Apostolou, Eirini, Rosén, Anders · Journal of internal medicine · 2024 · DOI
This review examines how viruses, particularly Epstein-Barr virus, may cause lasting changes to how our cells work in ME/CFS patients. The authors found that in about 70% of ME/CFS cases, the illness begins after a viral infection, and viruses can hide in the body while triggering long-term problems with energy, thinking, and immune function. Understanding these viral-triggered changes could help explain why different patients experience ME/CFS differently and may lead to better treatments.
This work provides a mechanistic framework linking viral infections to the multi-system dysfunction observed in ME/CFS, which could guide research toward epigenetic biomarkers and targeted interventions. Understanding how viruses manipulate cellular regulation may reveal why ME/CFS symptoms persist long after acute infection and why some patients deteriorate with exertion. This knowledge is particularly relevant given the overlaps between ME/CFS and long COVID.
This narrative review does not establish definitive causal relationships between specific viruses and ME/CFS—it synthesizes existing evidence without new experimental data. It does not prove that viral reactivation occurs in all ME/CFS patients or that targeting viral epigenetic mechanisms will reverse symptoms. The review cannot determine whether observed epigenetic changes are primary causes of ME/CFS or secondary consequences of systemic illness.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Apostolou, Eirini & Rosén, Anders (2024). Epigenetic reprograming in myalgic encephalomyelitis/chronic fatigue syndrome: A narrative of latent viruses.. Journal of internal medicine. https://doi.org/10.1111/joim.13792
BibTeX
@article{mecfsatlas-apostolou-2024-epigenetic-reprograming,
author = {Apostolou, Eirini and Rosén, Anders},
title = {Epigenetic reprograming in myalgic encephalomyelitis/chronic fatigue syndrome: A narrative of latent viruses.},
journal = {Journal of internal medicine},
year = {2024},
doi = {10.1111/joim.13792},
note = {PubMed: 38693641},
url = {https://www.mecfsatlas.com/evidence/apostolou-2024-epigenetic-reprograming},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/apostolou-2024-epigenetic-reprograming
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