Herbs & HIV
To mark Herbal Medicine Awareness
Week (19-26 May), herbalist Marcos Patchett explains the
pros and cons of treating people living with HIV
Herbal
medicine uses plants to treat illness and support health. The herbal approach
to treating people with HIV is a complementary one, using the capacity of
medicinal plants to support the immune system and bodily functions. This can
be adapted if a patient is taking antiretrovirals, as many herbs can be used
alongside traditional pharmaceutical drugs.
Subtle, broad and supportive
Herbalists use fresh or dried plants to make tinctures (concentrated alcohol/water
extracts), teas, powders, capsules, tablets, ointments and pessaries. We’re
trained with similar diagnostic skills to GPs but aim to tackle existing symptoms
by supporting the patient’s constitution and improving their overall
health, rather than suppressing the apparent causes of the illness. This is
primarily because the broad spectrum of
activity in many medicinal plants (their ability to subtly affect many different
processes in the body at the same time) is more suited to supporting body
function than, say, attacking bacteria or viruses.
Selecting herbs
Most medicinal herbs have been selected by trial and error over years, centuries
or even millennia of human experience. While drugs usually contain higher
amounts of only one, or a very few, compounds, medicinal plants contain mixtures
of many different compounds in small amounts and have a broader spectrum of
action. They tend to be weaker in effect, at least over the short term. When
used properly, they can be safer and more versatile than pharmaceutical drugs.
Chamomile, for example, contains several sedative and anti-inflammatory substances
which have a far greater effect when combined in the plant than when used
separately. The combination of anti-inflammatory, anti-anxiety, anti-microbial
and anti-spasmodic properties in this plant makes it helpful in a very wide
range of digestive, nervous and allergic disorders.
Practical
HIV care with herbs
At Tony’s Holistic Centre, in King’s Cross, London, my colleague
Lynne Hulka and I see patients with a wide range of HIV-related health problems,
and tailor our prescriptions and recommendations to fit with their existing
prescriptions. We obtain consultant and GP details at the first meeting to
enable us to contact their doctors with their approval. We aim to provide
a multidisciplinary care system by collaborating with other healthcare providers,
informing them about our treatments and adapting our approach to suit the
patient’s overall healthcare programme. We prescribe herbs according
to their traditional use, their known pharmacology and following a detailed
case history interview with the patient. There is a wide range of plants useful
in HIV infection, so my prescriptions vary widely. Many contain compounds
that suppress viral replication, but the complexity of plant chemistry means
they are often far milder in effect than conventional anti-virals.
Evidence for using herbs
Many herbs contain antiretroviral compounds tested in the lab. A few have
been tested in living organisms, and a tiny number have been tested in clinical
situations. However, no clinical trials have yet been conducted on the effectiveness
of supportive herbal treatment in HIV, and as each patient’s prescription
is different, this would be difficult to achieve.
The aim of herbal treatment is to support the patient, rather than simply
suppress viral replication. But, for those on Highly Active Antiretroviral
Therapy (HAART), herbs can be sele-cted to treat the patient’s symptoms
from the wide range of plants with apparent antiretroviral properties. In
the absence of clinical data, these herbs are selected on the basis of:
• Documented antiretroviral effects in humans or animals.
• Known content of antiretroviral compounds.
• Traditional use in viral infections, especially ‘enveloped’
viruses similar to HIV, like flu.
Benefits
of elderberry
Elderberry contains several antiretroviral compounds: oleanolic, ursolic and
chlorogenic acids, betulin and quercetin. There are anecdotal reports of six
patients experiencing decreased viral loads while taking elderberry. Clinical
trials show the extract also inhibits the flu virus, and lab research indicates
the whole plant extract has reverse transcriptase inhibitor activity.
Elderberry has traditionally been used as a general preventative against infectious
diseases, mainly viral in
origin. All the herbs I use in my practice are supported by similar indications.
What herbal medicine lacks in rigorous clinical research is compensated for
by an extensive body of traditional knowledge, which testifies to their safety
and provides important pointers to the symptom picture for each herb, which
indicates the situations in which they may be most useful.
Herbs for people not on therapy
The real benefit of herbal medicine to patients not currently on HIV meds
is its ability to reduce viral replication and support health, keep CD4 counts
up and potentially delay the need to begin HAART. In the majority of patients,
there are clear benefits for appetite, digestive problems (diarrhoea, bloating),
energy levels and fatigue. Skin problems and mood disorders are also responsive
to treatment.
Although there is no single effective treatment for peripheral neuropathy,
it’s sometimes responsive to longer-term treatment, depending on its
cause. HIV-related neuropathy is often helped by herbal treatment as general
health improves. However, drug-related neuropathy may be more difficult to
treat without reducing the effectiveness of antiretrovirals. Treatment responses
vary from person to person.
Herbs
on HAART
For patients on meds, herbs can be used to deal with side effects of drug
treatment and complement them by improving immunity and general health, while
the antiretrovirals tackle the HIV.
Given time, herbal treatment can help most HIV-associated problems, though
herbs sometimes take longer to work than pharmaceutical drugs, owing to their
chemical complexity and relative weakness. Prescriptions must be adjusted
over time to find out which combination of herbs works best for each individual.
It must be emphasised that anybody with HIV considering using herbal medicine
must see a properly qualified medical herbalist, as medicinal plants, like
any drugs, can be harmful when used inappropriately, and many interact with
prescription medications.
A typical prescription
For patients not on HAART, I ensure at least 50 per cent of the prescription
contains plants with antiretroviral properties. The rest will contain plants
that tackle the patient’s symptoms or are particularly suitable for
that patient. I include at least one immuno-modulating herb that helps sustain
the immune response to the virus, and maintain CD4 counts and HIV-fighting
antibody production.
A patient with night sweats, poor appetite, diarrhoea, depression, anxiety
and fatigue, with a CD4 count of 300 and a viral load of more than 20,000
may receive a prescription as follows:
Tincture,
a concentrated liquid mixture, containing:
Vervain anti-anxiety, bitter digestive stimulant, anti-viral,
possibly antiretroviral.
Ashwagandha immuno-modulator, adaptogen which helps the body
adapt to stress, cumulative anti-anxiety agent, anabolic.
Rose astringent to reduce diarrhoea, contains antiretroviral
compounds, traditionally regarded as an antidepressant.
St John’s wort antidepressant, antiretroviral, astringent.
To be taken in doses of one teaspoonful in water, three times daily, on an
empty stomach.
PLUS
Tea, containing:
Sage several antiretroviral compounds, astringent and helps
reduces sweating.
Rosebay Willowherb astringent, contains antiretroviral compounds.
Marigold gastrointestinal tract anti-inflammatory, contains
antiretroviral compounds and saponins, soapy molecules which help dissolve
active compounds from other herbs in the tea.
Three cups daily, steeping one tablespoon of dried herb per cup boiling water
approx. 10-15 minutes.
For patients already on HAART, I follow a similar protocol but emphasise immuno-modulation
and symptom relief and bear in mind the following:
• Herbs known to interact with antiretrovirals, such as garlic and St
John’s wort, are avoided.
• Herbs with antiretroviral properties are used discriminately; only
those with known antiretroviral mechanisms, which work differently from the
drugs used in HAART, are prescribed, to avoid possible complications.
• Herbs that affect the liver are used with caution.
Respecting the liver
In practice, many patients on HAART experiencing digestive problems due to
drug treatment
do benefit from hepatics, herbs that help liver function, without experiencing
any loss of treatment effectiveness.
But the choice of hepatics and the decision to use them should be left to
the qualified herbalist, who will avoid using such plants when it isn’t
necessary and ensure the whole prescription bolsters the effect of the antiretrovirals.
Over-the-counter
herbs
Anyone with HIV considering using herbs to control or improve their symptoms
on a regular basis should see a qualified medical herbalist. This is absolutely
essential for HIV positive people on HAART as many herbs available over-the-counter
(OTC) affect liver function and could reduce treatment effectiveness.
Occasional use of some OTC products like peppermint tea is unlikely to be
a problem, but medicinal use of St John’s wort, garlic and milk thistle
should be avoided by people on HAART.
There are theoretical concerns that echinacea may increase viral replication
and possible interaction with protease inhibitors (PIs) have been reported.
However, I believe this fails to take account of the action of the whole herb
in the body. In practise I’ve found short-term use for periods of up
to two weeks is fine for people living with HIV, but never for longer than
this. Anyone on PIs should always consult a practioner before taking echinacea.
Davide: panic attacks banished
Davide Gostoli, 39, wants to avoid taking HAART if possible. He has been using
herbs, supplements and nutrition to help maintain his health for seven years.
Since consulting us a year ago, Davide has received continuous herbal treatment
for the last eight months. He takes vitamins, probiotics and Pau d’Arco
tea in addition to prescribed herbs. He had digestive discomfort with diarrhoea
and abdominal pain, and was experiencing panic attacks and palpitations.
“Herbal treatment helps my appetite and digestion; my abdominal pain
in the morning is mostly better. It also seems to keep my CD4 count stable.
As long as it keeps me away from combination therapy, I’m happy.”
Davide’s panic attacks and palpitations have disappeared and his viral
load has decreased from an initial count of around 177,000 to around 18,000.
His CD4 count varies between 300 and 400.
Michael: weight gain
Michael Charlton, 46, is not on antiretrovirals and has taken herbal medicine
for five months. He originally complained of poor appetite, fatigue, insomnia,
abdominal cramps and digestive problems. He sometimes finds herbal medicines
hard to take regularly. “The whole thing altered my life: it’s
fantastic stuff for eating and digestion; five stars on that one. The sleeping
stuff is also helpful.” His best friend tells him that his depressive
bouts now seem to occur at wider intervals. Michael has also gained over a
stone in weight since using herbal treatment.
George:
calm and confident
George Rodgers, 45, received three months of herbal treatment during a ‘drug
holiday’ from HAART several months ago after developing severe peripheral
neuropathy. On stopping his meds he began to get night sweats, panic attacks
and palpitations. He became fatigued and depressed, lost weight, and developed
warts on his hands and feet.
“The herbal prescription helped to keep me above water. It calmed me
down a bit and had a positive effect.” The warts have almost gone, his
sweats have disappeared and his confidence has increased. George is currently
taking a break from all HIV medication.
Diep*: physical strengthening
Diep, 57, is on heart medication following a heart attack and bypass operation
but is not on HAART. His HIV-related complaints included reduced appetite,
nausea and peripheral neuropathy. In addition he was experiencing head pain,
tinnitus, hip pain, shortness of breath and palpitations. After using herbs
for five weeks, he said: “I can’t be sure it’s the herbs
yet, but the overall feel of my body seems to be cleaner; I have a general
feeling of physical strengthening.” Diep says his head pain, tinnitus
and digestive problems have also improved.
Chris*: help with digestion
Chris, 37, who complained of poor sleep, diarrhoea, flatulence, nasal congestion
and painful joints,
has taken herbs for three weeks. He is on HAART
and takes zopiclone to help him sleep. “The herbs have definitely helped
with digestion and sleep, although perhaps slowly.” His nasal congestion
is reduced, although as yet there is no change in the joint pain.
Final
thoughts
Western herbal medicine represents a bridge between pharmacology and folklore,
tradition and scientific investigation, and it affords many opportunities
for experimentation, exploration and innovation in treatment approaches.
Working with people with HIV certainly is a learning experience. Failures
stick in the mind more than successes: a patient’s diarrhoea did not
go away, another had to resort to antidepressants despite our best efforts,
but cases like these encourage us to learn more. Herbal treatment can be used
alongside prescription medication, and it can provide side-effect-free health
promotion and symptom control. But don’t forget: herbal treatment is
only as good as your herbalist. Make sure they are qualified, and that you
get on with each other.
• For a list of qualified herbalists around the
country, check out www.nimh.org.uk,
the website of the National Institute of Medical Herbalists, the UK’s
largest herbalists’ organisation. Not all qualified herbalists belong
to this organisation.
• Tony’s Holistic Centre, www.thcweb.net
• Marcos Patchett is a qualified medical herbalist practising at Neal’s
Yard Remedies’ Therapy Rooms in Covent Garden, and Tony’s Holistic
Centre in King’s Cross, both in London. In 2005 he was awarded the Elsevier
publisher’s science prize at Middlesex University for herbal pharmacy.
His current projects include research into herbal treatment in HIV infection
(with Lynne Hulka)
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