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Epstein-Barr, HIV and CFS
May 9, 2000

I was diagnosed all at one time of being HIV+, having had Epstein-Barr exposure and now I have most of the symptoms of Chronic Fatigue Syndrome. I have been faithful to my drug regimen,and now I have an undetectable VL and CD4 cells in the 500 range (which were never low to begin with). But, I exhibit 80% of the CFS symptoms, and still can't work, since I sleep 16 hours a day, feel fatigued even after this and worse when I get less sleep and exert myself. What is the correlation of having been tested positive for Epstein-Barr(is it simply mono) and CFS, and did I get hit with a double whammy by contracting HIV at the same time? No research has been available to me that says Epstein Barr=Chronic Fatigue Syndrome, but coupled with a compromised immune system, it has been hard to convince the Social Security Admin. that I still am not able to work. Any holistic studies on these three diseases which have been a trioga to my life's demise?

Response from Dr. Frascino

Chronic Fatigue Syndrome is difficult to diagnose, as it refers to a collection of symptoms and laboratory abnormalities not related to other potential diseases or conditions. That is why it's referred to as a "syndrome" rather than a disease. In the past, it was thought that it might be linked to Epstein-Barr infection, as this does cause mononucleosis, which also induces considerable fatigue; however, this viral infection does not appear to explain CFS.

Many people who have ongoing fatigue or the other symptoms of CFS show evidence of past infection with Epstein-Barr virus.

Fatigue in the setting of HIV disease is very common and the potential causes are numerous. Certainly anemia is a common cause and can be easily detected by measuring your hemoglobin. Correction of even mild decreases have led to significant improvements in energy levels. Depression is also common with any chronic illness such as cancer or HIV disease. Fatigue can often be a symptom of depression.

Sixteen hours of sleep per day certainly is excessive. It is possible to have several things contributing to your fatigue. For instance, laboratory tests can determine if you have mononucleosis or just past exposure to Epstein-Barr. If you have mono, that would explain the fatigue.

The Social Security Administration is not very responsive to cases claiming CFS, as it is so poorly defined and often over-diagnosed. Fatigue related to your chronic HIV disease and use of potent antiviral drugs is easier to document. Check with your doctor to rule out other causes of fatigue, such as anemia and depression. Then reapply to SSA if your symptoms are persisting.

Best of luck.

RJF


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