Suggested Approaches to Therapeutic Goals in a Stealth Virus Infected Patient

1. Establish baseline illness profile through history and clinical examination.
2. Review and simplify existing medications and other support measures.
3. Obtain laboratory data related to overall health, and to screen for specific illnesses.
4. Have patient complete a questionnaire and provide a copy to CCID.
5. Provide educational material to patient, including reference to www.ccid.org web site.

Collective Recommendations of Several Clinicians Treating Stealth Virus Infected Patients

Based on direct discussions with various clinicians and with some of their patients, and supported by a review of pre- and post therapy stealth virus cultures, CCID is developing a set of recommendations that may be of value to other clinicians. The recommendations have not been evaluated through double-blinded studies. Patient care is clearly the responsibility of the treating clinician and these recommendations may be inappropriate for some patients, including children. See www.ccid.org web site Initiate therapy using graduated escalation of dosages and number of medications, as deemed to be suitable and acceptable for each individual patient. Note the use of clarithromycin (Biaxin) is being suggested, not for its anti-bacterial actions, but for its apparent ability to suppress cytokine/chemokine production. This approach is based on recent work suggesting that at least some stealth viruses may be utilizing chemokines as growth factors (see web site for details). Quercetin is a flavinoid anti-oxidant but may also possess potent anti-reverse transcriptase activity. Its use is suggested by the possible role of this type of enzyme in stealth virus replication and assembly. Anti-herpesvirus medications (acylovir/Valtrex) and the more broadly acting ganciclovir, are based on the herpesvirus origins of several stealth adapted viruses. Ganciclovir therapy should be initiated in severely ill, (hospitalized), patients.

A. Suppression of virus activation and replication

(1) Clarithromycin 250 mg/day for 5 days, b.i.d. for 5 days; then 500 mg b.i.d. Discontinue therapy if significant bowel toxicity occurs.

Quercetin (OTC medication) 500 mg t.i.d. with meals for 5 days, increase to 1,000 mg t.i.d.

(2) If no significant response is reported (via telephone call) by day 10-14, progressively add medicines from list of DMARDS (disease modifying anti-rheumatic drugs). Refer to CCID for current recommendations.

(3) If the patient is beginning to experience unusual fluctuations in severity of illness, with some signs of improvement, continue along these lines for at least 4 weeks.

(4) If no clinical changes by 3 weeks, try acylovir (or Valtrex) for a week

(5) Repeat virus culture at 4 weeks, plus basic laboratory screening for possible toxicities. If no virus suppression seen, proceed in adults with ganciclovir (either oral up to 4,500 mg/day) or intraveneous (up to 5 mg/Kg/ b.i.d.). Supplement with enhanced anti-oxidant support and other measures. Monitor closely for toxicity, and repeat culture 1 week after full dose is achieved.

(6) Confer with CCID regarding follow-up culture results and for suggestions regarding children.

B. Support cellular metabolism

(1) Establish balanced diet by addressing any dietary irregularities engaged in by the patient.

(2) Over-the-Counter (OTC) supplements selected on the basis of prior experience of the patient, severity of symptoms, financial constraints, etc. Includes vitamins C, E and A; L-tyrosine; [choice of one or more of the following mitochondria supports: co-enzyme Q10, NADH; æ-lipoic acid, N-acetly-cysteine, or L-carnitine], omega-3 fatty acids in fish oil; folic acid; vitamin sublingual vitamin B12; [S-adenosylmethionine or betaine].

(3) A typical suggestions for someone on a balanced diet would be vitamins 500 mg vitamin C, 500 i.u. vitamin E, and 5,000 i.u. vitamin A; 10 mg NADH a.m.; 500 mg L-tyrosine b.i.d. and 1,000 mg omega-3 fatty acids.

Strengthen neural networks

(1) Behavioral modifications to promote wellbeing and minimize stresses

(2) Neurontin (100 mg/day for 5 days; 100 mg b.i.d. for 5 days, 100 mg t.i.d. until review at second visit). Progressively increase dose if mood and/or neurocognitive improvement noted or if pain diminishes

(3) Other medications selected on basis of symptoms and can include anti-depressants, psychostimulants and/or anti-seizure medications.

(4) More sophisticated profiling of the potential therapeutic benefits of various neural acting drugs can be conducted

Search for and remedy other disorders

(1) Thyroid therapy based on elevated TSH with or without low free T3 levels. Check for anti-microsomal antibodies.

(2) DHEA therapy if signs of adrenal dysfunction

(3) Probiotics if bowel dysfunction. Screen for altered bowel flora, yeasts.

(4) Hypercoagulation. Note, fibrin deposition and low ESR may be noted as part of stealth virus testing. If confirmed by other testing consider low dose heparin or bromelain as suggested by other investigators.

(5) Allergy, food intolerance and/or auto-immune components. Identify by history, auto-antibody and immune complex testing.

Periodic Assessments

(1) Questionnaire and reports by others to assess progress, and identify additional diseases

(2) Laboratory testing to show efficacy and to exclude possible toxicity of the various medications

(3 Stealth virus cultures at about 6 month intervals

Note that clinical fluctuations in disease manifestations and in overall severity of symptoms are a common feature of the illnesses seen in many stealth virus infected patients. Flare ups can occur soon after initiating therapy and in subsequent months. It is, nevertheless, advisable to maintain the treatment protocol for at least 4-6 months before concluding a lack of long term benefit.