Question
Can you comment on these herb and selenium studies?
12 February 2009. Related: All topics, Supplements and herbs.
Hi, I was reading your response to other questions on herbal medicine 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.
Answer
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.
Hi Lengwe,
What meds are you taking?
Can an HIV patient take selenium whilst on arvs? Please advise.
Hi Snori,
The above post goes into a lot of detail about selenium. As to whether you choose to use it, this is up to you.
At the moment the only thing that is really known to help a persons HIV is ART. What’s your CD4 count?
Can I take selenium, I’m not ready to take ARVs.
Hi,
The only thing that can effectively combat HIV is anti retro-viral treatment (ARVs). Selenium may have general health benefits but it won’t directly affect the level of virus in your body.
Can selenium pills help me with improving my viral load?
Thanks again for your response.
I will be really specific about what was paradoxical and quite frankly a bit frightening for me. My doctor told me the criteria in the treatment guidelines that are currently in place when I first saw her. She said that a viral load over 100,000 or a T-cell count lower than 350 is when they start recommending that a patient consider drug treatment. She further went on to state that it is an either/or situation with the emphasis being on T-cells because they are the more relevant measure.
From what I have read this is a relatively common stance that accurately reflects the mainstream position on when to start treatment right now. I am aware that there is currently a discussion about increasing treatment guidelines to starting treatment if at 500 T-cells or possibly even higher.
My doctor then went on to recommend that I start treatment because of an initial T-cell count of 301 even though I was symptom free and had a viral load of 20,000. My viral load at that time was 1/5 of the minimum for when treatment should be considered.
I understand that the T-cell was lower than the current treatment guidelines, but she left me no room to improve and very little room to consider my options. The pressure was intense. My other labs were excellent, including cholesterol, liver function, blood sugar, etc. I felt like the single deficiency in T-cells was dictating her treatment recommendations.
As I mentioned earlier, I made it my priority to improve this deficiency in order to relieve the pressure from my doctor. In that process I discovered a lot of other information. My T-cells improved to 460 plus and my viral load has fluctuated between 6000 and 20000 as of November 2008.
My confusion grew at a visit with my doctor in August 2008 when she said that my viral load measurement is not particulary relevant as more than a measure of contagion and that she was making her recommendations on my T-cell counts. At that time in August of 2008 my T-cells were 342 and the viral load was 6000. I understand that there is some variance and viral load can fluctuate up to 3 times in either direction and that T-cells fluctuate some as well depending on the time of day, sleep deprivation, etc. However, my doctor was applying the pressure big time to start HAART when my T-cells were just below the guidelines and my viral load seemingly had improved.
If viral load is not so important to my doctor in a treatment-naive patient such as myself, then why is an undetectable viral load so important for my health if and when I were to start HAART? As far as I know HIV, the virus is relatively benign towards organs and does not itself cause death or illness without an individual becoming sick with an AIDS defining illness or cancer. The obviously dangerous thing about HIV is the damage it does to an individual’s immune system.
My issue is that a stronger immune system should effectively protect one from complications from HIV if you can maintain that immune system while carrying a relatively stable level of virus in your body. The whole chronic inflammation and activation of the immune system thing seems to be the concern if an individual has a viral load, but is immune system fatigue inevitable? Everyone seems overly concerned with becoming undetectable or with treatment failing if they carry any viral load, but they seem less concerned about how to make their immune systems stronger.
I am really glad that you mentioned the statistics about improving immune systems on HAART because I had not heard those numbers before.
Thanks.
I’m not sure I understand what you mean by ‘there is not a more transparent discussion of HAART/ARV
Thank you for your thorough response. As you might imagine I have augmented my research on these compounds with further research into their bioactivity, common usage and dosage information.
I am taking my healthcare seriously and to be honest I feel great and I am not all exercise and supplements.
I acknowledge and understand that HAART/ARV’s work very well at reducing viral load to undetectable levels even though I find it a bit paradoxical that there is not a more transparent discussion of HAART/ARV’s effect on strengthening people’s immune systems, specifically increasing their T cell count.
My other reservation right now about HAART/ARV’s is that there also seems to be a lack of discussion about side effects, their frequency, liver damage, and the longterm implications of lifelong usage.
Right now this is not so much an issue for me because of my improving health, but if HAART/ARV’s are to be a treatment option for me then I really want some clarification.
Thanks again for your response and I look forward to continuing to engage in future discussions.