Half of the U.S. patients infected with HIV use alternative therapies while taking powerful AIDS drug cocktails, and nearly one in four choose alternative treatments that could interfere with conventional AIDS therapy. And many never share that information with their doctors, researchers have found.
Patients often believe that so-called natural treatments are helping to keep them healthy and diminishing the unpleasant side effects of prescription drugs. But megadoses of vitamins, homeopathic remedies and some herbs can reduce the effectiveness of the antiretroviral drugs that have prolonged patients' lives.
For example, the popular herbal antidepressant St. John's wort lowers blood levels of protease inhibitors, including indinavir (Crixivan) and ritonavir (Norvir). As a result, the medication can stop working and the virus can become resistant to antiretrovirals. "When that happens, we can't always save the person's life," warned Dr. Charles Farthing, medical director of the AIDS Healthcare Foundation in Los Angeles, the nation's largest community-based HIV-AIDS medical provider. Garlic can have similar effects on the AIDS drugs, he said.
In many cases, patients are combining multiple supplements with their mix of prescription drugs. "The simplest thing is to understand one drug and one herb, but the reality is most people are taking more than that," said Dr. An-Fu Hsiao, lead author of a study about HIV and alternative medicine appearing in the current issue of the Journal of AIDS. Hsiao's study was sparked by his longtime interest in alternative medicine and his experiences with HIV patients, some of whom were reluctant to discuss their use of alternative therapies because other doctors had "looked down upon them."
Hsiao, a UCLA internist, and colleagues at UCLA and Rand Corp. analyzed data from a national survey of 2,466 HIV-positive adults, all of whom had received care for HIV-related illnesses in 1996. The researchers found that 53% of study participants used some form of alternative medicine; nearly 26% used forms that might be harmful; and 3% substituted alternative treatments for prescribed antiretroviral therapy.
"Patients doing this are taking risks and essentially experimenting with themselves," said Farthing, who was not involved in the study. Unlike prescription medications, which contain standard doses of compounds and have been tested for toxicity, herbs contain hundreds of compounds that could potentially react with prescription medications. Also, because HIV patients' livers are often weakened, he said, "herbs that might not be toxic to the general population might be toxic to AIDS populations on these various medicines."
While AIDS care providers strongly support alternative therapies like acupuncture, relaxation, massage and hypnotherapy, along with sensible use of multivitamins, they recommend patients avoid herbal remedies or megadoses of vitamins, which can damage the kidneys and other organs.
Martin Delaney, founder of Project Inform in San Francisco, an AIDS treatment information and advocacy organization, said that since the study data were collected in 1996, when protease inhibitors were first used, fewer patients seem to be seeking substitutes for prescription treatments because newer formulations have "gotten better, are less toxic and are easier to use." But, he said, many HIV patients still ignore warnings about drug-herb combinations.