When & How to Treat Chronic Viruses in Lyme: A Brief Guide

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How to treat viruses in a Lyme disease treatment image from Marty Ross MD

About Chronic Virus Infections in Lyme Disease

Because chronic viruses exist in healthy people, it is hard to decide when it is time to treat reactivated viral infections in people with Lyme disease. In this chapter, I describe the best virus tests to help determine if treating chronic viruses will help. I also describe when and how to treat chronic active virus infections. When chronic viruses are active, in my experience the best treatments include herbal antivirals and natural immune boosters.

In chronic Lyme and associated diseases, a variety of infectious agents may cause health problems. For some, to recover requires treating Lyme and other infections transmitted by a tick like Bartonella, Babesia, Ehrlichia, and Anaplasma. Some must also treat parasites, yeast, and chronic viral infections.

Chronic virus infections occur in healthy people, too. The trick is to determine if they are causing a problem when they exist in someone with Lyme disease. These germs are kept under control in healthy people and do not usually cause any ongoing health problems. However, in chronic Lyme disease, they can become active due to immune suppression. This can lead to ongoing fatigue, body pain, and many other Lyme disease symptoms.

If a person is not recovering from Lyme disease after 6-9 months of treatment, then test for the viruses and treat if testing is positive.

The known viruses that cause chronic illness are: human herpesvirus 6 (HHV-6), the mono Epstein-Barr virus (EBV), cytomegalovirus (CMV), and parvovirus B19. Some science indicates enterovirus infections may cause problems, as well. In addition to these, there likely are other viruses that cause health problems in Lyme-like retroviruses.

Marty Ross MD Explains Virus Controversies

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Testing for Chronic Viruses in Lyme Disease

IGG Antibody Levels

There are three ways to test for chronic active virus infections. One is to measure IGG antibody levels. These are available for HHV-6, EBV, CMV, and parvovirus. IGG antibodies develop and remain in the body after the acute phase of an infection. IGG antibodies are the memory of the immune system, so they will always remain present for the virus infections, even if these germs are not active as the immune system controls them.

There is a theory, with very limited science, that very elevated IGG levels indicate viruses are active leading to health problems. In 2012, Jose G. Montoya, MD and colleagues tested this theory in people with chronic fatigue syndrome. They studied people who had large increases in IGG levels for HHV-6 and EBV. People in the study were placed on a prescription antiviral medicine called Valcyte for six months. At the end of the study, many participants had improvements in chronic fatigue syndrome symptoms.

Therefore, the Montoya study suggests that the presence of marked elevations of IGG antibodies means an infection is active and not controlled by the immune system. However, IGG antibodies can also be elevated because the immune system is doing a good job of keeping the viruses under control. No one has replicated the Montoya study to know if its findings were accurate.

T Cell Activation (Elispot)

Another option is to see if T white blood cells that fight specific viruses are active. The T cell activation test is also called an Elispot test. In the test, T white blood cells from a person are placed in a tube. Then proteins from a specific virus, like EBV or HHV-6, are added to the tube. The test measures cytokine inflammation chemicals released by the T cells. In theory, T cells only make cytokines against a virus if they have tried attacking the virus in the last two months.

However, this test technique does not prove an increased viral load. It could be that the T cells are active because they are doing a great job keeping the chronic virus infection in check.

Enter Nagalase

Others have proposed using nagalase testing as an indication of increased viral activity. Nagalase is an enzyme made in the covering of viruses. It deactivates Gc-MAF, which is supposed to turn on macrophage white blood cells to fight viruses. In theory, an elevated nagalase is an indirect measurement of increased viral load. Unlike IGGs or Elispots that only show the immune system is working to control viruses, nagalase could suggest increased viral load. Nagalase testing is available from Health Diagnostics Laboratory.

Clinically, there is benefit in using this test to guide virus treatment decisions. Generally, based on my clinical experience, treating when a level is above 1.2 helps. However,  there are no clinical experiments validating  my observations in people with chronic Lyme disease.

While an elevated nagalase suggests an increased viral load in the body, it does not indicate which of the viruses are increased. However, this does not matter, because the natural viral treatment options I recommend below are not specific to a certain virus. Rather, these treatments target any active viral infection.

Wait Six to Nine Months to Treat Viral Infections in Lyme Disease

At 6-9 months of Lyme disease treatment, if no adequate progress has occurred, it is time to test IGG viral antibodies and nagalase. It is not clear to me if nagalase is always elevated in a chronic active virus infection and specifically for each of the known chronic virus infections. However, I advise testing for nagalase because in theory it can detect activity from known and unknown chronic active virus infections

How to Treat Viruses in Lyme Disease

There is limited science about what works to treat chronic viruses. The approach below comes from my medical practice; I find it helpful for many of my patients.

Turn on the Immune System

The best way to treat the chronic active viruses is to follow all the steps in The Ross Lyme Support Protocol, which collectively support the immune system. Often, the immune system will work more effectively and control the chronic active virus infections when Lyme disease and the co-infections are under control.

However, after treating the Lyme infection (Borrelia) and the co-infections for nine months or more without major improvements following all of the steps in The Ross Lyme Support Protocol, then treat the chronic virus infections with natural medicines described below because they could be an ongoing source of health problems and immune suppression.

Natural Medicines

Olive Leaf Extract and Monolaurin are antiviral herbs that may kill the known and unknown chronic active virus infections. When treating these viruses, it is also helpful to promote the antiviral components of the immune system with reishi mushrooms, thymic protein A, or transfer factors targeted against viruses. This treatment option is useful for those with elevated virus IGG antibodies or those with elevated nagalase levels or those who have both. Read the following articles for more information: Olive Leaf Extract, Thymic Protein A , and Transfer Factors: Turn On The Army.

Mushrooms, like reishi mushrooms, are shown to turn on Th1 cellular immunity. This means they activate immune cells that fight viruses. Thymic protein A also turns on cellular immunity. Transfer factors are proteins made by the immune system that target it to fight specific infections. A targeted transfer factor mix, like the Transfer Factor PlasMyc I mention below, includes transfer factors against specific infections, such as HHV-6, EBV, and other viruses.

Use either monolaurin, olive leaf extract, or a combination to kill the viruses. Olive leaf extract is best and can work alone without the monolaurin, but if it is not tolerated, then switch to monolaurin. In general, a treatment with this approach takes six months or more. Also start treatment with reishi mushrooms and Transfer Factor PlasMyc. If these are not working well enough in one to two months, then add the Thymic Protein A.

  • Olive Leaf Extract 500 mg 1 pill 3 times a day. Increase up to 3 pills 3 times a day as tolerated. Do not advance the dosing until any die-off-reaction or worsening of symptoms decline.
  • Monolaurin 300 mg 1 pill 3 times a day. Increase up to 3 pills 3 times a day as tolerated. Do not advance the dosing until any die-off-reaction or worsening of symptoms decline.
  • Reishi Gano Mushrooms 400 mg 1 pill 3 times a day.
  • Transfer Factor PlasMyc 1 pill 1 time a day for 7 days, then 1 pill 2 times a day.
  • Thymic Protein A 4 mcg 1 packet under the tongue 2 or 3 times a day. Three times a day is best.

Prescription Medicines

Some of my colleagues use antiviral medications like Valcyte, acyclovir, or Valtrex. I have tried these approaches and did not find them helpful. These antivirals only target a few of the viruses that can cause problems in Lyme. Specifically, Valcyte targets EBV and HHV-6, while acyclovir and Valtrex work on herpesviruses alone.

Final Word

Be careful treating the chronic active viruses. Killing viruses can cause a severe Herxheimer die-off-like reaction. To manage this, at minimum take curcumin 500 mg 1 pill 3 times a day.  For more severe reactions add liposomal glutathione 500 mg 1 time a day. For very severe Herxheimer reactions use nebulized or IV glutathione instead of the liposomal glutathione. For more information, read Herxheimer Die-off Reaction: Inflammation Run Amok, Curcumin, and Glutathione: The Great Fixer.


The ideas and recommendations on this website and in this article are for informational purposes only. For more information about this, see the sitewide Terms & Conditions.


View Citations

  1. Guggenheim AG, Wright KM, Zwickey HL. Immune modulation from five major mushrooms: Application to integrative oncology. Integr Med (Encinitas). 2014;13(1):32-44. (View)
  2. Lindequist U, Niedermeyer THJ, Jülich W-D. The pharmacological potential of mushrooms. Evid Based Complement Alternat Med. 2005;2(3):285-299. doi:10.1093/ecam/neh107 (View)
  3. Omar SH. Oleuropein in olive and its pharmacological effects. Sci Pharm. 2010;78(2):133-154. doi:10.3797/scipharm.0912-18 (View)
  4. Rosenbaum ME, Vojdani A, Susser M, Watson CM. Improved immune activation markers in chronic fatigue and immune dysfunction syndrome (CFIDS) patients treated with thymic protein A. J Nutr Environ Med. 2001;11(4):241–47. doi:10.1080/13590840120103085
  5. Watt T, Oberfoell S, Balise R , et al. Response to valganciclovir in chronic fatigue syndrome patients with human herpesvirus 6 and Epstein–Barr virus IgG antibody titers. J Med Virol. 2012;84(12):1967-1974. doi:10.1002/jmv.23411 (View)
  6. White A. A Guide to Transfer Factors and Immune System Health. 2nd ed. BookSurge; 2009.
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About The Author

Marty Ross, MD is a passionate Lyme disease educator and clinical expert. He helps Lyme sufferers and their physicians see what really works based on his review of the science and extensive real-world experience. Dr. Ross is licensed to practice medicine in Washington State (License: MD00033296) where he has treated thousands of Lyme disease patients in his Seattle practice.

Marty Ross, MD is a graduate of Indiana University School of Medicine and Georgetown University Family Medicine Residency. He is a member of the International Lyme and Associated Disease Society (ILADS), The Institute for Functional Medicine, and The American Academy of Anti-Aging Medicine (A4M).

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