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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