Treatment of Neuropsychiatric Manifestations of Long-COVID with Empiric Acyclovir

Oral Antiviral Associated with Clinical Improvement and Reductions in Antibody Titers PETER MCCULLOUGH, MD JAN 27 By Peter A. McCullough, MD, MPH The US HHS Biden Administration Long-COVID research program has spent $1B tax payer dollars and yielded zero new drugs, protocols, or ideas of how the clinical community can manage the plethora of patients with post acute sequelae after SARS-CoV-2 infection. This report from German et al caught my attention. Four cases were seen in a psychiatry office all with well documented neuropsychiatric manifestations of long-COVID syndrome including delirium, seizures, dissociative and encephalopathic symptoms. Each case was treated with oral acyclovir, presumptively for either persistent SARS-CoV-2 replication or systemic reactivation of an endogenous virus. Acyclovir is active against Herpes simplex virus type 1 (HSV-1), HSV-2, Varicella zoster virus (VZV), Herpesvirus simiae (B-virus), and to a lesser degree Epstein-Barr virus (EBV). The rationale is given by the authors: Acyclovir acts by competitively inhibiting DNA polymerase through phosphorylation of the drug compound [14,15]. Acyclovir is now also being proposed to act by preventing the binding of IL-12 to the IL-12 receptor. This is promising for the treatment of COVID-19 by treating the high levels of serum cytokines, inhibiting the cytokine storm inflammatory response [16]. The use of acyclovir is FDA-indicated for the treatment of herpes zoster infections, genital herpes, varicella, and herpes simplex virus encephalitis [17,18]. Acyclovir has been used to treat COVID-19, with proven efficacy, safety, and low cost in small-scale studies [15]. In each case after several months of therapy, there was clinical and serologic evidence of viral clearing. Large prospective, double-blind, placebo-controlled trials are required to make therapeutic claims and strong treatment recommendations. However, the next time I see a patient who falls into this syndromic category, I am going to consider this safe and widely available generic medication for an empiric trial of acyclovir 400 mg three times daily. German ER, Jairath MK, Caston J. Treatment of Long-Haul COVID Patients With Off-Label Acyclovir. Cureus. 2023 Apr 21;15(4):e37926. doi: 10.7759/cureus.37926. PMID: 37228547; PMCID: PMC10205150. Share Courageous Discourse™ with Dr. Peter McCullough & John Leake is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber. Upgrade to paid Please subscribe to Courageous Discourse as a paying or founder member so we can continue to bring you the truth. Peter A. McCullough, MD, MPH President, McCullough Foundation www.mcculloughfnd.org German ER, Jairath MK, Caston J. Treatment of Long-Haul COVID Patients With Off-Label Acyclovir. Cureus. 2023 Apr 21;15(4):e37926. doi: 10.7759/cureus.37926. PMID: 37228547; PMCID: PMC10205150. Courageous Discourse™ with Dr. Peter McCullough & John Leake. © 2024 Peter McCullough MD MPH 548 Market Street PMB 72296, San Francisco, CA 94104