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

Answer: Simon Collins

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 J et al. Broad-spectrum micronutrient supplementation in HIV-infected patients with dideoxynucleoside-related peripheral neuropathy: a prospective, double-blind, placebo-controlled trial.

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.