Question
Questions about herbal medicine and HIV
23 February 2007. Related: All topics, Supplements and herbs.
(1) What role does herbal medicine have for those with HIV?
(2) What advice do you have about using herbal medicines?
(3) Are there any specialists in this area whose details could be passed on to me?
(4) Is there anything I can help with? I would love my dissertation to form a new leaflet or at least inform others….
I ask this as a student of herbal medicine at degree level. I am looking to specialize in men’s health (esp gay men’s health) and i know there are several immune supporting herbs. I want to research the benefits pre-anti viral therapy of herbs to keep CD4 count high. I have used your search option on this web site and am pleased to have over 300 results. I will work my way through them, but i am convinced that there are useful herbs that don’t have negative interactions.
Answer
Role of herbal medicine for peope with HIV
Although there is a lot of interest in herbal medicine and use of supplements, unfortunately there is very little data that shows any real effect in relation to HIV. However because herbal treatment are often cleared from the body using the same enzymes that many HIV drugs use, most of the reports on the i-Base website cover these interactions. I do not know of any studies of herbal medicine that increase CD4 count.
Also, if an HIV-positive person is not using ARV treatment then it is not necessarily a good idea to stimulate their immune system anyway. By boosting CD4 counts you would increase the target cells for HIV and potentially increase HIV replication.
Using herbal medicine
We caution people against using herbal medicine with HIV drugs unless there is information on an interaction with their HIV drugs. Some of these interactions can be very serious. If HIV drug levels are dropped, your risk of drug resistance and treatment failure increases. If HIV drug levels are increased then side effects and organ failure may occur. The effect of increasing levels of any active agent in the herbal medicine are also unknown. Therapeutic drug monitoring may be useful though to look at individual drug levels.
Only drugs that specifically target HIV (ARVs) have been shown to substantially reduce HIV viral load, and this break from high viral load levels allows the body to become stronger and increase CD4 counts – ie even HIV drugs in themselves do not increase CD4 count directly.
We also recognise though that because individual approaches to HIV are very different, if a complementary treatment, or use of supplements or vitamins helps a particular individual, then so long as there isn’t a negative interaction, it probably wont be do any harm. The difficulty is that there often isn’t any information on drug interactions.
Specialists
Research into supplements and vitamins is probably broader than into herbal medicine, but even this has very few clear studies. One of the few studies to show an effect on CD4 count from vitamins was presented by Jon Kaiser at the 11th CROI in San Francisco in 2004:
Kaiser is a Californian doctor who takes a holisitic approach to treating HIV, that included complimentary therapy, exercise, nutrition, supplements – but also crucially – HIV drugs.
However, this specific study has many limitations. It doesn’t support a general role for vitamin supplements because it involved people who were taking earlier HIV meds that had some of the most difficult drug-specific side effects. As these drugs are rarely used any more, it is unlikely that siilar result would be expected using modern meds.
A web search on Google should bring up other references.
One of the best online source of references for use of supplements for HIV are the treatment pages on the community-run DAAIR website.
Is there anything else I can help with?
Perhaps the results of your research would be of interest to Positive Nation, a monthly community-based publication that features articles on a wide range of HIV-related issues.
Thanks for all these links. It is great to see you going into such detail. It is really important to go into the full research behind any study before drawing conclusions. This is especially important if you are going to use the information as part of your health care or treatment.
I’m don’t have expertise in the biochemistry details of drug development but the olive leaf, astragalus root and green tea studies are all very preliminary studies looking at whether these compounds have activity against HIV in the lab. As with my initial post, any positive findings may be the basis for developing a drug, but this still involves a lot more research, and at any stage, even promising compounds can still fail.
Sometimes the active ingredient can’t be formulated in a way that the body absorbs, or the test tube results can’t be duplicated in humans. Very commonly, extremely impressive compounds end up with unpredictable side effects that stop the development. This is just as likely to happen with compounds derived from ‘natural’ sources as form those designed based on their chemical structure.
Many established drugs do come from natural sources. Two famous examples are artemisinin for malaria (developed from a Chinese herb) and rifamycin an essential TB drug, developed from a natural antibiotic found in a soil sample in France.
This is why environmental issues are important to all of us. We will never know the potential of lost species of plants, animals, bacteria etc once they have gone – and they are being lost at an alarming rate. The best HIV drug could be based on a compound found in a the bark of a tree in the rain forest.
An important caution though is that the source compounds are not active against HIV as a treatment now – they are just potential for research – like thousands of other compounds that may, or may not finally, find a clinical use.
The selenium link is more interesting because it is a well designed study in people with HIV. It is randomised and placebo controlled, both of which are essential to know if there is a real effect. It also has a reasonably large number of participants (although a lot drop out in the study) and it measures viral load and CD4 count.
If you are interested in trial design from a community perspective see this online resource in the treatment manual.
So, there is a lot to go into, but most of the study reports effect of selenium supplementation on selenium levels. As you would hope, levels increase from the supplement and this is related to adherence.
The impact on viral load though is very small in real terms: 0.2 log increases over 9 months in the placebo group compared to no viral load increase in people taking selenium. This level of change (20%) would be too small to be likely to have any clinical effect (most drugs have a minimum of 0.5 log and usually much more – some over 3.0 logs), and is too small to be considered real in any individual because it is less that the error margin for variability for viral load tests: a viral load test can be 30% higher or lower and still count as the same result.
The study acknowledges its own limitations on this from only having two measurements – one at the start and one after 9 months. All sorts of other factors could account for the small difference seen and not having more regular results to see whether there was a steady trend would need to be confirmed.
From this study I would think that the main interest in selenium will continue to be based on any effect it may have on the immune system rather than any direct activity against HIV.
I hope this long answer is helpful – thanks for taking the discussion to this level.
Everything you are doing for your own health care sounds fine – good luck with everything.
PS – I have also posted this as a new question so other might find it easily.
Thank you for your response. I posted links for each of the four articles. I was only able to get full text on 2 of the articles. The others are unable with paying right now and unfortunately I did not save the entire text of those when I read the full text.
The olive leaf article is a more recent computational study by the same authors, but you can view an abstract of the 2003 article via google.
Thanks again and I look forward to hearing your response.
Olive leaf extract study link
Selenium study link
Astragalus root study link
If you post web links for each study I’m happy to look at them.
Although many compounds show anti-HIV activity in the test tube, developing this potential into a therapeutic drug in much more difficult.
Any direct impact on HIV, for example, from green tea, is likely to be very modest, if it occurs at all. There is some data to support the benefit of selenium.
Hi, I was reading your response above and I wanted to get your opinion on each of the studies below this comment.
I understand that there has been no clinical trials of these substances in humans outside of the selenium study, but I was curious of your opinion.
I enjoy reading the responses on this site and I am currently taking not unusual amounts daily of all the minerals and herbs mentioned in the articles below. I drink a pot of green tea per day and I eat 4-5 brazil nuts to get selenium.
I exercise daily for an hour, I am 35 and healthy every day since I tested positive for HIV over 1 year ago. My viral load lingers at 20, 000 or below and my T-cells have improved from 301 about 5 months after my positive test to 463 at my latest lab.
I am not taking ARVs and I do not plan on starting absent dramatic changes in my health. My own doctor ignores me when I ask about these articles. She is quite well respected so I continue seeing her in the interest of hearing opinions contrary to my own. Even though she agrees right now that I do not need to start ARVs.
I look forward to your comments.
Dr. Sylvia Lee Huang-NYU-
No. They may be good for you in other ways but none of the research has lead to them being used to effectively treat HIV.
Can maitake mushrooms help treat HIV or improve your CD4 count?
Hi Tahiru
There is nothing I know of at the moment. My personal opinion is that there is unlikely to be anything that is more effective at fighting HIV than antiretroviral drugs, certainly for the near future.
Is there any hope for a herbal treatment for HIV?
The answer I gave was open to different approaches, but does caution against the risk from unstudied interactions between herbal preparations and HIV drugs.
If you are responding to a different question, please send me the link so I can re-read it and answer.
If you would like to forward any specific research that shows a beneficial link between HIV and herbal medicine, I would be happy to review it.
China both produces it’s own versions of Western antiretroviral drugs, and imports other ARVs to treat HIV-positive in China. largely because these benefits have been demonstrated in clinical trials.
This is important.
For example, only after research into artemisinin (a chinese herb) was studied in trials and published was it possible to isolate the active ingredient, and produce a reliable pharmaceutical equivalent. This is now the most important drug used in combination treatment for drug resistant malaria.
I just read your response to someone’s question regarding Chinese herbal medicine.
I think it’s a good idea for doctors to not limit themselves to only Western ways of thinking about how our bodies heal.
Your position is powerful and influential. Please either do more investigating into the benefits of herbal/traditional medicine or just simply say I do not know!.