Andrew Lloyd

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Source:UNSW Sydney

Andrew R. Lloyd, MB BS Syd, MD UNSW, FRACP, is an infectious disease physician, and an epidemiology, virology and immunology researcher. He is a professor at the School of Medical Sciences, University of New South Wales, Sydney, Australia.[1]

He is one of the authors of the 2002 Australian chronic fatigue syndrome (CFS) guidelines, which were immediately criticized by ME/CFS Australia[2] who stated the guidelines:

  • do not describe accurately and fully the symptoms and characteristics of the illness;
  • misrepresent the illness and people with CFS;
  • do not provide an accurate, balanced and objective consideration of the research evidence;
  • demonstrate a consistent bias towards a psychiatric-psychological approach to the illness;
  • dismiss, downplay or ignore biological evidence;
  • make illness management suggestions that are potentially harmful for many with CFS; and
  • do not mention other ways of effectively managing the illness.[3]

In a following letter to the Medical Journal of Australia, ME/CFS Australia stated:

"Following an extensive review of the literature, it is considered that the evidence is not good enough for the Guidelines to be called ‘evidence-based,’ the assessment and presentation of the evidence has not been objective, the Working Group was not truly representative and so the end product is unreliable. The document provides potentially harmful management suggestions with insufficient supporting evidence."[4]

More than 700 people signed a petition[5] asking him to stop the roll out of training medical professionals to use CBT and GET on people diagnosed with chronic fatigue syndrome. The university responded, stating the people who are protesting harbour ‘resentment against the notion that CFS may have psychological causes’[6], while there is no evidence for their argument.

Lloyd is on the Australian government's ME and CFS advisory committee[7].

Lloyd described the PACE trial has having "reasonably solid data".[8]

Awards[edit | edit source]

  • Member, Order of Australia (A.M): “For service to medicine and the community, particularly through provision of hepatitis services in prisons, and research in infectious diseases”[9]

Clinic[edit | edit source]

  • The Fatigue Centre, Newtown, New South Wales, Australia, was created and is supervised by Dr. Andrew Lloyd to serve patients with CFS and post-cancer fatigue.
  • David Tuller met with patients of the clinic, who 'reported that their experience included some positive and some very negative aspects'.[10]

Book Chapters[edit | edit source]

  • 1999, "Chronic fatigue syndrome: current concepts of pathogenesis and treatment," in Current Clinical Topics in Infectious Diseases, edn. Original[11]
  • 2005, "Fatigue states following infection," in Infectious Diseases A clinical approach, edn. 2[12]

Notable studies[edit | edit source]

  • 1990, A double-blind, placebo-controlled trial of intravenous immunoglobulin therapy in patients with chronic fatigue syndrome[13]
  • 1997, Intravenous immunoglobulin is ineffective in the treatment of patients with chronic fatigue syndrome[14]
  • 1998, Chronic fatigue syndrome: An immunological perspective[15]
  • 2003, Identification of ambiguities in the 1994 chronic fatigue syndrome research case definition and recommendations for resolution[16](Full Text)
  • 2006, Post-infective and chronic fatigue syndromes precipitated by viral and non-viral pathogens: Prospective cohort study[17](Abstract)
  • 2006, Preliminary evidence of mitochondrial dysfunction associated with post-infective fatigue after acute infection with Epstein Barr Virus[18](Full Text)
  • 2006, Prolonged Illness after Infectious Mononucleosis Is Associated with Altered Immunity but Not with Increased Viral Load (Full Text)[19]
  • 2007, Postinfective fatigue syndrome is not associated with altered cytokine production[20]
  • 2007, Fatigue: case definition and guidelines for collection, analysis, and presentation of immunization safety data[21](Preview)
  • 2010, Serum Cytokine Levels in Postinfective Fatigue Syndrome (Full Text)[22]
  • 2010, Autonomic hyper-vigilance in post-infective fatigue syndrome[23]
  • 2010, Reduced heart rate variability predicts poor sleep quality in a case-control study of chronic fatigue syndrome[24]
  • 2011, Sleep-wake behavior in chronic fatigue syndrome[25]
  • 2012, Reduced Cardiac Vagal Modulation Impacts on Cognitive Performance in Chronic Fatigue Syndrome[26]
  • 2015, Capturing the post-exertional exacerbation of fatigue following physical and cognitive challenge in patients with chronic fatigue syndrome[27]
  • 2016, University of NSW tests graded activity program on mild chronic fatigue syndrome patients[28]
  • 2016, Fatigue Exacerbation by Interval or Continuous Exercise in Chronic Fatigue Syndrome[29]
  • 2016, Outcomes and predictors of response from an optimised, multidisciplinary intervention for chronic fatigue states[30]
  • 2016, Gene Expression in Response to Exercise in Patients with Chronic Fatigue Syndrome: A Pilot Study (Full Text)[31]
  • 2016, Neurocognitive improvements after best-practice intervention for chronic fatigue syndrome: Preliminary evidence of divergence between objective indices and subjective perceptions[32]
  • 2016, The natural history of acute Q fever: A prospective Australian cohort[33]
  • 2017, Cytokine signature in chronic fatigue syndrome[34]
  • 2017, Autonomic nervous system function, activity patterns, and sleep after physical or cognitive challenge in people with chronic fatigue syndrome[35] [pubmed:30741357](Abstract)
  • 2018, Personalised relaxation practice to improve sleep and functioning in patients with chronic fatigue syndrome and depression: study protocol for a randomised controlled trial[36](Full Text)
  • 2018, The International Collaborative on Fatigue Following Infection (COFFI)[37](Full text)
  • 2019, The Invisible Burden of Chronic Fatigue in the Community: a Narrative Review[38](Abstract)

Talks and interviews[edit | edit source]

Online presence[edit | edit source]

See also[edit | edit source]

Learn more[edit | edit source]

References[edit | edit source]

  1. https://medicalsciences.med.unsw.edu.au/people/professor-andrew-lloyd
  2. "ME/CFS Australia (SA) Inc: Letter to eMJA (March 7, 2002)". sacfs.asn.au. Retrieved Oct 2, 2018. 
  3. "ME/CFS Australia (SA) Inc: Letter to eMJA (March 7, 2002)". sacfs.asn.au. Retrieved Oct 2, 2018. 
  4. "ME/CFS Australia (SA) Inc: Letter to eMJA (April 24, 2002)". sacfs.asn.au. Retrieved Oct 2, 2018. 
  5. "Stop graded exercise therapy trial at University of NSW". #MEAction. Retrieved Oct 2, 2018. 
  6. "Lloyd's university responds: CBT/GET training trial for chronic fatigue syndrome". ME Australia. Mar 30, 2017. Retrieved Oct 2, 2018. 
  7. "Australian government's ME and CFS advisory committee". ME Australia. Apr 23, 2018. Retrieved Oct 2, 2018. 
  8. "How the UNSW chronic fatigue syndrome studies use 'potentially harmful' guidelines". ME Australia. Mar 31, 2016. Retrieved Oct 2, 2018. 
  9. https://medicalsciences.med.unsw.edu.au/people/professor-andrew-lloyd
  10. "Trial By Error: A Post About Andrew Lloyd". www.virology.ws. Retrieved Oct 2, 2018. 
  11. Current Clinical Topics in Infectious Diseases, edn. Original, Blackwell Science Asia, Carlton, Victoria, pp. 138 - 159
  12. Yung A; McDonald M; Spelman D; Street A; Johnson P; Sorrell T; McCormack J (ed.), Infectious Diseases A clinical approach, edn. 2, IP Communications, East Hawthorn, Victoria, Australia, pp. 195 - 204
  13. Lloyd, A.; Hickie, I.; Wakefield, D.; Boughton, C.; Dwyer, J. (November 1990), "A double-blind, placebo-controlled trial of intravenous immunoglobulin therapy in patients with chronic fatigue syndrome", The American Journal of Medicine, 89 (5): 561–568, ISSN 0002-9343, PMID 2146875 
  14. Vollmer-Conna, U; Hickie, I; Hadzi-Pavlovic, D; Tymms, K; Wakefield, D; Dwyer, J; Lloyd, A (1997). "Intravenous immunoglobulin is ineffective in the treatment of patients with chronic fatigue syndrome". American Journal of Medicine. 103: 38 – 43. doi:10.1016/S0002-9343(97)90045-0. 
  15. Vollmer-Conna U;Lloyd A;Hickie I;Wakefield D, 1998, 'Chronic fatigue syndrome: An immunological perspective', Australian and New Zealand Journal of Psychiatry, vol. 32, pp. 523 - 527
  16. Reeves, W.C.; Lloyd, A.; Vernon, S.D.; Klimas, N.; Jason, L.A.; Bleijenberg, G.; Evengard, B.; White, P.D.; Nisenbaum, R.; Unger, E. (2003), "Identification of ambiguities in the 1994 chronic fatigue syndrome research case definition and recommendations for resolution", BMC Health Services Research, 3 (25), doi:10.1186/1472-6963-3-25 
  17. Hickie, Ian; Davenport, Tracey; Wakefield, Denis; Vollmer-Conna, Ute; Cameron, Barbara; Vernon, Suzanne D; Reeves, William C; Lloyd, Andrew (Sep 16, 2006). "Post-infective and chronic fatigue syndromes precipitated by viral and non-viral pathogens: prospective cohort study". BMJ. 333 (7568): 575–. doi:10.1136/bmj.38933.585764.ae. PMC 1569956Freely accessible. PMID 16950834. 
  18. Vernon, SD; Whistler, T; Cameron, B; Hickie, IB; Reeves, WC; Lloyd, A (2006), "Preliminary evidence of mitochondrial dysfunction associated with post-infective fatigue after acute infection with Epstein Barr Virus", BMC Infectious Diseases, 6 (15), doi:10.1186/1471-2334-6-15, PMID 16448567 
  19. Cameron, Barbara; Bharadwaj, Mandvi; Burrows, Jacqueline; Fazou, Chrysa; Wakefield, Denis; Hickie, Ian; Ffrench, Rosemary; Khanna, Rajiv; Lloyd, Andrew (2006), "Prolonged Illness after Infectious Mononucleosis Is Associated with Altered Immunity but Not with Increased Viral Load", Journal Infectious Disease, 193 (5): 664-671, doi:10.1086/500248 
  20. Vollmer-Conna U; Cameron B; Hadzi-Pavlovic D; Singletary K; Davenport T; Vernon S; Reeves WC; Hickie I; Wakefield D; Lloyd AR, 2007, 'Postinfective fatigue syndrome is not associated with altered cytokine production', Clinical Infectious Diseases, vol. 45, pp. 732 - 735, http://dx.doi.org/10.1086/520990
  21. Jones, James F.; Kohl, Katrin S.; Ahmadipour, Nooshin; Bleijenberg, Gijs; Buchwald, Dedra; Evengard, Birgitta; Jason, Leonard A.; Klimas, Nancy G.; Lloyd, Andrew (Aug 2007). "Fatigue: Case definition and guidelines for collection, analysis, and presentation of immunization safety data". Vaccine. 25 (31): 5685–5696. doi:10.1016/j.vaccine.2007.02.065. ISSN 0264-410X. 
  22. Barbara Cameron, David L. Hirschberg, Yael Rosenberg-Hassan, Dharam Ablashi, Andrew R. Lloyd. (2010). Serum Cytokine Levels in Postinfective Fatigue Syndrome. Clinical Infectious Diseases, 50 (2): 278-280. doi:10.1086/649546
  23. Kadota Y;Cooper G;Burton AR; Lemon J; Schall U; Lloyd A; Vollmer-Conna U, 2010, 'Autonomic hyper-vigilance in post-infective fatigue syndrome', Biological Psychology, vol. 85, pp. 97 - 103, http://dx.doi.org/10.1016/j.biopsycho.2010.05.009
  24. Burton AR; Rahman K; Kadota Y; Lloyd A; Vollmer-Conna U, 2010, 'Reduced heart rate variability predicts poor sleep quality in a case-control study of chronic fatigue syndrome', Experimental Brain Research, vol. 204, pp. 71 - 78, http://dx.doi.org/10.1007/s00221-010-2296-1
  25. Rahman K;Burton A;Galbraith S;Lloyd A;Vollmer-Conna U, 2011, 'Sleep-wake behavior in chronic fatigue syndrome', Sleep, vol. 34, pp. 671 - 678
  26. Beaumont A;Burton AR;Lemon J;Bennett BK;Lloyd A;Vollmer-Conna U, 2012, 'Reduced Cardiac Vagal Modulation Impacts on Cognitive Performance in Chronic Fatigue Syndrome', PLoS ONE, vol. 7, http://dx.doi.org/10.1371/journal.pone.0049518
  27. Keech A;Sandler C;Vollmer-Conna U;Lloyd A;Barry B, 2015, 'Capturing the post-exertional exacerbation of fatigue following physical and cognitive challenge in patients with chronic fatigue syndrome.', in Physiotherapy, Elsevier, Singapore, Vol. 101, pp. e121 - e122, presented at World Congress of Physical Therapy, Singapore, 01 - 04 May 2015, http://dx.doi.org/10.1016/j.physio.2015.03.262
  28. "University of NSW tests graded activity program on mild chronic fatigue syndrome patients". ME Australia. May 9, 2016. Retrieved Oct 2, 2018. 
  29. Sandler CX, Lloyd AR, Barry BK. (2016). Fatigue Exacerbation by Interval or Continuous Exercise in Chronic Fatigue Syndrome. Medicine and Science in Sports Exercise 2016 Oct;48(10):1875-85. doi: 10.1249/MSS.0000000000000983
  30. Sandler CX;Hamilton BA;Horsfield SL;Bennett BK;Vollmer-Conna U;Tzarimas C;Lloyd AR, 2016, 'Outcomes and predictors of response from an optimised, multidisciplinary intervention for chronic fatigue states', Internal Medicine Journal, vol. 46, pp. 1421 - 1429, http://dx.doi.org/10.1111/imj.13251
  31. Keech, A., Vollmer-Conna, U., Barry, B. K., & Lloyd, A. R. (2016). Gene Expression in Response to Exercise in Patients with Chronic Fatigue Syndrome: A Pilot Study. Frontiers in Physiology, 7, 421. http://doi.org/10.3389/fphys.2016.00421
  32. Cvejic E;Lloyd AR;Vollmer-Conna U, 2016, 'Neurocognitive improvements after best-practice intervention for chronic fatigue syndrome: Preliminary evidence of divergence between objective indices and subjective perceptions', Comprehensive Psychiatry, vol. 66, pp. 166 - 175, http://dx.doi.org/10.1016/j.comppsych.2016.02.002
  33. Hopper, B.; Cameron, B.; Li, H.; Graves, S.; Stenos, J.; Hickie, I.; Wakefield, D.; Vollmer-Conna, U.; Lloyd, A.R. (Oct 2016). "The natural history of acute Q fever: a prospective Australian cohort". QJM. 109 (10): 661–668. doi:10.1093/qjmed/hcw041. ISSN 1460-2725. 
  34. Roerink ME, Buckland M, Lloyd AR, van der Meer JWM. (2017) Cytokine signature in chronic fatigue syndrome. Proc Natl Acad Sci U S A. 2017 Nov 7;114(45):E9435. doi: 10.1073/pnas.1714011114.
  35. Cvejic, Erin; Sandler, Carolina X.; Keech, Andrew; Barry, Benjamin K.; Lloyd, Andrew R.; Vollmer-Conna, Uté (Dec 2017). "Autonomic nervous system function, activity patterns, and sleep after physical or cognitive challenge in people with chronic fatigue syndrome". Journal of Psychosomatic Research. 103: 91–94. doi:10.1016/j.jpsychores.2017.10.010. 
  36. Macnamara, Claire L.; Cvejic, Erin; Parker, Gordon B.; Lloyd, Andrew R.; Lee, Gina; Beilharz, Jessica E.; Vollmer-Conna, Ute (2018). "Personalised relaxation practice to improve sleep and functioning in patients with chronic fatigue syndrome and depression: study protocol for a randomised controlled trial". Trials. 19: 371. doi:10.1186/s13063-018-2763-8. 
  37. Katz, Ben Z; Collin, Simon M; Murphy, Gabrielle; Moss-Morris, Rona; Wyller, Vegard Bruun; Wensaas, Knut-Arne; Hautvast, Jeannine L.A.; Bleeker-Rovers, Chantal P; Vollmer-Conna, Uté; Buchwald, Dedra; Taylor, Renée; Little, Paul; Crawley, Esther; White, Peter D; Lloyd, Andrew (Apr 3, 2018). "The international collaborative on fatigue following infection (COFFI)". Fatigue: Biomedicine, Health & Behavior. 6 (2): 106–121. doi:10.1080/21641846.2018.1426086. ISSN 2164-1846. PMID 30666281. 
  38. Fatt, Scott J.; Cvejic, Erin; Lloyd, Andrew R.; Vollmer-Conna, Ute; Beilharz, Jessica Elise (Feb 2019). "The Invisible Burden of Chronic Fatigue in the Community: a Narrative Review". Current Rheumatology Reports. 21 (2). doi:10.1007/s11926-019-0804-2. ISSN 1523-3774. 
  39. https://www.actionforme.org.uk/uploads/pdfs/cmrc-2014-conference-report-final.pdf

chronic fatigue syndrome (CFS) - A fatigue-based illness. The term CFS was invented invented by the U.S. Centers for Disease Control as an replacement for myalgic encephalomyelitis (ME). Some view CFS as a neurological disease, others use the term for any unexplained long-term fatigue. Sometimes used as a the term as a synonym of myalgic encephalomyelitis, despite the different diagnostic criteria.

bias - Bias in research is "a systematic deviation of an observation from the true clinical state".

chronic fatigue syndrome (CFS) - A fatigue-based illness. The term CFS was invented invented by the U.S. Centers for Disease Control as an replacement for myalgic encephalomyelitis (ME). Some view CFS as a neurological disease, others use the term for any unexplained long-term fatigue. Sometimes used as a the term as a synonym of myalgic encephalomyelitis, despite the different diagnostic criteria.

chronic fatigue syndrome (CFS) - A fatigue-based illness. The term CFS was invented invented by the U.S. Centers for Disease Control as an replacement for myalgic encephalomyelitis (ME). Some view CFS as a neurological disease, others use the term for any unexplained long-term fatigue. Sometimes used as a the term as a synonym of myalgic encephalomyelitis, despite the different diagnostic criteria.

double blinded trial - A clinical trial is double blinded if neither the participants nor the researchers know which treatment group they are allocated to until after the results are interpreted. This reduces bias. (Learn more: www.nottingham.ac.uk)

antibody - Antibodies or immunoglobulin refers to any of a large number of specific proteins produced by B cells that act against an antigen in an immune response.

serum - The clear yellowish fluid that remains from blood plasma after clotting factors have been removed by clot formation. (Blood plasma is simply blood that has had its blood cells removed.)

heart rate variability (HRV) - A measurement of the variability of the heart rate over time. When the heart rate is consistent, there will be a low heart rate variability. When the heart rate is constantly changing, there will be a high heart rate variability. Heart rate variability is often used by ME/CFS patients to monitor their autonomic nervous system, as high heart rate variability is associated with the sympathetic nervous system and low heart rate variability is associated with the parasympathetic nervous system.

chronic fatigue syndrome (CFS) - A fatigue-based illness. The term CFS was invented invented by the U.S. Centers for Disease Control as an replacement for myalgic encephalomyelitis (ME). Some view CFS as a neurological disease, others use the term for any unexplained long-term fatigue. Sometimes used as a the term as a synonym of myalgic encephalomyelitis, despite the different diagnostic criteria.

randomized controlled trial (RCT) - A trial in which participants are randomly assigned to two groups, with one group receiving the treatment being studied and a control or comparison group receiving a sham treatment, placebo, or comparison treatment.

BMJ - The BMJ (previously the British Medical Journal) is a weekly peer-reviewed medical journal.

mitochondria - Important parts of the biological cell, with each mitochondrion encased within a mitochondrial membrane. Mitochondria are best known for their role in energy production, earning them the nickname "the powerhouse of the cell". Mitochondria also participate in the detection of threats and the response to these threats. One of the responses to threats orchestrated by mitochondria is apoptosis, a cell suicide program used by cells when the threat can not be eliminated.

myalgic encephalomyelitis (ME) - A disease often marked by neurological symptoms, but fatigue is sometimes a symptom as well. Some diagnostic criteria distinguish it from chronic fatigue syndrome, while other diagnostic criteria consider it to be a synonym for chronic fatigue syndrome. A defining characteristic of ME is post-exertional malaise (PEM), or post-exertional neuroimmune exhaustion (PENE), which is a notable exacerbation of symptoms brought on by small exertions. PEM can last for days or weeks. Symptoms can include cognitive impairments, muscle pain (myalgia), trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, among others. An estimated 25% of those suffering from ME are housebound or bedbound. The World Health Organization (WHO) classifies ME as a neurological disease.

somatic symptom disorder - A psychiatric term to describe an alleged condition whereby a person's thoughts somehow cause physical symptoms. The actual existence of such a condition is highly controversial, due to a lack of scientific evidence. It is related to other psychiatric terms, such as "psychosomatic", "neurasthenia", and "hysteria". Older terms include "somatization", "somatoform disorder", and "conversion disorder". Such terms refer to a scientifically-unsupported theory that claims that a wide range of physical symptoms can be created by the human mind, a theory which has been criticized as "mind over matter" parapsychology, a pseudoscience. Although "Somatic Symptom Disorder" is the term used by DSM-5, the term "Bodily Distress Disorder" has been proposed for ICD-11. (Learn more: www.psychologytoday.com)

The information provided at this site is not intended to diagnose or treat any illness.
From MEpedia, a crowd-sourced encyclopedia of ME and CFS science and history.