Is CFIDS related to AIDS?

Below is some extensive and fascinating research about CFS and AIDS by author Neenyah Ostrom. It is used here with permission. Interestingly, my allergist told me in 1990 that I had something like AIDS, only I didn't "acquire" it. He thought I had been born with an immune deficiency. I had the most severe allergies of any patient he had tested in the past 3 years of his busy practice in the "allergy capital of Florida." - Dominie

America's Biggest Cover-Up: 50 More Things Everyone Should Know About The Chronic Fatigue Syndrome Epidemic And Its Link To AIDS

2. A Virus Found In AIDS Patients Is Found In CFS Patients With Brain Lesions And May Be The Primary Attacker Of The Immune System

9. A Mysterious Organism Called A Mycoplasma May Be Peripherally Involved In CFS

10. Just As In AIDS, Immune System Cells Called Monocytes Do Not Work Properly In CFS Patients

11. As In AIDS, The Immune System Is Both Over-Stimulated And Depressed In CFS

12. One Researcher Thinks That CFS Should Be Called "Lymphokine Overdose Disease"

19. Like AIDS Patients, CFS Patients May Be Especially Susceptible To Tuberculosis

29. Like AIDS Patients, CFS Patients May Bruise More Easily Than Healthy People

36. CFS Patients Can Develop Skin Rashes And Other Disorders, Especially Acne And Shingles

39. In CFS Patients, As In AIDS Patients, The T4 Cells May Be Sequestered In The Lymph Nodes

46. An Experimental Drug That Appears Promising For CFS And AIDS Is Being Evaluated By The FDA

47. Nothing Is Being Done To Protect The Blood Supply From CFS- Infected Blood

48. CFS Has Spawned A Powerful Patient Movement That Has Become Mired In Denial

50. A Virus That Causes An "Acquired Immune Deficiency Syndrome" In Pigs May Be The Real Cause of CFS And AIDS

Chronic Fatigue Syndrome is not the only illness that is frustrating contemporary medical science. Gloom pervaded the Ninth International AIDS Meeting (held in Berlin in June 1993), as clinicians and researchers acknowledged that little progress was being made in fighting the illness. The drug that has been touted for years by the U.S. government as stopping the progression of AIDS and extending patients' lives, AZT, does neither. In fact, researchers revealed, AZT is so toxic that it may actually hurt AIDS patients more than it helps. And the immune system marker used to evaluate AIDS patients' health (and AZT's action), T4 cell counts, it was admitted in Berlin, has essentially no correlation with patients' health.

Although uneasiness and distress permeated news reports during and following the Berlin meeting, no reporter asked the obvious question: Is it possible that so little progress has been made in combating AIDS because a mistake has been made in the definition of the epidemic?

This book will attempt to answer not only that question, but also other, potentially even more alarming, ones: Is CFS actually part of the AIDS epidemic? Are CFS and AIDS, in fact, the same illness?

Since the Berlin conference, for anyone interested in observing it, evidence linking these two refractory epidemics, AIDS and Chronic Fatigue Syndrome, has continued to accumulate.

Anxiety about the direction of AIDS research had really begun at the previous international AIDS conference, held in Amsterdam in 1992.

The bombshell of 1992's AIDS conference was the announcement that some researchers had identified cases of AIDS without evidence of infection with the "AIDS virus," HIV.

These "non-HIV AIDS cases" had severely depleted T4 (or CD4) cells, like AIDS patients; they also developed life-threatening opportunistic infections.

What wasn't known to most observers was that one of the researchers who had first publicly identified some of the non-HIV AIDS cases, Dr. Sidhur Gupta of the University of California, Irvine, is a Chronic Fatigue Syndrome researcher.

And some of the non-HIV AIDS cases, it was soon revealed, were actually CFS patients.

Shortly after the June 1992 AIDS conference in Amsterdam, Chronic Fatigue Syndrome researcher Dr. Paul Cheney announced that he had 20 CFS patients in his practice who had the same immune system deficiencies as the non-HIV AIDS cases.

The hallmark of the HIV-negative AIDS cases, as defined by the Centers for Disease Control and Prevention, is a depletion of the T4 (or CD4) cells.

Therefore, the CDC decided to call the HIV-negative, AIDS-like disease "ICL" (an abbreviation of the tongue twisting "idiopathic CD4-positive T-lymphocytopenia," which means, simply, an unexplained loss of T4 cells).

Most healthy people have a T4 cell count of approximately 1,000; a T4 cell count below 800 is considered abnormal. In order to be diagnosed with ICL, a person must have a T4 cell count of less than 300.

One of the most puzzling things about the ICL cases to AIDS researchers -- other than the fact that they don't have HIV -- is that most of the patients do not fit into recognized AIDS "risk behavior" categories; that is, they are not gay men, IV drug users, or the sexual partners of people in those risk groups.

How can AIDS exist in the absence of the virus that causes it? None of the AIDS researchers gathered in Amsterdam in June 1992 seemed able to answer that question.

The mystery of what role HIV plays in causing the immune system deterioration and symptoms seen in AIDS deepened in early October 1992 when a British medical journal carried a report about a strain of HIV that does not appear to cause any kind of illness.

An Australian research team wrote to The Lancet to report on five people who had received blood from a man later found to be infected with HIV. However, ten years following the transfusions, the five blood recipients, as well as the original, HIV-positive donor, remained free of AIDS symptoms and were apparently healthy. The Australian researchers concluded that all six people were infected with a non-disease-causing strain, or type, of HIV.

Studies have shown that HIV is spread only through blood products (i.e., in transfusions), or through exchange of bodily fluids, such as during sex. AIDS is considered to be primarily a sexually-transmitted disease, but one that requires many exposures -- some estimates run as high as 500 exposures -- to catch.

CFS appears to be transmitted much more easily; some researchers have guessed that it might be spread by saliva, as when people share eating utensils. Dr. Cheney, in fact, has reported that as many as 40 percent of his CFS patients also have a close associate -- not a sexual partner -- who has an illness similar to CFS.

Dr. Cheney's statistic -- along with the mystery of why AIDS could develop without HIV infection and why HIV infection does not always lead to AIDS -- raises the possibility that a virus or bacteria that spreads more easily than HIV could be attacking people's immune systems.

Dr. Cheney described the immune system damage seen in CFS patients for the Food and Drug Administration in May 1993. Dr. Cheney told the FDA that five of his CFS patients had died during the preceding six months. Two of these patients committed suicide, which is all too common among CFS patients. But three of Dr. Cheney's patients who died, like AIDS patients, succumbed to overwhelming infections that their damaged immune systems just couldn't fight off.

But Dr. Cheney's CFS patients, like the ICL patients, appeared not to be infected with HIV, even though they developed AIDS-like immunodeficiencies and, in some cases, life-threatening opportunistic infections.

One of the AIDS-like immunodeficiencies seen in CFS involves cells in the immune system that are important in fighting infections: natural killer cells. Natural killer cells are the scavengers of the immune system; they attack and kill anything that appears to be foreign, including the body's own cells that are infected with viruses or other disease-causing agents. Because of that activity, natural killer cells are considered to be part of the immune system's front line of defense against both viruses and cancer.

Natural killer cells are also essential in protecting against tuberculosis, but at the same time, they are disabled by the TB germ. If a person's natural killer cells are not working properly, they are at much increased risk for developing active tuberculosis.

In both AIDS and Chronic Fatigue Syndrome patients, natural killer cells are almost completely disabled. One study of CFS patients found that their natural killer cells' functioning was decreased by 86 percent.

In other words, if a healthy person's natural killer cells worked at 100 percent capacity, a CFS patient's natural killer cells are working at only 14 percent.

Of all the conditions in which natural killer cell activity has been studied, only AIDS patients have been found to have natural killer cells as disabled as those of CFS patients.

However, most AIDS researchers have concentrated on studying the immune system cells implicated in the non-HIV AIDS cases, the T4 (or CD4) cells. T4 cells have been thought to be a good indicator of failing or improving health in AIDS patients; when their numbers decreased, patients were thought to be at higher risk of developing serious infections. Conversely, rising numbers of T4 cells were seen as proof that therapies, such as AZT, were improving patients' health.

As a result of this belief that T4 cell numbers correlated well with health status, very few scientists have studied the natural killer cells and how they fit into the puzzle of AIDS.

In early 1993, however, a study was published in the prestigious British medical journal Nature which not only forged several more links between the AIDS and Chronic Fatigue Syndrome epidemics, but also went a long way toward explaining why natural killer cells stop working in both syndromes.

National Cancer Institute researcher Dr. Robert C. Gallo and his colleagues made an astonishing assertion in the Nature study: They reported that a virus found to be actively growing in both AIDS and Chronic Fatigue Syndrome patients, Human Herpes Virus 6 (HHV-6), infects and kills natural killer cells. Moreover, according to the report from the Gallo laboratory, HHV-6 is the only virus known to be able to do that.

This landmark study answered two previously unanswered questions: It explains at least part of what the actively growing (or "replicating") HHV-6 is doing in AIDS and Chronic Fatigue Syndrome patients, and it partly explains why natural killer cells don't work in those patients.

In fact, Dr. Gallo and his co-workers suggested that HHV-6 "may contribute to the immune dysfunctions associated with CFS and AIDS."

Even studies of T4 cells published in early 1993 inadvertently linked the AIDS and Chronic Fatigue Syndrome epidemics.

The government scientist responsible for Chronic Fatigue Syndrome research at the National Institutes of Health, Dr. Stephen Straus, finally admitted in early 1993 -- after 13 years of trying to prove that Chronic Fatigue Syndrome is a type of depression -- that immune system deficiencies are part of the illness. Dr. Straus and his colleagues published data showing that CFS patients, like AIDS patients, experience a drop in the number of T4 cells in their blood.

Dr. Straus proposed a novel mechanism to explain the loss of T4 cells in CFS patients: The T4 cells of CFS patients are not destroyed, as they are in AIDS patients, according to Dr. Straus; the T4 cells are just hiding in the lymph nodes where they cannot be detected by blood tests.

Therefore, according to Dr. Straus, the T4 cell depletion observed in CFS patients is completely different from the T4 cell depletion seen in AIDS patients.

Unfortunately, Dr. Straus was unable to produce any evidence to support this theory (and still has not). Dr. Straus did not suggest, in contradiction to what Dr. Cheney has found, that any of his CFS patients had T4 cell counts so low they could be identified as ICL patients.

Almost simultaneously, Dr. Yvonne Rosenberg, a scientist working at the Henry M. Jackson Foundation Research Laboratory in Rockville, Maryland, announced that her studies had indicated that T4 cells in AIDS patients are not as decimated as they might appear to be. Instead, Rosenberg suggested, at the prestigious Keystone Conference held the last week of March, 1993, that AIDS patients' T4 cells are sequestered in the lymph nodes where they remain unmeasured by blood tests.

Although Dr. Anthony Fauci, the man in charge of AIDS research in the United States, attended the conference and presented the work his research group had performed on the lymph nodes of AIDS patients, neither he nor any other government scientist chose to comment about the parallel finding about T4 cells in the lymph nodes of AIDS and CFS patients.

And, as the Centers for Disease Control and Prevention (CDC) lurches toward finishing its several-year-long surveillance study to estimate how many people in the U.S. have Chronic Fatigue Syndrome, new information on that subject has come from a surprising source. A group of researchers at the New England Medical Center (in Boston) studying Lyme disease discovered that up to 50 percent of people diagnosed with Lyme disease actually have Chronic Fatigue Syndrome.

The Lyme disease researchers set out to answer another question altogether. They were trying to figure out why Lyme disease treatment is unsuccessful in so many cases.

Lyme disease is caused by a bacterium similar to the one that causes syphilis; it is treated with antibiotics. But a large percentage of people diagnosed as having Lyme disease didn't improve when treated with antibiotics, and the Boston researchers were trying to find out why.

They discovered that the patients whose Lyme disease didn't respond to antibiotics didn't have Lyme disease.

Even more surprisingly, they found that almost 50 percent of those wrongly diagnosed with Lyme disease had, instead, a putatively viral illness: Chronic Fatigue Syndrome.

In addition to its importance to people with Lyme disease and their physicians, this study potentially has enormous importance for the CDC surveillance study. The CDC study is examining people diagnosed with CFS, to see how many of them fit the very strict CDC definition. From those numbers, CDC investigators will extrapolate to the rest of the population and attempt to estimate how many Americans have CFS.

But they are not examining people who have been diagnosed with other, more accepted illnesses, like Lyme disease.

As the New England Medical Center study showed, there could be thousands -- or hundreds of thousands -- of people who have Chronic Fatigue Syndrome who have been diagnosed as having some other disease. Those people are quite unlikely to be counted by the CDC.

The CDC's estimate of how many Americans have CFS could, therefore, be terribly wrong unless this type of misdiagnosis is taken into consideration.

And this kind of misdiagnosis is likely to continue until there is a diagnostic test available for CFS.

Many researchers are attempting to create such a test for CFS. One line of research that originally appeared to be promising involved finding a retrovirus, like the virus that supposedly causes AIDS, in CFS patients. Some researchers had believed that finding such a retrovirus, and proving that it causes CFS, would result in a definitive way to diagnose the syndrome, as the HIV antibody test has done for AIDS.

But the "CFS retrovirus" research apparently ran into some roadblocks, and little progress has been made since the single report describing the retrovirus was published in early 1991.

Meanwhile, HIV has come under intensified scrutiny as a disease-causing organism.

Although the controversy over whether HIV causes AIDS -- with or without the help of "co-factors" -- has continued, few attacks on the retrovirus have appeared in the medical literature. In June 1993, however, an Australian research team published a devastating attack on the HIV antibody test, often called the "AIDS test."

The Australian research team, in fact, raised serious questions not only about whether HIV causes AIDS, but even about its existence as a distinct, infectious retrovirus.

Writing in the June 11, 1993, issue of the journal Bio/Technology, Eleni Papadopoulos-Eleopulos and her colleagues examined the HIV antibody test and found that it had many problems.

Eleopulos and her co-workers found that the HIV antibody test is not consistent; that is, the same blood sample tested in several laboratories does not give the same results in every test performed. They suggest that some of the biological molecules that the HIV antibody test is measuring may be just background junk, cell proteins that are contaminating the test.

Even more disturbing, through an extensive study of the HIV literature, Eleopulos and her colleagues raised the question of whether HIV has ever really been isolated as a discrete entity. The answer they reached is that it has not.

This research caused Eleopulos and her co-workers to conclude that, not only is the HIV antibody test extremely unreliable and perhaps not at all useful, but that it may be a test for something that does not cause AIDS.

This takes us back to the original questions: Is it possible that a mistake has been made in formulating the definition of AIDS? Is Chronic Fatigue Syndrome actually part of the AIDS epidemic?

If this is even a remote possibility, why haven't other books been written about it? Why isn't every health reporter in the country writing about it, every investigative reporter investigating?

The answer, I believe, is pretty simple, and it is a problem that has dogged the AIDS epidemic from the beginning: denial.

From the very beginning of the AIDS epidemic, the syndrome has been characterized as affecting "the other": Haitians (i.e., blacks), gay men, IV drug users, and these groups' sexual partners. These individuals have been contrasted -- and still are -- with the "innocent victims" of the AIDS epidemic: the unknowing wives, and their babies.

AIDS patients, and people who test HIV-positive (whatever that actually turns out to mean), have been so badly treated, so discriminated against, so scapegoated and demonized that it is not surprising that there is an almost reflexive recoiling from the possibility that AIDS is not the narrowly-defined illness that it has been portrayed as being.

People have been murdered for testing HIV-positive; they have been accused of murder; they have been driven to suicide; they have been jailed; they have been denied jobs and health insurance and places to live.

Given all this, denial that AIDS could be even more widespread than government officials admit is not too surprising. What rational person would want to be diagnosed with an illness that could produce such terrible repercussions in every area of life?

Oddly enough, this denial appears to be most fiercely concentrated among medical researchers, and not among the patients themselves.

Chronic Fatigue Syndrome patients, in fact, know they suffer from a profoundly debilitating, life-altering illness that is destroying their immune systems.

Until the denial among medical professionals about the relationship between the AIDS and Chronic Fatigue Syndrome epidemics is overcome, however, it is difficult to imagine how either epidemic can be ended.

A disturbing announcement was made at the July 1992 international AIDS conference held in Amsterdam: Several people with symptoms of AIDS, but who had no evidence of infection with either HIV-1 or HIV-

2 (the viruses generally believed, at the time, to cause AIDS), had been identified by the U.S. Centers for Disease Control. A few weeks later, in early September, Newsweek made an even more shocking announcement: that Chronic Fatigue Syndrome researcher Dr. Paul Cheney had in his practice 20 CFS patients who had the same immune system deficiencies as the non-HIV AIDS cases revealed at the Amsterdam conference.

What wasn't known to most observers was that one of the researchers who had first said publicly that he was aware of such cases, Dr. Sidhur Gupta of the University of California, Irvine, is himself a Chronic Fatigue Syndrome researcher.

The fact that some CFS patients were developing exactly the same immune system problems as AIDS patients, however, raised the questions not only of what was causing that immune system destruction but also of the relationship that exists between the two syndromes.

The hallmark of the HIV-negative AIDS cases, as established by the Centers for Disease Control, is a depletion of a type of immune system cell called T4 (or CD4) cells. The T4 cells of AIDS patients can fall to very low levels and, although recent studies have suggested that there is no real correlation with health status, a decreasing T4 cell count is generally viewed as a sign of worsening disease.

The CDC decided to call the HIV-negative, AIDS-like disease "ICL" (an abbreviation for "idiopathic CD4-positive T-lymphocytopenia," which simply means an unexplained depletion of T4 cells).

One of the most puzzling things about the ICL cases to AIDS researchers -- other than the fact that they didn't have HIV -- is that most of the patients do not fit into recognized AIDS "risk behavior" categories; that is, they were not gay men, IV drug users, or the sexual partners of people in those risk groups. These cases may, in fact, be dramatic evidence that federal officials have not told the public the whole truth about the nature and the full scope of the AIDS epidemic.

The mystery of what role HIV actually plays in causing the immune system deterioration and symptoms seen in AIDS deepened in early October 1992. The British medical journal The Lancet reported that five people had received blood from a man later found to be infected with HIV; however, ten years later, the five transfusion recipients as well as the original, HIV-positive blood donor remained free of AIDS symptoms and were apparently healthy. The Australian researchers who reported those cases concluded that these six people were infected with a non-disease-causing strain, or type, of HIV.

The link between the immune system dysfunction seen in AIDS and in CFS was made explicit in early 1993 when government scientists admitted that CFS patients, like AIDS patients, suffer a decline in T4 cells. The government's leading CFS researcher, Dr. Stephen Straus at the National Institute of Allergy and Infectious Diseases, published a research paper in The Journal of Clinical Immunology in which a decrease in the number of T4 cells in CFS patients was documented.

Dr. Straus proposed a novel mechanism to explain the loss of T4 cells in CFS patients: The T4 cells of CFS patients were not depleted, as they were in AIDS patients, according to Dr. Straus; they were just hiding in organ tissues. Unfortunately, Dr. Straus was unable to produce any evidence to support this theory (and still has not done so). Dr. Straus did not suggest that any of his CFS patients had T4 cell counts so low that they could be identified as ICL patients.

Meanwhile, Dr. Cheney, in addition to announcing that some of his CFS patients had low enough T4 cell counts to be considered non-

HIV AIDS cases, reported that as many as 40 percent of his CFS patients also had a close associate with an illness similar to CFS. This information -- along with the mystery of why AIDS could develop without HIV infection and why HIV infection does not always lead to AIDS -- raised the possibility that a virus or bacteria that spreads more easily than HIV could be attacking people's immune systems.

A virus that has been considered for several years a possible cause of Chronic Fatigue Syndrome is Human Herpes Virus 6 (HHV-6). This virus was first discovered in AIDS and cancer patients in the mid-1980s at the National Cancer Institute. It was subsequently found that people with Chronic Fatigue Syndrome, like people with AIDS, can have extremely high levels of antibodies to HHV-6.

As more is learned about HHV-6, its ability to attack the immune system -- and perhaps other parts of the body, like the nervous system -- has been documented in more and more frightening ways. Even more alarmingly, the most recent research on HHV-6 suggests that it, and not HIV, is the primary infection that destroys an important part of the immune system in AIDS.

That part of the immune system is the natural killer (NK) cells. NK cells are crucial to the immune system's front-line defense against both viruses and cancer, because they attack and kill any cells they perceive to be foreign. If the NK cells aren't working properly -- which they aren't, in both AIDS and CFS -- this very important protection is knocked out.

The research team that discovered the existence of HHV-6, working with Dr. Robert C. Gallo at the National Cancer Institute, announced in early April 1993 that HHV-6 is the only virus known to be able to infect and kill NK cells.

Furthermore, Dr. Gallo and his colleagues asserted, HHV-6 infection allows the AIDS virus, HIV, to invade NK cells and kill them.

The question of how many other kinds of cells require HHV-6 to be present before HIV can invade them remains, at this time, unanswered.

HHV-6 is capable of wreaking all kinds of havoc, not all of which is confined to the immune system. In January 1992, a study was published showing that a large percentage of CFS patients who had HHV-6 actively growing in their blood streams also showed evidence of organic brain disease.

When CFS patients from the first detected outbreak of CFS in the U.S. -- which occurred in Incline Village, Nevada, in the mid-1980s -- were studied, brain scans showed that 80 percent of those infected with actively growing HHV-6 had (several years after the initial outbreak) developed brain lesions.

No one knows what the lesions mean or are doing to the patients, or whether HHV-6 is actively growing at the site of the brain damage.

But the Incline Village CFS patients were also found to have NK cells that weren't functioning properly. Now, we know that HHV-6 is, most likely, directly responsible for the dysfunction in the CFS patients' NK cells, but the virus' involvement in causing the brain lesions has yet to be proven conclusively.

The scientists studying the Incline Village patients concluded that there was an infectious agent, capable of being spread from person to person, in the CFS patients: HHV-6.

This very important study of CFS patients not only indicates that CFS is a contagious illness, but also suggests that HHV-6 is its cause.

Human Herpes Virus 6 (HHV-6) was first discovered in people with damaged immune systems who had cancer or AIDS. However, when studies showed that it seemed to infect about 90 percent of the world's population by age three, HHV-6 was generally portrayed by scientists as a fairly harmless virus.

More recent research, however, has thrown the supposition about HHV-6 being harmless into doubt. For one thing, there are two different types of HHV-6; one is isolated from infants, and seems to cause only a mild childhood illness, with fever and rash, called roseola.

The other type of HHV-6, however, is found in very sick adults who have AIDS, cancer, Chronic Fatigue Syndrome, or other immune system abnormalities. And the newest research on this type of HHV-6 suggests that it may be the cause of the immune system deficiencies seen in both AIDS and CFS.

National Cancer Institute researcher Robert Gallo and his co-workers are generally credited with the discovery of HHV-6, and Dr. Gallo and his lab workers have continued to study the virus intensively. (Dr. Gallo's claims to virus discovery have to be taken with a grain of salt, however. He also claimed, for a number of years, to have discovered HIV, the "AIDS virus." After a lengthy investigation and charges of virus-lifting by other scientists, however, Dr. Gallo admitted that he had simply "discovered" a virus that had been sent to him by Pasteur Institute scientist Luc Montagnier and his research group. For having made false claims about discovering the "AIDS virus," Dr. Gallo was judged guilty of scientific misconduct by the National Institutes of Health in December 1992.)

The HHV-6 that Dr. Gallo and his colleagues are studying at the National Cancer Institute is the type that infects adults who have AIDS, cancer, or Chronic Fatigue Syndrome.

In April 1993, Dr. Gallo and his colleagues published an astonishing report in the prestigious British medical journal Nature. They reported that HHV-6 was able to infect and kill the natural killer cells, which are an important part of the immune system, and that it was the only virus ever found to do so.

Natural killer cells are the body's front-line defense against viruses and some kinds of cancer. When natural killer cells encounter a cell that is "foreign" -- either because it is infected with a virus or because it has become cancerous -- they engulf and destroy it. Unlike other types of immune system cells, natural killer cells do not require any type of priming or activating by another part of the immune system; that is why they are considered to be the first line of defense in protecting the body against certain invaders.

In both AIDS and Chronic Fatigue Syndrome patients, the natural killer cells just don't work the way they do in healthy people. One researcher found a natural killer cell activity deficit of 86 percent in the Chronic Fatigue Syndrome patients she studied. AIDS patients have similar deficits in natural killer cell activity. Before Dr. Gallo's study linking HHV-6 and natural killer cell destruction, no one had been able to explain why natural killer cells stopped working in AIDS and CFS patients.

Dr. Gallo and his colleagues, however, not only showed that HHV-6 can infect and kill natural killer cells, but actually suggested that the virus "may play a role in the acquired immunodeficiency syndrome (AIDS) and in the chronic fatigue syndrome, two disorders associated with a defective NK cell activity."

They are also the first researchers to confirm that the immune system abnormalities seen in AIDS and CFS are actually the same.

In fact, in the conclusion of their research report, Dr. Gallo and co-workers stated that their results "elucidate a novel mechanism whereby HHV-6 may contribute to the immune dysfunction associated with CFS and AIDS."

Further studies of HHV-6 in AIDS and CFS patients may provide even more examples of how this virus causes the immune system abnormalities the two syndromes share and may even suggest even more strongly that CFS and AIDS are simply different manifestations of the same illness.

People who receive organ transplants are given drugs that suppress their immune systems so that they do not reject the transplanted organs, thus placing them in a state that is similar to AIDS or CFS. While they are in that immunosuppressed state, they are especially vulnerable to infections, just like CFS and AIDS patients are. Now it appears that an often-fatal lung illness that can occur following bone marrow transplantation may be caused by a virus that infects AIDS and CFS patients, Human Herpesvirus 6 (HHV-6).

If HHV-6 is causing lung disease in bone marrow transplant recipients, that raises the question: Is HHV-6 also causing lung disease in CFS and AIDS patients?

Another extremely serious immunological complication that occurs after bone marrow transplantation, Graft-Versus-Host Disease (GVHD), may also be caused by HHV-6. Both of these findings were published in the New England Journal of Medicine in July 1993.

The lung illness caused by HHV-6 is pneumonitis, which is inflammation of the lung (basically, a type of pneumonia). When lung tissues from patients who'd had bone marrow transplants and subsequently developed pneumonitis of unknown cause were examined by a research group in Seattle, the tissues were found to contain considerable amounts of HHV-6.

That led the researchers to conclude that HHV-6 was probably causing some cases of the often-fatal pneumonitis in bone marrow transplant patients.

This is the first time that HHV-6 has been implicated in causing a lung illness.

Graft-Versus-Host Disease (GVHD) is another potentially life-threatening illness that strikes bone marrow transplant recipients. In GVHD, the donor's healthy T-cells (which are impaired in AIDS and CFS) attack the recipient's tissues; GVHD is a form of organ rejection. The symptoms of GVHD include fever, rash, hepatitis, diarrhea or abdominal pain, vomiting, and weight loss.

Some of the bone marrow transplant patients studied by the Seattle researchers who developed pneumonitis caused by HHV-6 also developed severe GVHD.

Those patients were also found to have very high levels of HHV-6, particularly in their lungs.

That is to say, three conditions occurred together in the patients: high levels of HHV-6, pneumonitis, and severe GVHD.

This led the Seattle researchers to suggest that HHV-6 is the likely cause of both the pneumonitis and the GVHD seen in some bone marrow transplant recipients.

Another report about HHV-6 also appeared in the same issue of the New England Journal of Medicine. This report was from Japan, where researchers had observed a ""mononucleosis-like illness'' they believed to be caused by HHV-6.

The 43-year-old man described by the Japanese research team was admitted to the hospital with a high fever, rash, swollen lymph nodes, a swollen spleen, and inflamed tonsils; he was also suffering from liver dysfunction.

This man, too, had high levels of HHV-6 during his illness, leading the Japanese researchers to conclude that the man's ""mononucleosis-like illness'' had been caused by HHV-6.

Although some researchers have suggested that HHV-6 is a basically harmless virus that infects approximately 90 percent of the world's population by the age of three, new information being published about the virus indicates that some varieties, or strains, are capable of causing profound immune dysfunction and serious illness. These three problems may be just the tip of the iceberg in terms of the damage that HHV-6 is able to inflict on the immune system.

One of the viruses that has been found to be active in both CFS and AIDS patients, Human Herpes Virus 6 (HHV-6), has been linked by Japanese scientists to miscarriage.

HHV-6 is a virus that primarily invades the T-cells of the immune system (though it can also live in other immune system cells). T-cells are critical in regulating immune responses -- both in getting an immune response started, and in shutting it down. When the T-cells don't work because a virus is attacking them, the immune response can be severely affected, as is seen in both CFS and AIDS.

Very recently, HHV-6 has been found to be the only virus that is capable of invading and killing natural killer (NK) cells. NK cells don't work properly in both CFS and AIDS; a deficiency of NK cell activity, in fact, has been cited by numerous researchers to be the most consistent immune system abnormality found in CFS patients. If the NK cell activity of AIDS patients is examined, it, too, is found to be consistently abnormal. HHV-6, which is known to be actively growing in both AIDS and CFS patients, has been identified as the only virus known to be able to infect and kill NK cells. It is reasonable to assume that it is causing the abnormal NK cell activity seen in both sets of patients.

HHV-6 has also been linked, in CFS patients, to the development of brain lesions (areas of dead or damaged brain tissue). A recent study found that CFS patients with a lot of active HHV-6 also had developed brain lesions that are visible on specialized brain scans; patients without active HHV-6 did not have brain lesions.

A Japanese research team from the Nara Medical University studied 30 patients who'd had miscarriages early in pregnancy (at 6-12 weeks). When tissue from the miscarriages was examined, they were found to contain HHV-6 antibodies that were four times higher than those found in pregnant women who did not miscarry. In a report published in the British medical journal The Lancet in November 1992, the Japanese research team suggested that active HHV-6 "may predispose" to miscarriage in pregnant women.

Human Herpes Virus 6, HHV-6, has been presented to the world as rather a Dr. Jekyll-Mr. Hyde kind of a virus: On the one hand, researchers like Dr. Jay Levy at the University of California-San Francisco point out that HHV-6 infects so large a percentage of people world-wide that it must be essentially harmless. On the other hand, some pediatricians have reported that HHV-6 infections have been fatal.

It is possible, given that more than 10 different strains, or types, of HHV-6 have been identified, that different strains of the virus cause different levels of illness, ranging from almost unnoticeable (a "silent" infection) to deadly.

High levels of antibodies to HHV-6 have been found in several groups of very sick patients, including AIDS and CFS patients.

No one knows for sure what damage HHV-6 is doing in those patients. In the laboratory, however, it has been demonstrated that at least some strains of HHV-6 are very efficient killers of immune system cells -- especially T4 (or CD4) and natural killer cells, the two types of cells most affected in both CFS and AIDS.

And HHV-6 has recently been found in more than one-third of a group of Kaposi's sarcoma tumor biopsies, suggesting that it may play a role in causing this unusual cancer seen in AIDS patients.

Recently, the HHV-6 strains have been divided by researchers into two groups, or variants: Variant A, viruses which have been isolated from sick adults (those with CFS, AIDS, or cancer); and Variant B, which has been found in relatively healthy babies.

Most of the fatal HHV-6 infections identified in the medical literature, however, have occurred in very young children. Cases of fatal hepatitis, or liver disease, caused by HHV-6 in children were reported in the medical literature in 1990 and 1991. HHV-6 infection was localized, not surprisingly, primarily in the children's livers.

In summer 1992, however, a group of New York University re searchers reported a fatal, systemic -- that is, spread throughout many different organs and tissues -- HHV-6 infection in a 13-month-old girl.

The child's illness began with a fever and lack of appetite; soon, however, she began to show evidence of hemorrhaging -- uncontrolled bleeding or leaking of blood vessels -- on her face, trunk, arms, legs, and around her lips. This child also developed liver disease. She died from congestive heart failure on the fifth day after being hospitalized.

When an autopsy was performed on the child, HHV-6 infected white blood cells were found in numerous internal organs: heart, lungs, liver, spleen, thymus, kidney, and bladder, as well as in the gastrointestinal tract, salivary glands, bone marrow, lymph nodes, middle ear, peripheral nerves, and skeletal muscle.

Not too surprisingly, the physicians concluded that this disseminated, or very widespread, HHV-6 infection had killed the little girl.

If certain strains of HHV-6 are capable of causing fatal illnesses -- assuming that this is a strain-dependent phenomenon, which it may not be -- it seems that a reasonable next step in HHV-6 research would be to identify the most deadly strains.

A new virus, called Human Herpes Virus 7 (HHV-7), was isolated from a CFS patient in 1992. This virus was found in the National Cancer Institute; it has been studied most intensively in the laboratory of Dr. Robert C. Gallo.

Whenever Dr. Gallo and his colleagues claim to be studying a new virus it should again be noted that he, and certain colleagues, have been under investigation for several years because of allegedly fraudulent claims that the Gallo lab isolated the AIDS virus (HIV) in 1983. In fact, on December 31, 1992, Dr. Gallo and one of his colleagues involved in the isolation of HIV were found by the National Institutes of Health (only one of the regulatory bodies investigating Dr. Gallo and his colleagues) to be guilty of scientific misconduct.

The other virus found actively growing in both AIDS and CFS patients, Human Herpes Virus 6 (HHV-6), was also isolated in the Gallo laboratory in the mid-1980s; Dr. Gallo's account of the discovery of that virus, like his account of the discovery of the AIDS virus, has been challenged by other scientists.

It is not known whether HHV-6 -- which is closely related to HHV-7 -- contributes to causing CFS, or AIDS. It is known that HHV-6 infects and kills not only T4 cells, one of the major cells that is affected in AIDS, but also infects and kills natural killer cells, which are dysfunctional in both AIDS and CFS.

And also like HHV-6, HHV-7 is quite similar to cytomegalovirus (CMV), which can cause blindness and other serious illnesses in AIDS patients. However, HHV-7 is different enough from both HHV-6 and CMV to be declared by Dr. Gallo's research team to be an entirely new human virus.

An important question not posed by these investigators is: Where are these "new" viruses, found to be infecting both AIDS and CFS patients, coming from?

The immune system has evolved many different mechanisms to fight invaders: viruses, bacteria, parasites, and anything perceived as "non-self," such as defective or cancerous cells. Some of those mechanisms are incredibly specific, like antibodies; others are pretty general, like natural killer cells. One of the continuing mysteries of the immune system is how all of these mechanisms interact, overlap, and appear to compensate for each other to protect against infectious agents.

One way the immune system protects against viruses is through a biochemical pathway with the name "2'-5'A synthetase/RNase L pathway." This pathway's anti-viral effects are turned on by interferon, one of the chemicals (called cytokines) produced by T-cells and other cells of the immune system.

Although this sounds rather technical -- and it is -- the most important fact about the pathway is very simple: It malfunctions in both CFS and AIDS patients.

Basically, the pathway works like this: When a virus is detected by the immune system, interferon is produced. Interferon stimulates the inactive chemical 2'5'A synthetase; it interacts with other chemicals and produces a biologically active substance called 2'-5'A. "Biologically active" means that the 2'-5'A is capable of acting on other molecules and making them active, too.

And that is what 2'-5'A does; it activates another immune system substance, RNase L. Activated RNase L is then able to stop the invading virus from reproducing itself and spreading the infection.

When this pathway works correctly, interferon production results, through the steps outlined, in stopping viruses from spreading throughout the body. But in CFS patients -- and AIDS patients -- the pathway doesn't work properly.

Dr. Robert Suhadolnik, working at Temple University in Philadelphia, has discovered that CFS patients have too much of both active substances in the pathway, 2'-5'A and RNase L.

As a result, not only viral reproduction, but also much of the cell's own internal activity, is halted. That means that the cells of the immune system are unable to react properly to invaders.

The failure of this pathway is another example of how an overreaction by a portion of the immune system in a person with CFS can actually result in decreased immunity.

The defect in the anti-viral pathway also suggests that CFS patients, like AIDS patients, are vulnerable to opportunistic infections that can make them very sick.

Interestingly, one of the experimental treatments for CFS (and one which has also shown promise in treating AIDS) is Ampligen, a chemical that is structurally similar to interferon. It appears to correct the defect seen in the 2'-5'A Synthetase/RNase L pathway. Studies using Ampligen to treat CFS are currently being reviewed by the Food and Drug Administration.

Another interesting observation made by Dr. Suhadolnik demonstrates how a malfunction in the immune system in CFS can result in either up- or down-regulation. While most CFS patients studied by Dr. Suhadolnik have increased amounts of RNase L, he has also reported that he has seen some CFS patients in whom there is virtually no detectable RNase L -- which is exactly what is found in AIDS patients.

That finding has led some researchers to speculate that a retrovirus -- like HIV, the "AIDS virus" -- may be involved in causing CFS.

This natural anti-viral pathway may provide not only an understanding of what goes wrong in CFS, but also a way to diagnose the syndrome. In July 1992, a research firm in Houston, Texas, announced that the firm had developed a diagnostic test for CFS. The company is Oncore Analytics, Inc., and the test measures the anti-viral pathway. The Oncore test is performed on a blood sample.

The virus that causes CFS has not yet been identified and, in fact, there are still researchers and clinicians who do not believe that a virus -- or any infectious agent -- causes CFS. If the Oncore test, which measures a defect in an anti-viral pathway, is capable of reliably separating CFS patients from healthy people, that would be another piece of evidence suggesting that CFS is caused by a virus.

Mycoplasmas are extremely small bacteria, and are perhaps the smallest self-sufficient organisms that exist. Mycoplasmas can cause human disease -- particularly pneumonia and a type of urinary tract infection -- but have not been considered to be major human pathogens. Since 1986, however, there has been speculation that a newly-discovered type of mycoplasma may be involved as a co-factor in causing AIDS and, perhaps, even CFS.

The new mycoplasma was discovered in AIDS patients by Dr. Shyh-Ching Lo at the Armed Forces Institute of Pathology. The mycoplasma appears to invade many internal organs -- kidneys, spleen, brain, liver -- and causes the organ tissue to die.

While Dr. Lo's suggestion that the mycoplasma might play some role in causing AIDS is controversial, Dr. Luc Montagnier, the Pasteur Institute researcher who discovered HIV, the "AIDS virus," has found the same kind of mycoplasma infecting French AIDS patients. Dr. Montagnier, like Dr. Lo, believes that this mycoplasma may play an important role in causing AIDS.

And Dr. Lo has been able to accomplish with the mycoplasma what no scientist has been able to do using HIV: Dr. Lo has taken mycoplasma from AIDS patients' tissues, injected them into animals, watched the animals die of a wasting illness that resembles AIDS, and then re-isolated the mycoplasma from the animals' tissues.

In other words, Dr. Lo has created a classical animal model for the mycoplasma-caused illness. Such an animal model does not exist for HIV and AIDS; no animal has ever been made to develop an AIDS-like illness after being infected with HIV.

Dr. Lo also found the new mycoplasma in a number of non-AIDS patients -- previously healthy people who died very suddenly following a flu-like illness. These cases prove that this particular mycoplasma can infect people who do not have AIDS.

Fortunately, mycoplasma can be controlled by readily-available antibiotics such as doxycycline or tetracycline. The fact that many CFS patients report that their symptoms improve when they take doxycycline causes Dr. Lo to suspect that the mycoplasma may be involved in causing some cases or symptoms of CFS.

Unfortunately, Dr. Lo's work is still very much in the research stage, and a diagnostic test for the mycoplasma is not readily available. But if a physician suspects a CFS patient may be infected with the mycoplasma, it is safe to treat the patient with an anti-mycoplasma antibiotic, just in case, according to Dr. Lo.

Some CFS patients report considerable improvement in their symptoms when they take antibiotics. "The burning feeling in my spine and head disappear," CFS patient "Ruth" told me, when she takes ciprofloxacin, an antibiotic. She added, "The joint pain -- especially the neck pain -- goes away, and I am able to think clearly when I take ciprofloxacin."

Cells called monocytes are an essential part of the immune system. Monocytes are found in the circulating blood, and they perform a variety of functions: They ingest and kill invaders, they communicate with other immune system cells to indicate when an immune response should be mounted, and they make a number of enzymes that are essential to properly functioning immunity.

Monocytes are the precursor cells to another very important type of immune system cell called macrophages. Macrophages are essentially the mature forms of monocytes; they are found situated in organ tissues (rather than in the blood, like monocytes). Macrophages perform basically the same functions as monocytes.

Like just about every other cell in the immune system, monocytes do not work properly in CFS patients. Some research teams have found that about half of CFS patients have monocytosis, in which too many monocytes are produced. When there is an excess of monocytes, there can be an excess of the lymphokines that the monocytes produce; these lymphokines can make patients feel very sick.

Additionally, a Spanish research team from the University of Navarra, in Pamplona, studied monocyte function in CFS patients and found it to be disturbed in a large percentage of patients. The Spanish researchers examined the delicate fibers on the surfaces of monocytes and macrophages, called "vimentin filaments," that are thought to help the cells move about in the body and to play a role in immune responses.

When the monocytes and macrophages of CFS patients were compared to those of healthy people, the Spanish scientists found a "marked reduction" in the vimentin filaments. Consequently, they found, the monocytes and macrophages of CFS patients are quite dysfunctional.

In fact, 30 of 35 people who fit the U.S. CDC criteria for CFS (six men and 29 women who ranged in age from 19 to 51) had, according to the Spanish research team, "monocyte dysfunction."

The balance maintained between the interacting parts of the immune system appears to be extraordinarily delicate, we are learning as scientists unravel more and more of its mystery. What is becoming clear is that it's possible for one part of the immune system to be over-stimulated at the same time as other parts are depressed.

In CFS, the immune system cells called T-cells are often over-stimulated; this state is called "T-cell activation." Research has shown that, when T-cells are activated, they make immune system chemicals called cytokines; interleukin and interferon are examples of cytokines. When the T-cells make excessive amounts of cytokines, they can actually cause symptoms similar to those seen in CFS.

Fever, swollen glands, sore throat, aching muscles and joints, sleep disturbance, and even psychological symptoms can be caused by excessive amounts of cytokines.

Dr. Paul Cheney, who was one of the first physicians to recognize CFS in the U.S. -- and who has a number of CFS patients who can be designated "non-HIV AIDS cases" because they have very low T4 cell counts -- explains it this way: The sicker his patients feel, the more T4 cells (which are also called CD4 cells) they have. The less sick the patients feel, the lower their CD4 cell counts are.

Dr. Cheney says that the notion of "sick" is used differently with respect to AIDS and CFS patients.

"Sick is a semantic term in the sense that it implies different meaning in CFS than it does in AIDS," Dr. Cheney says. "We have sort of defined AIDS patients as what happens to them, and when bad things happen to them, they have low CD4 counts. CFS patients feel bad all the time, and their CD4 counts are actually high."

Dr. Cheney blames his sickest patients' symptoms on having activated T-cells. "It will make you royally sick" to have activated T-cells, he points out. "And, I'll tell you, the sickest people I have, the people who come in here who are really, really, sick, they'll have CD4 counts of 2,000," which is about twice as high as normal. "And the cytokines that are being expressed, of course, typically cause CD4 cell proliferation" -- so the T-cells, which are already too high, increase even more. This is the type of T-cell malfunction that can occur when the immune system is over-stimulated.

But Dr. Cheney also has CFS patients with very low CD4 cells counts; so low, in fact, that they can be diagnosed as being "non-HIV AIDS," or ICL, cases. Dr. Cheney believes that both sets of patients -- those with high CD4 cell counts and those with low CD4 cell counts -- have CFS. He thinks that the patients with the low T4 cell counts, however, are in "a different state" from other CFS patients.

Dr. Cheney says that his CFS patients who have fewer than 200 CD4 cells -- a level that is considered very dangerous for AIDS patients -- are "not feeling so good." He also points out, however, that those patients who have CD4 counts between 300 and 500 typically don't feel too bad, even though 1000 T4 cells is considered "normal."

"Looking at this group as a whole, the patients with low CD4 counts are relatively less sick -- less symptomatic, I should say," Dr. Cheney says. "Their symptoms aren't as severe. They seem to be more stable. If I had to guess what is happening, I think what is happening is that you are looking at the same disease in two different states."

One of those states is "up-regulated," in which the T-cells are activated and producing large amounts of cytokines; the other is a state of down-regulation, in which even the numbers of immune system cells drop.

Sometimes increased amounts of certain cytokines can cause the depression of some types of immune system cells. One of the cytokines that is elevated in CFS, for instance, is interleukin 1 (abbreviated IL-1). IL-1 has been shown to cause other parts of the immune system -- like natural killer cell activity -- to be suppressed. This is only one example of how an elevation in one part of the immune system can cause the depression of another part.

Dr. William A. Carter is a Professor of Oncology and Hematology at Hahnemann University in Philadelphia. He is also the co-developer of an experimental drug called Ampligen, which has shown promise in treating both Chronic Fatigue Syndrome and AIDS, and is currently under review by the Food and Drug Administration. At a conference held in late 1991, Dr. Carter discussed a clinical trial of Ampligen and explained that he thinks CFS could be called "lymphokine overdose disease."

Lymphokines are substances produced by white blood cells (also called lymphocytes) when the immune system encounters an invader. They include the interferons (alpha-, beta-, and gamma-interferon), the interleukins (there are at least 12 interleukins), tumor necrosis factor, and others. Most lymphokines stimulate cells to do something: either to reproduce themselves (interleukin-2 used to be called "T-cell growth factor," for instance), or to interact with other components of the immune system (gamma-interferon works in this way).

When Dr. Carter made his 1991 presentation at the 31st Interscience Conference on Antimicrobial Agents and Chemotherapy, he was also interviewed by the on-site Conference Journal. The lymphokine that Dr. Carter spoke about in his interview was interleukin-1 (IL-1), the primary action of which is to stimulate cells to produce interleukin-2 (IL-2).

Dr. Carter told the Conference Journal that his research group had determined that more than two-thirds of CFS patients have abnormally high levels of lymphokines; because of that, he suggested that CFS might more appropriately be named "lymphokine overdose disease."

According to Dr. Carter, many of the symptoms of CFS -- such as fatigue, memory loss, and other problems with thinking -- are probably caused by the high levels of lymphokines that patients are making in their own bodies.

CFS patients who have very high levels of IL-1 responded well to Ampligen treatment, Dr. Carter told the Conference Journal. Just as importantly, the patients in Dr. Carter's study who had high levels of IL-1 and who received a placebo (inert, or phony) substance instead of Ampligen got progressively worse.

One of the most disturbing findings made by Dr. Carter and his research team was that CFS patients with abnormally high levels of IL-1 had "anatomic holes" in their brains that were detected by using brain scans. It was not clear to the research team whether the holes were reversible or permanent.

From this information, Dr. Carter and his colleagues concluded that IL-1 is important in causing the symptoms of CFS, particularly the mental symptoms. Dr. Carter said that increased IL-1 could be used as a "footprint" to help diagnose severe CFS.

Tumor Necrosis Factor, TNF, was one of the first lymphokines to be discovered. Lymphokines -- also called cytokines -- are chemicals that are produced by immune system cells; they help different kinds of cells to communicate with each other in mounting immune responses.

TNF is produced by the immune system cells called macrophages, and was named "Tumor Necrosis Factor" because it was observed to make cancer cells die. TNF is also primarily responsible for causing the extreme weight loss observed in people with cancer and AIDS.

TNF has been found by some researchers to be increased in CFS patients. Other lymphokines -- gamma-interferon, interleukin-2, and interleukin-6, for example -- have also found to be increased in CFS. But some researchers have found these same lymphokines to be decreased in CFS, pointing out once again that a malfunctioning of the immune system can result in contradictory information being gathered.

Whether these cytokines are produced at increased or decreased levels in CFS, it is clear that their normal production is disturbed in these patients. Also, because different lymphokines and various types of immune system cells interact with each other in not-yet-understood ways, it's not clear exactly why CFS patients have abnormal amounts of TNF and other cytokines.

TNF has also been observed to cause HIV to reproduce at higher levels than it normally does. For that reason, Dr. Jay A. Levy, a prominent AIDS researcher in California, has suggested that AIDS is primarily a TNF disease. Dr. Levy has also suggested that, if TNF levels were decreased, a lot of the symptoms and illnesses seen in AIDS patients would disappear.

Interestingly, an experimental drug that has shown promise in treating both AIDS and CFS, Ampligen, has been shown to lower TNF levels, as well as improving symptoms.

Zinc is a trace mineral that is very important in maintaining a healthy immune system. But as many as 85 percent of CFS patients may have a serious zinc deficiency, which is extremely common among AIDS patients as well.

Zinc is perhaps the most important "growth factor" in the human body; any cells that are rapidly reproducing -- such as those involved in healing wounds, immune system cells that are actively fighting infections, and growing fetuses -- require a steady supply of zinc. Zinc deficiency in a pregnant woman can cause very serious birth defects in her child. The most dramatic birth defect caused by zinc is an encephaly, in which a child is born with only part of a brain, or actually no brain at all.

Zinc deficiency can also cause stunted growth (in children), skin lesions, hair loss, and increased susceptibility to infections because of impaired immunity.

A physical sign of zinc deficiency -- which is, according to some researchers, found in a large number of CFS patients -- is white spots on the finger nails, a condition called "leukonychia." Some CFS researchers have reported that a large majority of their CFS patients exhibit the white spots on their fingernails that are indicative of zinc deficiency.

Zinc deficiency may be responsible for another symptom of CFS -- alcohol intolerance. Many CFS patients are unable to tolerate alcohol. Zinc is responsible for helping to form the enzyme that breaks down alcohol, called alcohol dehydrogenase. Too little zinc may lead to insufficient production of alcohol dehydrogenase and, therefore, to alcohol intolerance.

Zinc deficiency, then, may not only contribute to lowered immunity and birth defects among CFS patients and their children, but also to the alcohol intolerance that is often a symptom of the disease.

Magnesium is a trace element that is necessary for the activities of many enzymes; serious deficiency can cause vascular problems, convulsions, tremors, depression, and psychotic behavior. In 1990, a British research team discovered that not only did CFS patients have a deficiency of magnesium in their red blood cells, but that magnesium injections actually helped some symptoms to improve.

In the British study, 35 CFS patients were divided into two groups. One group received a magnesium injection once a week for six weeks; the other group received a placebo injection (in this case, sterile water) once a week for six weeks.

At the end of the study, the patients who were treated with magnesium had much greater improvement in energy, pain, and emotional reactions than the placebo group did.

The British investigators concluded that, while magnesium may not be a cure for CFS, it could prove to be helpful in treating some symptoms of the syndrome.

The U.S. government's leading Chronic Fatigue Syndrome researcher, Dr. Stephen Straus at the National Institute of Allergy and Infectious Diseases, has for several years wasted a great deal of the government's resources by attempting to prove that CFS is a psychiatric illness, similar to depression. In one recent study in which he compared certain hormonal levels in CFS patients to those in people with depression, however, Dr. Straus uncovered a hormonal abnormality that contradicted his own theory.

Dr. Straus, working with researchers at the National Institute of Mental Health and the National Institute of Child Health and Human Development, found that CFS patients have decreased amounts of a hormone called cortisol, which is part of the natural "fight or flight" response.

CFS patients also have decreased amounts of the hormone that instructs the brain to produce cortisol, which is called CRH (which is short for "corticotropin releasing hormone").

Interestingly, cortisol deficiency is also one of the most common hormonal abnormalities seen in AIDS.

Both cortisol and CRH deficiencies can cause lethargy and fatigue. Therefore, Dr. Straus and his colleagues suggested that the CRH and cortisol deficiencies together, or either deficiency alone, could contribute to causing some of the symptoms of CFS.

In the course of this study, however, Dr. Straus inadvertently disproved his hypothesis that CFS is a form of depression. The cortisol and CRH levels found in patients with depression are actually opposite to those found in CFS patients: People with depression have increased amounts of both CRH and cortisol.

Although Dr. Straus's hormone study contributes to our understanding of one system that doesn't work in CFS, it unfortunately doesn't help in finding a treatment or cure. Because of the complex way in which hormonal systems interact, giving CFS patients extra cortisol would signal the body that it isn't necessary to make more cortisol. This could actually worsen the deficiency.

In spite of government documents acknowledging that cortisol treatment of CFS patients could be dangerous, Dr. Straus has proposed a clinical trial to treat CFS patients with compounds like cortisol.

Dr. Straus's possibly dangerous plan to treat CFS patients with steroids like cortisol fails, also, to take into account the fact that the growth of Human Herpes Virus 6 (as well as other viruses) is stimulated by such drugs.

If HHV-6 is causing CFS by growing out of control, cortisol treatment might actually worsen the illness in ways that we don't even understand yet.

A medical bulletin broadcast on the Cable News Network (CNN) in early 1993 reinforced the point that treatment with steroids such as cortisol can have unexpected negative side effects. CNN broadcast a report about a young boy whose asthma was being treated with steroids (like cortisone) when he contracted a mild case of chicken pox.

Chicken pox is caused by a herpes virus called Herpes zoster. Although it is a childhood illness from which most people recover with no deleterious after-effects, this particular young boy actually died from his chicken pox.

The reason he died, according to the CNN report, was because the steroid being used to treat his asthma caused the Herpes zoster virus to grow out of control and kill him.

A Long Island physician who studies CFS, Dr. Burke A. Cunha, has discovered what he calls "crimson crescents" in the throats of CFS patients. The crescents are so distinctive that Dr. Cunha believes that their presence indicates that CFS is present, even if the physician (or the patient) observes no other indication of the syndrome. Even more intriguing, Dr. Cunha has found that the crescents are associated with high levels of Human Herpes Virus 6 (HHV-6), a virus that is found to be actively growing in AIDS and CFS patients.

Dr. Cunha described his finding in a medical journal, and in November 1992, it was the cover story of the Infectious Disease News, a newsletter for primary care physicians. The crescents are described as being "crimson purple," and looking like half of a crescent moon.

After he reported his finding in the Annals of Internal Medicine, Dr. Cunha says he received calls from physicians all over the country. They told Dr. Cunha that, once they knew to look for the crescents, they were also finding them in their CFS patients.

Dr. Cunha thinks that many physicians may not have seen the crescents because they occur on both sides of the back of the throat, behind the back molars. Most physicians, Dr. Cunha remarked to Infectious Disease News, don't really look at the sides of the throat.

Dr. Cunha is convinced that the crimson crescents are highly correlated with CFS. "If your patient has crimson crescents, you can now say it is probably chronic fatigue syndrome," Dr. Cunha told Infectious Disease News.

Dr. Cunha also said, however, that he has found the crimson crescents in three to five percent of all patients who complain of sore throat -- which may mean that the number of people who have CFS has been grossly underestimated. The crescents have not been seen in patients with other illnesses that produce sore throats, such as mononucleosois, strep throat, cytomegalovirus infection of the throat, or common viral sore throat.

Dr. Cunha thinks that the crescents may occur in CFS patients because they are caused by the active HHV-6 found in the patients.

"I believe that the virus that causes chronic fatigue comes from young adults or children who give it to adults," Dr. Cunha told Infectious Disease News. "...I don't know why there is a difference, but the children do not have chronic fatigue. HHV-6 is a virus of children, and it may manifest as chronic fatigue in adults."

Dr. Cunha is trying to culture HHV-6 out of the crescents, but he has found that laboratories that perform throat cultures usually do not have the facilities to detect HHV-6, which is a fairly new human virus. To try to find HHV-6, he plans to perform biopsies on the crescents, Dr. Cunha told Infectious Disease News.

Dr. Cunha also pointed out that increased HHV-6 and decreased natural killer cell activity are the two most consistent laboratory findings in CFS. He thinks that the presence of the crimson crescents by themselves, however, are evidence enough that CFS is present.

"If you are a physician out in the middle of nowhere and you can't get HHV-6 titers and you can't get the natural killer cell percentage, then the crimson crescents may be the only way besides history that can suggest the diagnosis" of CFS, Dr. Cunha told Infectious Disease News.

The "crimson crescents" identified in the throats of CFS patients by Long Island physician Burke A. Cunha are, he has pointed out, closely associated with increased antibodies to Human Herpes Virus 6 (HHV-6). Dr. Cunha's description of these crimson-to-purple crescents suggests that they may be manifestations of Kaposi's sarcoma (KS), a type of lesion or tumor seen in AIDS. A finding that strengthens this possibility is that HHV-6 has recently been found in Kaposi's sarcoma tissue. That fact raises several questions: Is HHV-6 the cause of KS? And, given that increased antibodies to HHV-6 are closely associated with the crimson crescents of CFS, are those lesions caused by the virus? And, most importantly, are the "crimson crescents" of CFS actually a form of KS lesion?

Although the conventional wisdom about AIDS says that KS develops only in certain "risk groups," such as gay men, autopsies have shown that greater than 94 percent of all AIDS patients have some form of the tumor-like growths in their internal organs. Experts have agreed that, since KS can occur in many different physical forms internally and externally (on the skin), the possibility exists that the crescents are a type of KS, which also varies in color from red or crimson to deep purple. That possibility should be easy to prove or disprove, once biopsies have been performed on a number of the crimson crescents; however, the research has not yet been performed.

The identity of the crimson crescents may also become mired in a dispute in the scientific community over the nature of KS itself. Some researchers believe KS to be a true cancer, manifest only in typical tumors (such as those observed on the skin). Others believe it is actually an overwhelming inflammatory response, occurring in numerous types of abnormal tissue responses, both in internal organs and on the skin. It does not appear that this dispute among scientists will be resolved any time soon.

Called a "neoplasm" -- which simply means a clump of growing cells -- most researchers agree that KS is not a typical cancer. It can produce lesions and tumors, both internally and on the skin, across a spectrum of different forms; other cancers usually manifest themselves in one particular form, such as breast cancer, for instance, which almost always forms a solid tumor.

In addition, the type of KS seen in AIDS is different from the generally harmless type of KS which was first described around a century ago in older, Mediterranean men.

And although KS in AIDS patients was initially believed to be caused by HIV, the "AIDS virus," numerous cases of AIDS-type KS have now been identified in HIV-negative people.

Speculation has abounded for several years that KS may be caused by a separate, as-yet-unidentified virus, but none has been discovered to date.

In May 1993, however, a research group from the University of Ferrara in Italy reported in the British medical journal The Lancet that they'd found HHV-6 in 35 percent of 20 biopsies of KS tissue. While more work needs to be done to verify this finding, the Italian scientists suggested that HHV-6's "possible contributions" to the development of KS should be investigated; in other words, they suspect that HHV-6 may be the long-sought-after cause of KS.

If the crimson crescents found in CFS patients, which are also associated with HHV-6, are found to be a form of KS, that would make it very difficult for anyone to argue that CFS and AIDS are unrelated diseases.

Tuberculosis is a sometimes-fatal illness that was all but eradicated before the AIDS epidemic began. It is possible for healthy people to become infected with the tuberculosis germ (a bacterium) without becoming sick; this is called a latent infection. But because people with AIDS do not have intact immune systems, they do become sick -- and, at the same time, are contagious to other people -- when they encounter the TB germ.

TB is of particular concern to public health officials because of the way it is spread, which is in saliva droplets that contain bacteria. While prolonged, close contact between people breathing the same air -- like people in jail -- is usually required for TB to spread, it is more casually contagious than almost any other equally serious illness.

And people whose immune systems aren't functioning properly -- like AIDS and CFS patients, as well as cancer patients -- become infected, and sick, with tuberculosis much easier than healthy people.

The natural killer (NK) cells are a front-line defense against other cells infected with TB germs but, in both AIDS and CFS, the NK cells don't work properly.

Ironically, new studies have shown that NK cells do not function properly in people who have TB. Therefore, the very cells that should be protecting the body against the TB infection are made less effective by that infection.

Therefore, a person whose NK cells were not working well in the first place can become very sick, very fast, from TB.

Most people are aware by now that AIDS patients are particularly vulnerable to TB. What isn't commonly known is that CFS patients are also more susceptible to TB than are healthy people, according to the Associate Director of the Centers for Disease Control and Prevention Tuberculosis Division, Dr. Donald E. Kopanoff.

Dr. Kopanoff told Spin magazine in December 1991 that CFS patients, because they are in generally poor health, are at much greater risk for contracting active TB than the rest of the public.

Another part of the immune system that doesn't work properly in CFS patients is the cell-mediated immunity; this is the type of immunity that is controlled primarily by T4 cells. Both CFS and AIDS patients sometimes have severely decreased numbers of T4 cells, which is partially why their cell-mediated immunity doesn't work.

The cell-mediated immunity produces the type of immune response that causes a bump to rise at the site of a skin test for TB (and other diseases, as well). If the cell-mediated immunity is not working properly, no bump is formed at the site of the test, even if the person is infected with TB.

Therefore, when the immune system is not functioning properly, there is no easy and reliable way to distinguish infected from uninfected individuals. The millions of people suffering with CFS all over the world could turn TB into a disaster of enormous proportions, which is another reason patients should demand that the truth be told about this epidemic.

It has been known for some time that CFS patients have abnormal blood flow in their brains; that is, some areas of the brain are not getting as much blood as they should. Very recently, however, studies of patients with AIDS dementia have shown that they, too, have abnormal brain blood flow, raising the question of whether a similar disease process is taking place in both sets of patients.

It has only been possible to measure blood flow in the brain with the development, over the last few years, of very specialized types of brain scan technologies. One type of brain scan that can detect blood flow abnormalities is called SPECT (which stands for "single photon emission computer tomography").

Dr. Ismael Mena has studied CFS patients' brains using SPECT scans at the University of California-Los Angeles, where he is a professor of radiology. Over several years' investigation, Dr. Mena has consistently reported that 71 percent of CFS patients have a diminished flow of blood in their brains.

Dr. Mena has also commented, at scientific conferences, that CFS patients do not have equal blood flow on the two halves of their brains. That is, when the blood flow on the right and left sides (or hemispheres) of the brain were compared in individual CFS patients, the flow in the two halves of the brain can differ by twice as much as they do in healthy people.

This information suggests that some type of organic brain disease may be a component of CFS. While it has long been recognized that AIDS patients can develop very serious mental problems, sometimes labeled "AIDS dementia," only recently have such patients been studied using SPECT scans. The similarity between "AIDS dementia" patients' SPECT scans and those of CFS patients are striking.

SPECT scans in AIDS patients were discussed at the 1992 international AIDS meeting (in Amsterdam) by a research team from the Houston Immunological Institute. Rather shockingly, they found that exactly the same percentage of AIDS patients -- 71 percent -- as CFS patients had abnormalities in brain blood flow. The Houston research team also found that more severe cases of AIDS dementia showed greater abnormalities in brain blood flow, and they suggested that SPECT scans could provide a very important diagnostic tool for physicians treating patients with AIDS.

Abnormal SPECT scan results have not yet been firmly associated with any of the mental abnormalities -- short-term memory loss, for instance, or difficulty concentrating -- observed in CFS patients. But as this still-new technique becomes more refined, it may well help unlock some of the mysteries of the mind associated with not only CFS, but also AIDS.

People who have CFS sometimes experience a dramatic weight loss or gain. Many women CFS patients I've spoken to have gained a significant amount of weight since becoming ill. This may be due to lack of exercise, or possibly even to the as-yet-not-understood hormonal problems associated with CFS.

Another possible explanation for CFS patients' weight gain is that organic changes occur in the brain. The central nervous system, directed by the brain, governs metabolism -- how fast calories, and stored fat, are burned. Changes in the brain waves, sugar metabolism, oxygen flow, and even in the physical appearance of the brain have been documented in CFS patients. It is possible that virus-induced changes in the brains of CFS patients also affect their metabolism, and thereby result in weight gain.

Significant weight loss, however, can also be a component of CFS. One patient I interviewed, a young man named Al, lost 55 pounds in just one year. His weight loss was so precipitous and unexpected, Al told me, that his doctor concluded that he must have either cancer or AIDS.

In AIDS, weight loss is often caused by an overproduction of tumor necrosis factor (TNF). If CFS, like AIDS, turns out to include a major disruption in the production of TNF, that may explain why patients lose weight at certain stages of the illness.

The fluctuation in weight experienced by CFS patients, however, is yet another example of how major systems are dysfunctional -- sometimes overactive, sometimes underactive -- in the syndrome.

Nearly all CFS patients have problems with balance and equilibrium, either occasionally or constantly. It is not known what causes these or other nervous system problems in CFS, or how to cure them.

One patient I interviewed, Al, told me that his dizziness was so pronounced, at times, that the sidewalk he was walking on appeared to be tilting up to meet him.

When this happened he would fall down, and be unable to get up or walk until the dizziness passed.

Balance can be tested very simply by any physician, and CFS re searcher Dr. Paul Cheney performs this test on his patients: The patient stands, feet together, arms at the sides, and closes his or her eyes.

"Then," Dr. Cheney told me, "they fall over." This type of imbalance is very common among his CFS patients, Dr. Cheney says.

AIDS patients can suffer very similar balance disturbances and dizziness, and even have seizures (which CFS patients can also experience). Headache, memory loss, confusion, and weakness of the limbs are other neurological problems that can develop in both CFS and AIDS.

Whatever the exact cause of the balance problems in CFS, it is clear that the central nervous system is very seriously affected by this syndrome.

Infected or inflamed sinus passages, or sinusitis, can become a chronic ailment in CFS patients, as it can in AIDS patients. Like many other aspects of CFS, no formal studies have determined what percentage of CFS patients develop chronic sinusitis. California researcher Dr. Carol Jessop has noted, however, that 40 percent of her CFS patients develop recurrent sinusitis, with bronchitis -- an inflammation of the air passage in the lungs -- developing in 30 percent.

Since as many as 90 percent of CFS patients report having some type of allergy problems, it is perhaps not too surprising that many would also develop chronic sinus problems.

Sinusitis is also often a major problem for AIDS patients. As the immune system becomes increasingly more depressed, it is less able to destroy the bacteria and other organisms that are inhaled with every breath of air. Pneumocystis carinii infection, which usually occurs in the lungs and causes pneumonia (commonly called PCP), can also occur in the sinuses. There is also the possibility that the sinus pain experienced by AIDS patients can be due to Kaposi's sarcoma, or lymphoma, or another kind of tumor.

After a steady decline over several years in deaths caused by childhood asthma, the number rose again sharply in the early 1990s. In March 1991, in fact, the National Institute of Allergy and Infectious Diseases funded a National Cooperative Inner-City Asthma Study to attempt to prevent the soaring number of asthma deaths.

In early 1992, a study published in the New England Journal of Medicine noted that Americans spent about $6.2 billion on asthma-related health care in 1990.

Is the CFS epidemic responsible for at least part of the rise in asthma, particularly childhood asthma, in the U.S.?

Asthma is caused by a temporary blockage of the airways in the lungs; the airways typically are blocked by an inflammatory response of some type (such as an allergic response) that can cause swelling in the airway, or by accumulation of excess mucous.

Dr. David Bell studied an outbreak of CFS in Lyndonville, New York, in which a number of children developed the syndrome. He found that more than half of the 74 children involved in the outbreak had allergies and/or asthma before developing CFS.

CFS, however, made these children's allergies/asthma worse, according to Dr. Bell. Half of those who had allergies/asthma before they developed CFS told Dr. Bell that their symptoms clearly worsened after they contracted CFS.

Five percent of the children involved in the outbreak who had never had allergies or asthma developed symptoms after being stricken with CFS.

No one knows why asthma and asthma-related deaths among children are rising. But, given that allergies and other inflammatory responses are so common among CFS patients (in both children and adults), the possibility that the CFS epidemic may be contributing to the rise should be investigated.

Endometriosis, a painful condition in which the tissue lining the inside of the uterus (the endometrium) migrates outside the uterus, appears to occur in much higher rates in women with CFS than it does in otherwise healthy women.

The endometrial tissue can migrate to any location in the body once endometriosis begins, but it is often found on the surfaces of organs and structures nearest the cervix, or entrance to the uterus: the bowel, bladder, fallopian tubes, ovaries, the uterine surface, and on the surfaces of the supporting tissues.

The most common symptoms of endometriosis are pain during menstruation (often a dull, persistent pain that seems to be located in the lower back), irregular or heavy menstrual bleeding, pain during sexual intercourse, and infertility.

A Long Island physician who has a large number of CFS patients in his practice, Dr. Perry Orens, believes that there is definitely an increased rate of endometriosis among women CFS patients. Dr. Orens believes that there is an as-yet-unidentified hormonal component in CFS that is causing the increased incidence of endometriosis. This hormonal component of the disease, Dr. Orens also believes, may explain why more women than men have or appear to have -- or at least are diagnosed with -- CFS.

Other researchers have reported that as many as 30 percent of female CFS patients have endometriosis.

The effect of pregnancy on CFS patients varies widely, as do many other aspects of the illness. Some physicians report that their pregnant patients feel much better than they did before they became pregnant; others report serious problems during or following pregnancy, for both mother and child. Since CFS patients are not routinely staged -- that is, there are no accepted guidelines to measure the length or severity of their illness -- these discrepancies may reflect what happens to women who become pregnant in different stages of CFS.

Dr. Paul Cheney, for instance, reports that he has seen some pregnant patients whose symptoms improve dramatically. Dr. Cheney suggests that this might be because of the action of the placenta, the umbilical cord that connects mother and fetus. Not only nutrients, but also blood, with all of its immune system components (like cells, lymphokines, antibodies, etc.), flow through the placenta. Dr. Cheney points out that one action of the placenta is to down-regulate the mother's immunity, so that the mother's immune system does not identify the fetus as something "foreign" that should be destroyed.

On the other hand, some researchers have found that certain problems associated with pregnancy -- like morning sickness -- and fertility can be worsened in CFS patients. California researcher Dr. Carol Jessop has found, too, that the incidence of miscarriage was somewhat higher than normal among her CFS patients.

The most disturbing information about CFS and pregnancy, however, comes from Canadian researcher Dr. Byron Hyde. At a research conference in 1991, Dr. Hyde discussed some women patients who did not have CFS until after they became pregnant. These patients gave birth to babies who died shortly after they were born, because they had what Dr. Hyde described at a research conference as "major, major birth defects" -- such as being born with serious heart defects, or without brains (which is called "anencephaly").

Dr. Hyde has urged that these very serious effects on pregnancy should be studied far more intensively than they have been to date.

Because the majority of patients first diagnosed with CFS were women, little attention has been paid to the problems that are unique to men with the disease. But one such problem is prostatitis, an infection and swelling of the prostate gland, which is instrumental in the production of semen (the fluid containing sperm). This symptom may parallel the recurrent urinary infections and reproductive/endocrinological problems (like premenstrual tension and endometriosis) that many women with CFS suffer.

Dr. Carol Jessop, who studies CFS in San Francisco, says that prostatitis, along with sinusitis, is the most common recurring infection she has observed in men with CFS.

It is not clear what is causing the prostatitis seen in men with CFS, but there are indications that it may be in some way infectious, or caused by an infectious agent. A CFS patient I interviewed, "Susan," told me that, after she developed CFS, her boyfriend developed a prostate infection that did not respond to standard treatment. Not only did Susan's boyfriend develop a refractory prostatitis, but so did a number of his male friends with whom he spent a lot of time, according to Susan.

Because CFS patients' natural killer cells -- which protect against both viral infections and some kinds of cancers -- do not work properly, it is possible that men with CFS are also more prone to developing prostate cancer, as well as prostatitis. Like many aspects of CFS, however, this possibility has not been the subject of a formal study.

A relatively high percentage of CFS patients develop of type of heart murmur called "mitral valve prolapse." Like many other aspects of CFS, this phenomenon has not undergone rigorous study; anecdotally, however, many patients and physicians have noted the prevalence of mitral valve prolapse among CFS patients.

This kind of heart murmur occurs when one of the valves in the heart (the mitral valve, which is on the left side of the heart) collapses to a certain degree (which varies from person to person). In minor cases, mitral valve prolapse can cause little more than a distinctive clicking sound heard when listening through a stethoscope. But in severe cases, mitral valve prolapse can cause chest pain, fatigue, heart arrhythmias -- typically, causing the heart to beat too fast -- or even sudden death.

It is not known why heart problems develop in some CFS patients, and many U.S. researchers doubt that they are connected to CFS. But Dr. Byron Hyde, who studies CFS in Toronto, commented at a 1991 research conference that the heart problems associated with CFS are "major." Dr. Hyde also pointed out that no one in North America is studying this potentially life-threatening aspect of the disease, a statement which is still true today.

Heart failure, however, is a fairly common cause of death in AIDS, and the heart can be affected by a number of problems encountered by AIDS patients. For instance, Kaposi's sarcoma has been found in heart tissue, as well as the tissue that covers the heart. KS has also been found in the aorta, and on the arteries that feed the heart itself.

Additionally, for unknown reasons, heart tissue may simply die in AIDS, a condition called "acute myocardial necrosis" that is fatal.

Viruses can attack the heart, especially the tissue around the outside of the heart muscle, and cause a condition called "endocarditis." It would be useful to determine if viruses that are active in both CFS and AIDS patients -- especially HHV-6 -- are capable of causing some of the heart problems found in both syndromes.

Bruises are caused by the collection of blood under the skin, usually resulting from some kind of trauma that causes superficial blood vessels to break. There is variability in how easily people bruise, of course, just as there is in how easily they sunburn. But when a person begins to bruise much more easily than he or she ever has before, it can be the sign of a serious immunological disease, like some forms of cancer (such as leukemia), CFS, or AIDS.

CFS patients sometimes find that they bruise more easily after they become sick. One reason for that can be the development of a condition called "thrombocytopenia," which is a blood clotting disorder. One reason that some CFS patients may develop thrombocytopenia and easy bruising is because they have decreased numbers of the blood cells most directly responsible for causing blood clots, called platelets.

Thrombocytopenia was recognized very early as an indication that AIDS might be present. In a 1984 physicians' handbook, AIDS: A Basic Guide For Clinicians (published by the W.B. Saunders Company), thrombocytopenia is listed along with fever, weight loss, fatigue, and swollen lymph glands as an indication to physicians that a patient might have AIDS.

A clue about why AIDS and CFS patients might develop thrombocytopenia emerged in mid-

1993, when Japanese researchers reported in the Pediatric Infectious Disease Journal that an infant with a severe HHV-6 infection had also developed thrombocytopenia. The Japanese researchers noted that HHV-6 is known to interfere with the differentiation of bone marrow cells, like those that develop into platelets. They suggested that the possibility that HHV-6 is directly responsible for causing thrombocytopenia in some cases, by infecting bone marrow cells and stopping them from developing into mature platelets, should be further investigated.

In another twist to the CFS story, some researchers hypothesize that CFS can be communicated between patients and their pets. It also appears that CFS patients' sick pets can develop clotting disorders reminiscent of thrombocytopenia.

In the Spring 1992 issue of the CFIDS Chronicle, which was entirely devoted to patients' letters and stories, a woman patient wrote about the illness and death of her dog, who suddenly became "strangely ill."

"Soon afterward, he began to suffer from nosebleeds, which in 1984 had been the prelude to the onset of my CFIDS," the patient wrote. The dog's condition continued to decline: He developed ulcers first in his mouth and around his eyes, then over his whole body, and "he grew unsteady on his feet, became dazed and disoriented," the patient wrote. The dog's laboratory tests showed "immune dysfunction, possibly due to a viral agent," according to this patient, who became convinced that her dog died from a bleeding disorder associated with CFS.

The fact that HHV-6 was isolated from a sick dog (which eventually died) belonging to a CFS patient suggests that this virus could be causing bleeding disorders in more than one species.

The soft tissues inside the mouth, particularly the gums, are quick to reflect ill-health. One reason for this is that the gums contain many blood vessels along which viruses and bacteria can travel. Gum disease, when it occurs in the absence of an obvious explanation (such as inadequate oral hygiene), can signal the presence of immunodeficiency, like that seen in CFS and AIDS.

One of the signs of impaired immunity that appears in both AIDS and CFS is oral thrush, which is an overgrowth of a common yeast, Candida albicans. Thrush is an "indicator" illness in AIDS; that means, if a person considered to be at "high risk" suddenly has thrush for no discernible reason, physicians usually consider the diagnosis of AIDS.

Oral thrush can also occur in CFS patients; in fact, Dr. Paul Cheney has said that oral thrush is "not uncommon" among CFS patients. To date, no formal study has determined exactly what percentage of CFS patients develop thrush.

Another condition that can signal immunodeficiency is a gum disease called gingivitis, a bacterial infection that causes gums to swell, turn red, and bleed (especially when the teeth are brushed). Some CFS patients can actually gauge the severity of their illness by the condition of their gums.

In 1991, the journal PAACNOTES, which is published by the Physicians Association for AIDS Care (based in Chicago), warned that the type of gingivitis developed by AIDS patients (called "ulcerative") is often unresponsive to typical treatment.

Additionally, the periodontal disease seen in AIDS patients -- which affects the jaw bone and can cause teeth to fall out -- can result in loss of 90 percent of the affected bone in as little as 12 weeks, according to PAACNOTES. The journal pointed out that, while some communities report that these gum diseases occur in a very small percentage of AIDS patients (as low as 10 percent), in other communities, they occur in more than 90 percent of AIDS patients.

In mid-1992, a research group at the University of California, San Francisco, reported at the international AIDS meeting held in Amsterdam that oral thrush is associated with AIDS progression and may be used to determine how rapidly a person's health may be failing -- an observation that may hold true for CFS patients, as well.

The nervous system symptoms experienced by CFS patients can be the most frightening: dizziness (also called vertigo) and visual problems such as blurred or double vision, as well as inaccurate depth perception, are extremely common. Transient, or temporary, blindness can occur in CFS. Like AIDS patients, CFS patients can develop "floaters" that obscure the vision and can be very distracting. These symptoms that impair vision may be the most hazardous to the health of CFS patients -- especially if they drive.

Patients have told me that they've sometimes become so confused while driving that they've had to pull over to the side of the road and rest before continuing. While it's not known for sure, it's possible that whatever is causing the visual and perceptual problems in CFS patients is also causing the mental confusion they sometimes experience.

For instance, researchers have found that CFS patients have real problems in processing information; they are unable to put pieces of information together properly. That can result in memory loss, as well as difficulty in judging both position and movement. For example, patients have told me that sometimes they feel so dizzy, they seem to themselves to be walking at an angle to the ground -- they really cannot tell whether they are standing upright or leaning at a slant.

For unknown reasons, the color vision of CFS patients can become quite disturbed. Also, they may lose their ability to see well at night, called "night vision." This can be especially dangerous for CFS patients who go out alone or who drive cars at night.

These perceptual problems may make even climbing stairs or taking an escalator, as well as crossing streets or actually driving a car, exceptionally dangerous for CFS patients while they are experiencing them.

And, of course, all these symptoms, as well as the general visual disturbances reported by patients, worsen with increased fatigue.

Just about every physician who cares for CFS patients mentions sleep disorder as one of the most important symptoms to control. Since fatigue can be overwhelming to CFS patients, sleep is critical to restoring what energy they possess. However, although they may sleep far more than they did before becoming sick, CFS patients often report that they wake up feeling just as tired as they did before sleeping.

Dr. Paul Cheney has characterized sleep as the single most important symptom to treat in CFS. Not only is sleep disorder one of the easiest problems to correct in CFS, according to Dr. Cheney, but he has found that CFS patients will not respond well to other treatments if they are not getting adequate sleep.

One possibile explanation for the unrefreshing sleep reported by CFS patients is that they have less dreaming, or REM, sleep time than healthy people.

REM sleep can be disrupted by many things. Nighttime twitching (seizures or ""fasiculations,'' abrupt movements of arms and legs) can interrupt REM sleep. So can pain upon movement, which many CFS patients experience at night.

CFS patients often have a body temperature that is slightly lower than that of healthy people and as a result, have colder extremities. If fingers and toes become too cold during sleep, they can become painful, and that pain can wake the patient.

Other kinds of pain -- like night time headache pain -- can wake the patient. So can frequent urination, which CFS patients -- particularly those prone to bladder infections -- tend to develop.

Breathing problems -- like sleep apnea, in which the person stops breathing for a short period of time -- can contribute to CFS patients' sleep dysfunction.

Nightmares can also disturb CFS patients' sleep. Although it is unknown what causes nightmares, and their significance in CFS is also unknown, many CFS patients report that their dreams have become more intense and more violent and disturbing since they became ill. Children with CFS have reported especially vivid nightmares.

Some researchers have suggested that the disturbed sleep patterns observed in CFS patients may be due to some abnormality in brain chemistry.

Dr. Byron M. Hyde, a physician who studies CFS in Ottawa, Canada, has suggested that major sleep disturbance may be one of the very first symptoms of CFS to develop.

The sleep patterns of CFS patients have also been studied extensively by another Canadian physician, Dr. Harvey Moldofsky, the director of the University of Toronto Sleep Disorders Clinic.

There are bizarre occurrences that can disrupt CFS patients' sleep, such as sudden, flashing lights in the eyes, which can also appear when the patient is awake, or increasingly vivid and disturbing nightmares. No one knows what these strange symptoms mean, what they are caused by, or if they really have anything to do with CFS.

Another reason that the sleep of CFS patients is disturbed is that they can suffer from night sweats, like AIDS patients. One study found that as many as 40 percent of CFS patients experience night sweats.

It is suspected that a person's quality of sleep may correlate with immune function, i.e. that poor quality of sleep may lead to impaired immune functioning. How disturbed sleep and immune dysfunction may be interacting in CFS is currently being studied by Canadian researchers. This research could also have important implications for those studying AIDS and other immune system disorders.

People with CFS have a variety of gastrointestinal problems: bloating, pain, constipation, and diarrhea. Often these symptoms are treated with an anti-ulcer drug named Tagamet, which has two primary actions: It blocks the action of histamine (a naturally-produced substance that governs the production of stomach acid, as well as some allergic reactions), and it stimulates natural killer cell activity. The fact that Tagamet can improve some CFS patients' symptoms rather dramatically has suggested to some observers that histamine may be very important in CFS.

But another gastrointestinal symptom suffered by CFS patients that has not received much attention is nausea. It appears, however, to be pretty common among CFS patients. Nausea can result from any number of causes, and no one knows what is causing it in CFS patients. It may be a side-effect of some kinds of neurological symptoms, such as dizziness but, to date, has not been studied in any systematic fashion.

One study found that 50-60 percent of CFS patients report nausea as a symptom. The same study commented that CFS can begin as something that resembles a "stomach flu," with nausea, fever, diarrhea, muscle aches, and fatig