Weird Science: Chronic Fatigue Syndrome and Off-Label Use of H.I.V. Medications

Source: NY Times

A recent article published in the New York Times reports the off-label use of HIV medications (antiretrovirals). Medications are frequently prescribed for off-label use, however, when used as a treatment for chronic fatigue syndrome, a malady without a clear etiology or pathophysiology, then such prescription practice is even less conventional.


At the heart of the controversy is a 2009 study linking chronic fatigue syndrome to a retrovirus called XMRV.  However, this finding has not been replicated, putting into question the pathophysiologic link between XMRV and chronic fatigue syndrome.  Science, the medical journal that published the original research has even taken the step of asking for a retraction from the study's authors. To my knowledge, there are no clinical studies, case series or even a single case report published on the successful use of antiretrovirals for chronic fatigue syndrome. Prescribing antiretrovirals for chronic fatigue syndrome is simply not supported by even low quality data.


With an estimated 1,000,000 Americans suffering from chronic fatigue syndrome, pharmaceutical companies have a potential financial gain.  Further, the prescription of antiretrovirals for chronic fatigue syndrome appears ethically unsound and may be associated with an opportunity cost especially as many HIV+ patients in the USA still have no access to medications.


Weird science and bad medicine.