Acyclovir May Be Used to Treat Certain Long COVID Patients Regardless of Herpesvirus Reactivation: Case Report

Fundamental causes of long COVID or Post-Acute Sequelae of COVID-19 (PASC) are still under investigation while it remains a significant burden to millions of patients worldwide even after a relatively mild acute Coronavirus Disease 2019 (COVID-19) episode. Treatment and management programs are yet to be developed. The foremost hypotheses for underlying PASC pathophysiology include: The persistence of the virus in certain tissues, hyperinflammation due to COVID-19 immune dysregulation, and microcoagulation. Reactivation of herpesviruses has been regularly observed in certain patients going through COVID-19 and PASC. Such reactivation is thought to facilitate the entry of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) virus into cells, enhancing the viral load, severity, and duration of symptoms. An unusual, non-hospitalized, and immunocompetent PASC patient is presented here. This study is a retrospective and descriptive review of the patient's clinical records with his consent. The prescriptions and clinical investigations were performed by his medical staff upon him seeking help voluntarily due to his symptoms. After suffering for about 12 months since his initial infection with SARS-CoV-2 in March 2020, he developed shingles in March 2021. He was prescribed 800 mg Acyclovir 5 times daily for 7 days by his primary care physician. He recovered not only from shingles but also from all of his PASC symptoms shortly after taking Acyclovir and resumed a normal life. Hence, the possible use of a well-known, safe, affordable anti-viral medication, Acyclovir, for long COVID patients is proposed. Full recovery of a long COVID patient after using solely Acyclovir for only 7 days is presented here for the first time. This observation supports the theory of SARS-CoV-2 lingering in various tissues of the body after several months as one of the causative factors for PASC: Since he recovered from all of his PASC symptoms and anti-viral Acyclovir might have acted against the remaining SARS-CoV-2 as well. Although more systematic clinical trials are needed to confirm these results, this finding could potentially transform the treatment options for PASC sufferers, especially with herpesvirus reactivation globally.