Did Anti-Herpes Drug Ease Long COVID Symptoms?

At last count, over 700,000,000 people worldwide have caught COVID-19. There have been more than 7 million deaths. In the US, the number is around 112,000,000 infected.  About 1.2 million people have died. We have seen a variety of estimates about the incidence of long COVID. In general, they range from 7% to 30% of those infected. A large study published in JAMA Network Open (Oct. 27, 2022) reported that “…15% of US adults with a prior positive COVID-19 test reported current symptoms of long COVID.”  That could translate into 15 million people. Could an anti-herpes drug be helpful? This reader believes valacyclovir (Valtrex) was beneficial.

Could the Anti-Herpes Drug Valtrex Be Helpful?

Q. I had the flu in March 2020 and then came down with another infection. I think it was COVID, but there were no home tests at the time. Even though my case was no worse than the flu, it left me with brain fog. I couldn’t concentrate well enough to pay a few bills and organize a simple budget.

After six months, I was still having trouble thinking. Then I suffered an outbreak of cold sores. My primary care doctor prescribed the antiviral drug Valtrex to treat them.

Coincidentally, after two rounds of medication, I found I was thinking much better than before. I am not certain if the Valtrex was responsible, but it was the only change I made. Perhaps the fact that both COVID and cold sores (herpes) are viral diseases helps explain it.

A. There is growing evidence that the virus that causes COVID-19 can affect brain function. That may be why so many long COVID patients complain of brain fog.

We have not seen clear explanations for the cause of brain after COVID infection. One hypothesis is that it could be a result of neuroinflammation (Frontiers in Neuroscience, Aug. 19, 2024).

Scientists do not appear to have studied valacyclovir for post-COVID brain fog.

Another reader found valacyclovir helpful, however:

“An immunologist prescribed valacyclovir for long COVID, and it helped me with brain fog. Sleeping issues and headaches were worse temporarily, but my brain is much more functional.”

Can COVID “Reactivate” Herpes Infections?

There is also some research to suggest that the SARS-CoV-2 virus might reactivate a herpes outbreak (Cureus, Sept. 16, 2021).

This is not the only study to suggest that the coronavirus may reactivate other dormant viruses lurking in the body. Although most people don’t like to think that they are harboring a variety of latent viruses, there is a suspicion that many people may have dormant herpes, varicella-zoster, cytomegalovirus (CMV) or Epstein-Barr (EB) viruses hanging out in cellular pockets.

Along comes COVID-19 and creates a hyperinflammatory reaction and/or a big immunological response. Some researchers think that such a shock to the system could reactivate some of these latent viruses (Nature, Aug. 25, 2022). Italian researchers report (Infectious Diseases and Therapy, Oct. 2022) that COVID-19 may lead to reactivation of herpes simplex virus 1 (HSV-1) in as many as 40% of patients.

A comprehensive review of this whole viral reactivation concept was published in bioRxiv, Nov. 16, 2024.

The authors offer this analysis:

“Chronically infecting viruses are prevalent in the general population, with individuals estimated to carry an average of 8 to 12 chronic viral infections at any given time. These viruses are generally innocuous and typically do not result in acute infectious symptoms, however, emerging evidence suggests that their reactivation is associated with and may contribute to multiple diseases, including autoimmune syndromes, malignancies, and chronic fatigue syndrome. Additionally, Herpesviridae, such as EBV [Epstein-Barr Virus] and CMV [cytomegalovirus], have been found to reactivate in severe infections and sepsis and have more recently been implicated in the pathophysiology of Long COVID/PASC [Post-Acute Sequelae of COVID-19].

“One of the leading emerging factors associated with PASC is chronic viral reactivation, particularly reactivation of EBV, for which PASC patients with neurocognitive symptoms have elevated antibody titers.

“Notably, our results raise the possibility that viral reactivation may contribute to the development of PASC. This finding underscores the pressing need to address chronic viral reactivation in the evaluation and management of acute COVID-19 and PASC.”

That said, scientists are uncertain what to do about the reactivation of latent viruses by SARS-CoV-2 (Journal of Intensive Care Medicine, Sept. 2022).

Why Would An Anti-Herpes Drug Help?

The antiviral drug valacyclovir (Valtrex) speeds healing from a herpes outbreak. It would be fascinating if it could also help ease the brain fog associated with COVID-19. At this time, all we can say is that this is a hypothesis. We could find no studies that support this concept.

We did find an article in the Journal of Alzheimer’s Disease (Nov. 24, 2020) by Dr. Ruth Itzhaki. In it she suggests that if antivirals like Valtrex worked against the long-term mental effects of  long COVID, they might also work against Alzheimer’s disease (AD). You can listen to our interview with Dr. Itzhaki in which she discusses the herpes theory of AD at this link.

Will an anti-herpes drug like Valtrex change the course of long-COVID? It is far too early to know. We can only hope that a researcher will follow up on our reader’s observation with valacyclovir.

Will Anyone Do the Anti-Herpes Drug Research?

I was intrigued to learn that one company, Virios Therapeutics, is exploring antiviral therapies to treat chronic illnesses.

It announced a collaboration with Bateman Horne Center of Salt Lake City:

“…to investigate the role of combination antiviral treatment for long Covid or Post-Acute Sequelae of Covid-19.”

They describe an interesting drug combo:

“A new combination of valacyclovir and celecoxib, IMC-2 merges two specific and synergistic mechanisms of action, deliberately chosen to hinder activation and replication of the herpes virus.”

Virios Therapeutics chief medical officer Michael Gendreau said:

“It is becoming increasingly clear that Covid-19 acutely depresses our immune system, which may allow for reactivation of neurotrophic pathogens such as viruses in the herpes family.”

Only time will tell if this combination of the anti-herpes drug valacyclovir and the NSAID celecoxib has potential against symptoms of long COVID.

Virios Therapeutics announced on August 8, 2024 that it had completed enrollment in a study:

“…comparing two dose levels of the valacyclovir/celecoxib combination vs placebo over 12 weeks to treat symptoms of LC [long COVID]…Top line results are expected in October 2024.”

We await data. In the meantime, please share your own experience with various viruses including SARS-CoV-2. Has anything helped? What about the anti-herpes drug valacyclovir?