Researchers find a promising association but not causation - at least not yet.
Psychiatrists often see patients whose symptoms have no apparent organic
etiology, although these patients might disagree that "the disease is all in
their heads." At times, an etiology is identified that explains the disease,
which shifts the disease paradigm. Because of their complaints about
depression and fatigue, patients with chronic fatigue syndrome (CFS) often
receive psychiatric referrals. Thus, a recent report about an infectious
retrovirus in patients with CFS has, unsurprisingly, received extensive
publicity, including an "op-ed" essay in the New York Times.
Immune system abnormalities had previously been detected in patients with CFS.
The current study focused on xenotropic murine leukemia virusâ?"related virus
(XMRV), previously found in a subset of prostate cancer patients. The
investigators detected XMRV in white blood cells from 68 of 101 CFS patients
(67%) from different geographic regions. Only 8 of 218 healthy controls had
XMRV. In vitro experiments showed that XMRV was infectious and stimulated an
immune response in plasma from CFS patients.
Comment: Retroviruses have also been associated with AIDS and cancer. This
study shows an association between XMRV and CFS. XMRV, which affects natural
killer blood cells that help attack tumor cells and virus-infected cells,
could explain the symptoms and immunologic problems of patients with CFS.
If XMRV is confirmed to be causative, antiretroviral therapies could be
identified, CFS would be recognized as a "real" disease, and stigma would
decrease. However, it is premature to conclude causation. XMRV might be a
cofactor in another infectious process, or the immunologic problems of CFS
patients may increase their susceptibility to XMRV infection. Patients with
depression also have impaired immune function; could psychiatric illness
predispose to XMRV? The 4% prevalence of XMRV infection in the control group
might indicate that XMRV infection is a risk factor for development of CFS.
- Jonathan Silver, MD
Published in Journal Watch Psychiatry December 14, 2009
Citation(s):
Lombardi VC et al. Detection of an infectious retrovirus, XMRV, in blood cells
of patients with chronic fatigue syndrome. Science 2009 Oct 23; 326:585.
Original article (Subscription may be required)
Medline abstract (Free)
Kean S. Chronic fatigue and prostate cancer: A retroviral connection? Science
2009 Oct 9; 326:215.
Original article (Subscription may be required)
Medline abstract (Free)
Coffin JM and Stoye JP. A new virus for old diseases? Science 2009 Oct 23;
326:530.
Original article (Subscription may be required)
Medline abstract (Free)
Johnson H. A case of chronic denial. New York Times Oct 21 , 2009; sect A31.
Psychiatry Editor-in-Chief
Peter Roy-Byrne, MD
Vice-Chairman and Professor, Department of Psychiatry and Behavioral Sciences,
University of Washington
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