anti-virals appropriate/helpful for PANDAS?

    Reply

  3. Jeffry
    Jan 05, 2011 @ 06:48:44

    Cheryl, Thank you for this information. Most parents of autistic spectrum children can attest to the fact that their child is sick. Once enough parents demand that their children be tested for immune dysfunction, we will start to see the "science" catch up to what parents have been saying all the long.Keep up the great work!Respectfully,Jeffry

    Reply

  4. Marie Johnson
    Jan 05, 2011 @ 07:17:05

    Thank you Cheryl. I have one question for you. Is the Acyclovir dosage the same as Valtrex only given more often? 2.5 yr old boy, 40 lbs, 250-500 mgs 5 x day?

    Reply

  5. Cheryl
    Jan 05, 2011 @ 10:30:16

    @Jen Stevens: The antivirals discussed here are strictly for herpes. There aren't any Rx protocols being used for the others. Although, there is one group using Amantadine for measles. But for most, measles is targeted through naturals. Flu, to my limited knowledge, isn't chronic.Yes, you can use LDN with antivirals.No, PANDAS is not helped with antivirals. It is a bacterial response. PITANDS is viral.@Marie No, you can't just transfer the mgs over from one drug to another. It still needs to be the appropriate dose for the drug. I saw how confusing that could be in my explanation so I went in and updated it. When my son was on it (around the same age as yours) he was on 300 mg 5x day.

    Reply

  6. Anonymous
    Jan 05, 2011 @ 17:21:00

    Thanks for the information. My dd is 29 months old and in November our dan completed the titers and her Rubella was 385.3.I'm so scared that I will not be able to get it out of her,what antiviral is best to treat Rubella?Thanks,Jennifer

    Reply

  7. Cheryl
    Jan 05, 2011 @ 20:56:26

    @Anon: That would fall under the measles category. See my reply to Jen Stevens. I'm guessing with those titers she got the jab. Your DAN will know what to do, that's a pretty standard thing.Don't be scared. Remember to keep things in perspective. She probably just got the jab less than 9 months ago which is going to be a part of the reason why the titers are so high.

    Reply

  8. Anonymous
    Jan 05, 2011 @ 23:49:06

    Hi, Our DAN doctor prescribed 250mg per day of valtrex for my son. He is 5 and ~42lbs. Is there a risk of virus mutation with just one dose per day?ThanksSye

    Reply

  9. Cheryl
    Jan 06, 2011 @ 00:03:49

    @Sye Please tell me you're kidding. Seriously. If it were me, I'd find another DAN.

    Reply

  10. Anonymous
    Jan 06, 2011 @ 14:54:10

    Hi Thanks for your response. She is really nice and seems to know what is she doing but as a parent I just dont want to do something that can hurt my child. Are you saying that 250Mg per day can harm him or it will not be as effective. My son is really high functioning and almost ADD. Appreciae your feedback.

    Reply

  11. Cheryl
    Jan 06, 2011 @ 16:06:43

    250 mg isn't going to hurt her, no. But I've never heard of a doctor trying to get away with giving it only once a day. My main concern would be viral mutation. I can't tell you that it will definitely happen, I don't know. The usual debate is over 2 or 3x a day. This is not even close to what you normally find being dosed.

    Reply

  12. Anonymous
    May 17, 2011 @ 12:09:18

    Cheryl,Thank you for making your Blog. Very helpful.We're looking into viral treatment and wanted to check my son's titers. He unfortunately got all these vaccines:The vaccines and the number of times he received: Diptheria (4x), Pertussis (4x), Tetnus(4x), Polio(4x), Hib (4x), Pneumococcal (4x), Hepatitis B (3x), MMR (2x), Meningoccoccal C (1x), Viravax(1x). 1.Should “titers” be pulled on all these?2.Which labs offer testing for Vaccine Titers?3.Are there now combo tests available at certain USA Labs since more people are asking for the tests now days with biomed treatments.

    Reply

  13. Anonymous
    May 17, 2011 @ 17:30:25

    Cheryl,Also forgot to mention we don't have any insurance so we'd be paying out of pocket. So If you know of Various labs please let me know and I'll compare prices.Thanks!

    Reply

  14. Cheryl
    May 17, 2011 @ 19:29:10

    @Anon: The only one you have to consider is Varivax as that is the only one that is a herpes virus. Current Rx antivirals only effect the herpes family.You can pull the others if you really want to just to see what the reaction was like (Hep B is what did my son in but good) but it's not necessary.If you plan to go natural, you could pull MMR and Hep B as those are the only others that are actively treated in biomed. Any of these titers can be pulled through local labs. Since you don't have insurance, you can call up Labcorp to find out how much it costs. I think those will likely be the best bang for your buck.If anyone else has better/cheaper lab choices (I have insurance so this isn't something I had to worry about – translation: not quite as helpful probably) please feel free to leave a comment.

    Reply

  15. Anonymous
    May 19, 2011 @ 13:31:11

    Thank you Cheryl! 🙂

    Reply

  16. Anonymous
    Jun 06, 2011 @ 19:59:35

    Hi there Cheryl,We did a viral Panel. My child's HHV6 was listed out of range 41.65I'm not sure if this is really high?Also did he get this reslt because of his vaccines? If so which vaccine(s) contain this HHV6?Thanks for your guidance.

    Reply

  17. Cheryl
    Jun 06, 2011 @ 20:55:22

    @anon That's actually a different test than I'm used to. The one typically used is the one that looks more like 1:320. I can't remember the exact name of the test and I can't remember the exact name of your test (and I'm too lazy to pull out my biomed book right now) but if it's out of range, really, it doesn't matter how high. To me (again, I'm not a doctor) I would be thinking about talking to my DAN about starting antivirals.Maybe I'm biased because they've been such a huge part of my son's recovery, but I honestly think that everyone should trial them no matter what the labs say. Labs are tools, not definitive answers. I've known too many families that have done antivirals even when the labs were negative and have *huge* gains. They've also seen titers shoot up after antivirals were started. Google "hhv-6 stealth virus" and you'll learn a lot.

    Reply

  18. Anonymous
    Jun 06, 2011 @ 21:34:51

    You make great points. Thank you Cheryl. Will do.

    Reply

  19. Anonymous
    Jun 06, 2011 @ 22:01:00

    Cheryl,I came across this link:http://www.100megsfree.com/wellnestrain/healingstation2hhv6info.htmlThey have listed various antiviral treatments… very confusing. So is the best treatment for HHV6 not Valtrex? Is Ganciclovir CYTOVENE better? Is oral better or intervenous treatments? Did you guys deal with HHV6 too personally? Did you only do Valtrex for antivirals?Thank you

    Reply

  20. Cheryl
    Jun 06, 2011 @ 22:20:39

    @anon – Please go back and reread this post. I cover ganciclovir in it.

    Reply

  21. Anonymous
    Jun 06, 2011 @ 23:14:12

    You're right 🙂 I needed a re-read! Yikes! Thank you.Ok, so did you guys just do Valtrax? And no other antivirals? If so how long did you treat for?Another thing is I hear there's the brand Valtrax and then the generic; does the generic vs the brand make a difference in your opinion?

    Reply

  22. Cheryl
    Jun 07, 2011 @ 08:51:45

    We've been on all 3 at one time or another (but remember, never at the same time).My son is still on antivirals. It's a long term therapy and some kids never get off. I know adults that are still on an antiviral. Autism, for most kids, isn't a mental disorder. It's a symptom. What it is a symptom of may or may not be curable but is, at least, quite often treatable. The hard part is finding out the problem and it's not going to be the same for every kid.Generic is perfectly fine and what most people use, including us.Read part 2 and part 3, too. There's more info there.

    Reply

  23. Anonymous
    Jun 25, 2011 @ 23:14:44

    Dear Cheryl,Do you have info on Vitamin C IV treatment as antiviral instead of Valtrax for instance? Is this an option?

    Reply

  24. Cheryl
    Jun 26, 2011 @ 22:47:08

    Anon – I don't believe that Vitamin C alone would be very effective for most. Many DANs give it in their chelation cocktails so if it were that effective alone, these people would need antivirals.I don't think anyone should use my opinion as any basis on whether or not to try it, though. I know IV vitamin c has helped a lot of people – just not in the way your hoping for, I think. My opinion is it's stronger as an antioxidant. But hey, I could be wrong.

    Reply

  25. Anonymous
    Jun 26, 2011 @ 22:57:41

    That helps. Thank you Cheryl 🙂

    Reply

  26. Anonymous
    Jul 16, 2011 @ 19:55:06

    Dear CherylI got another info I'd like to run by you as you are very experienced on this topic. I spoke to a homeopath recently and they said that CA-EDTA & DMSA can be used as antiviral instead of Valtax. Ever heard of such a thing? I thought that CA-EDTA and DMSA were only chelators? Is there more to these two agents chemistry wise that would allow for them to also be antivirals?

    Reply

  27. Cheryl
    Jul 17, 2011 @ 09:02:14

    @anon: Run, don't walk, from that homeopath. EDTA and DMSA are not antivirals, they are chelators. They will do nothing to any virus directly. They most definitely can't do what Valtrex does and can't replace it.

    Reply

  28. Anonymous
    Jul 17, 2011 @ 13:43:17

    Thank you Cheryl! So glad you are here.

    Reply

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