FIRST PROTOCOL AND THERAPEUTIC TEST WITH TENOFOVIR DF/ EMTRICITABINE (TRUVADA or generic) TO ASSIST THE DIAGNOSIS OF VIRAL PERSISTENCE IN POST ACUTE COVID SYNDROME (PACS) OR LONG COVID.

If there is a response to treatment, the presence of Viral Persistence is supported. We also indicate it for Post-Vaccine COVID Syndrome (PVACS) or Post-Vaccine Persistent Symptoms.

ABSTRAC.

There is a large number of patients with Acute Post COVID Syndrome (PACS), Long COVID or Persistent COVID, and there are many difficulties for its proper diagnosis.

Faced with this problem, in June 2020 we proposed the use of Therapeutic Tests using drugs against the viral load for patients with Acute Post COVID Syndrome (PACS), Long COVID or Persistent COVID.

Therapeutic Tests have been used as a diagnostic aid for several decades, for example, Levodopa is used for Parkinson's Disease and other movement disorders.

In the case of PACS or Long COVID, the Therapeutic Test is intended to help diagnose the presence of Viral Persistence, which, according to what we have observed, is its main cause.

We also indicate it for Post-Vaccine COVID Syndrome (PVACS) or Post-Vaccine Persistent Symptoms, , especially when they have more than 1 month of evolution, since the longer the time elapsed, the greater the probability that the cause of the symptoms is the reactivation of a latent infection by SARS CoV-2 and/or the activation from other persistent infections and/or the overgrowth of other viruses or microorganisms that existed from before in the patient, and that were activated in response to the vaccine.

In addition to serving as a diagnostic aid, according to our experience, the Therapeutic Test serves to identify whether the viral load is sensitive to the drugs that have been indicated, and in cases in which effectiveness against the viral load is evidenced, the Therapeutic Test passes to become a first Protocol or specific treatment scheme to follow.

The drugs included in this Therapeutic Test are based on the 3 Objectives or Lines of Action of the Therapeutic Plan for COVID that we established in the document that we published on May 2, 2020.

These 3 Objectives or Lines of Therapeutic Action are:

1st Objective or Line of Therapeutic Action: REDUCE THE VIRAL LOAD. It is the main objective, and here we include effective medicines to reduce Viral Load.

2nd Objective or Line of Action: REDUCE PLATELET HYPERACTIVITY AND BREAK DOWN PERSISTENT MICROCOAGULOS. Its objective is to counteract the "favorable environment" for the virus that is generated at the level of the blood vessels and that we propose becomes a factor associated with viral persistence. That is why in the first days of the Therapeutic Test, only the antiplatelet agent is started, so that it acts by helping to break down the microclots and in this way better results would be obtained when giving the medication against the viral load.

3rd Objective or Line of Action: TREAT NUTRIENT DEPLETION, OXIDATIVE STRESS AND IMMUNE DYSFUNCTIONS. Here Famotidine or Bicarbonate are considered, it is also indicated to follow a diet low in Histamine and high in Lysine and Vitamin D.

This document describes in detail the doses to be given of each of the medications included in the Therapeutic Test.

In the last 2 years, we have tested several drugs against viral load, noting that the virus quickly acquires drug resistance if it is not given in sufficient doses and time.

The use of Tenofovir disoproxil fumarate, also known as Tenofovir DF or TDF, together with Emtricitabine (marketed as Truvada or in generic versions) has several advantages over other antivirals.

In addition to being effective against SARS CoV2 and HIV viral load, it also has effects against Hepatitis B Virus (HBV), Epstein-Barr Virus (EBV) and Hespes Simple 2 (HSV-2).

It comes in presentation in tablets that already contain both antivirals together and in the amounts indicated to be taken orally at a dose of 1 tablet per day.

As for its cost, it is below that of other antivirals.

Other advantages are the experience in their use for 2 decades, they are currently considered the drugs of choice for Pre-Exposure Prophylaxis (PrPE) in HIV-negative people, and they are included in the list of essential drugs of the World Health Organization. Health.

It does not have major side effects and is often well tolerated, so it could be taken for several weeks or a few months, which is convenient to avoid subsequent reactivation of the infection.

Its most frequent adverse effects are discomfort or pain in the stomach that calms down after going to the bathroom, semi-liquid stools, diarrhea, nausea and loss of appetite.

When taking Tenofovir, you should avoid any medicine that can affect kidney or liver function, and these include NSAIDs, Metformin and Carbamazepine.

In those over 55 years of age, diabetics, hypertensive or with any kidney pathology, kidney function should be evaluated beforehand. And in them it is recommended that from the first day they additionally take Mebivolol at a dose of 2.5mg per day, and from the 5th day it is indicated to increase the dose to 5mg per day.

At the end of the Therapeutic Test, after 12 days of taking the indicated medications, the results must be obtained, first for each one of the symptoms, and then for all the symptoms as a -whole.

In those patients who result in an average improvement of 40% or more in all symptoms, or 4 or more points out of 10, it is recommended that they continue taking these antivirals, and our current suggestion is to indicate it for at least 2 to 3 months, being able to prolong the time, this especially in the cases of Multidrug-Resistance (MDR), with the objective of achieving the eradication or reduction to the minimum possible of the Viral Load.

In these cases, if the patient does not have bradycardia or hypotension, we recommend adding Nebivolol, which is a cardioselective beta-blocker that improves endothelial dysfunction and has nephroprotective effects, having been reported to improve renovascular alterations induced by Tenofovir. Additionally, in several studies it has been identified that it would have antiviral effects against SARS CoV-2.

More details about this Antiviral Treatment Protocol are described in the full text version of this document available at the following link:

https://www.researchgate.net/publication/366412536

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