Don't Confuse CFS with AIDS 7 April 2004
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Trevor G Marshall,
Research Director
Autoimmunity Research Foundation

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Re: Don't Confuse CFS with AIDS

One should not confuse CFS with AIDS. CFS results from a hyper-active Th1 immune response. AIDS suppresses the Th1 response.

We have been studying a 'rare' disease, Sarcoidosis, in which Th1 'autoimmune' processes are obvious and dominant [1,2]. Nearly all of these patients have been diagnosed, at some point or other, as suffering from 'CFS syndrome'. CFS symptoms typically are at their worst when the patient is presenting a high level of a steroid hormone characteristic of Th1 inflammation, 1,25-dihydroxyvitamin-D. The symptoms can sometimes be modulated by reducing the ingestion of the hormone's precursor, a Th1 immune stimulant which history has termed "Vitamin D" [3]. Serum 1,25-dihydroxyvitamin-D drops to negligable level as AIDS progresses, and it loses its ability to stimulate the Th1 response [4].

Intracellular bacterial pathogens are associated with a vigorous Th1 immune reaction [1,2]. Viral infections, on the other hand, typically elicit a Th2 immune response. Indeed, many viruses actively suppress the Th1 activity. An excellent explanation of how the non-infectious surface antigen of Hepatitis B (HBsAg) works to directly oppose the differentiation activity of 1,25-dihydroxyvitamin-D is expounded by Vanlandschoot, et al [5]. It is possible that HIV suppresses Th1 immune proliferation in a similar manner.

In other words, bacterial pathogens produce an excess of 1,25-dihydroxyvitamin-D in the inflamed tissues while typical viral infections (including Hepatitis B and HIV) actively counteract any the effects of 1,25-dihydroxyvitamin-D in those tissues.

In our cohort, we found that judicious use of antibiotics, in conjunction with control of Angiotensin II, eliminated all symptoms of the CFS syndrome [2].

While it is absolutely true that the U.S. is suffering an epidemic of CFS, it is totally incorrect to attribute that epidemic to an occult HIV infection. We believe the CFS syndrome is unlikely to result from a viral pathogen.

1. Berger A: Th1 and Th2 responses: what are they? BMJ 2000;321:424
Available from URL

2. Marshall TG, Marshall FE: Sarcoidosis succumbs to antibiotics - implications for autoimmune disease. Autoimmunity Reviews, in press, doi:10.1016/j.autrev.2003.10.001
Available from URL Accessed Nov 19, 2003

3. Hewison M, Gacad MA, Lemire J, Adams JS: Vitamin D as a cytokine and hematopoetic factor. Rev Endocr Metab Disord 2001, 2(2):217-27. PMID: 11705327

4. Haug CJ, Muller F, Rollag H, Aukrust P, Degre M, Froland SS: The effect of 1,25-vitamin D3 on maturation of monocytes from HIV-infected patients varies with degree of immunodeficiency. APMIS. 1996 Jul-Aug;104(7-8):539-48. PMID: 8920807

5. Vanlandschoot P, Van Houtte F, Roobrouck A, Farhoudi A, Leroux-Roels G: Hepatitis B virus surface antigen suppresses the activation of monocytes through interaction with a serum protein and a monocyte-specific receptor. Journal of General Virology (2002), 83, 1281-1289
Available from Last Accessed 4 April 2004

Competing interests: None declared