Sun
19
Apr
HIV Support
Definition
Note: None of these treatments has been proven effective as yet for the uses cited above.
HIV, or human immunodeficiency virus, is the virus responsible for AIDS (acquired immunodeficiency syndrome). First identified in 1983, this virus progressively destroys or damages cells in the immune system, making its host vulnerable to certain cancers and infections. So-called "opportunistic infections"—caused by microorganisms that do not ordinarily cause illness in healthy people—can have serious or even fatal effects on those with HIV.
Within a month or two of exposure, HIV may cause short-term flu-like symptoms, followed by a symptom-free period lasting months to years during which the virus continues to multiply. After this stage, people with HIV may develop swollen lymph nodes, recurrent herpes sores, diarrhea, weight loss, and/or chronic yeast infections (oral or vaginal)—a state previously called AIDS-related complex or ARC. Children may experience delayed development or fail to thrive. The infection is called AIDS when the number of immune cells known as CD4+ or helper t-cells drops below a certain level, or when opportunistic diseases such as Pneumocystis carinii pneumonia develop. Today, both ARC and AIDS are sometimes collectively called symptomatic HIV infection.
HIV is spread most commonly through unsafe sexual practices or by intravenous drug abuse. Mothers can infect their babies before or during birth, or later through breast-feeding.
New hope in treatment for HIV occurred with the discovery of two groups of drugs called reverse transcriptase inhibitors and protease inhibitors. Both help keep the virus from multiplying. Taken together, they can help slow the spread of the virus and delay the onset of AIDS. However, they can't prevent people from transmitting the virus to others. (One exception: Pregnant women who take one of these drugs, AZT, may have a much lower chance of passing the virus to their unborn babies.) Although powerful, these treatments do not eradicate the virus, and therefore aren't truly cures for the disease.
Surveys have shown that people with HIV often take natural remedies in addition to multiple medications. If you have HIV, it is particularly important to talk with your doctors about any natural substances you're taking and to be alert to possible interactions. Most importantly, individuals with HIV should not use St. John's wort or garlic (see Treatments to Avoid, below).
HIV, or human immunodeficiency virus, is the virus responsible for AIDS (acquired immunodeficiency syndrome). First identified in 1983, this virus progressively destroys or damages cells in the immune system, making its host vulnerable to certain cancers and infections. So-called "opportunistic infections"—caused by microorganisms that do not ordinarily cause illness in healthy people—can have serious or even fatal effects on those with HIV.
Within a month or two of exposure, HIV may cause short-term flu-like symptoms, followed by a symptom-free period lasting months to years during which the virus continues to multiply. After this stage, people with HIV may develop swollen lymph nodes, recurrent herpes sores, diarrhea, weight loss, and/or chronic yeast infections (oral or vaginal)—a state previously called AIDS-related complex or ARC. Children may experience delayed development or fail to thrive. The infection is called AIDS when the number of immune cells known as CD4+ or helper t-cells drops below a certain level, or when opportunistic diseases such as Pneumocystis carinii pneumonia develop. Today, both ARC and AIDS are sometimes collectively called symptomatic HIV infection.
HIV is spread most commonly through unsafe sexual practices or by intravenous drug abuse. Mothers can infect their babies before or during birth, or later through breast-feeding.
New hope in treatment for HIV occurred with the discovery of two groups of drugs called reverse transcriptase inhibitors and protease inhibitors. Both help keep the virus from multiplying. Taken together, they can help slow the spread of the virus and delay the onset of AIDS. However, they can't prevent people from transmitting the virus to others. (One exception: Pregnant women who take one of these drugs, AZT, may have a much lower chance of passing the virus to their unborn babies.) Although powerful, these treatments do not eradicate the virus, and therefore aren't truly cures for the disease.
Surveys have shown that people with HIV often take natural remedies in addition to multiple medications. If you have HIV, it is particularly important to talk with your doctors about any natural substances you're taking and to be alert to possible interactions. Most importantly, individuals with HIV should not use St. John's wort or garlic (see Treatments to Avoid, below).
Treatments
Proposed Treatments for HIV
Among the many proposed natural treatments for HIV, none has more than preliminary evidence. Inhibiting Viral Replication Currently, no natural remedies rival the effectiveness of antiretroviral drugs for inhibiting HIV replication in the body. However, preliminary research suggests that an extract of the leaves and stems of the boxwood shrub may delay the progression of HIV disease. Many other herbs and supplements have been proposed as well, but there is little evidence as yet that they work. Boxwood In a double-blind, placebo-controlled study of 145 people with HIV, French researchers studied the effects of two doses of a preparation made from the evergreen boxwood (Buxus sempervirens). The preparation was given in doses of 990 mg and 1,980 mg per day for periods ranging from 4 to 64 weeks.
When participants started the study, they had no symptoms of HIV and had never taken antiretroviral drugs. They were kept off anti-HIV drugs during the study (this was before the use of anti-HIV drugs became widespread). At the end, researchers found that among those taking the lower dose, fewer people developed AIDS, symptomatic HIV, or CD4+ counts below 200 compared to those taking the higher dose or placebo. Additionally, by the end of their treatment period, fewer people in the low-dose group had a large increasein the amount of HIV virus they carried compared to the other two groups.
The researchers had originally planned the study to continue for 18 months (78 weeks). However, as the study progressed, a review committee decided to halt the study early when the average participant had taken boxwood or placebo for only 37 weeks. They felt it was unethical to continue to have some people take placebo, given the positive results among those taking the extract. Nonetheless, further research is necessary to confirm the effectiveness of boxwood extract for HIV, particularly in combination with proven anti-viral drugs which have now become the standard of care for HIV infection.
No severe side effects were reported in this study, and the people taking boxwood had the same overall rate of side effects as those taking placebo.
However, there are some safety concerns with this herb. A substance called cycloprotobuxine is believed to be one of the active ingredients in boxwood. High doses of this substance can cause vomiting, diarrhea, muscular spasms, and paralysis.
Warning: For this reason, the herb should only be taken under medical supervision! Safety in pregnant or nursing women, young children, or people with liver or kidney disease has not been established. In addition, touching fresh boxwood leaves can occasionally cause skin irritation.
Note: Only a special boxwood extract has been studied as a treatment for HIV infection. Do not try to use raw boxwood leaf, as it might not be safe. Other Proposed Herbs and Supplementsfor Inhibiting Viral Replication Other substances that have been investigated for possible HIV suppression include bacailin, curcumin, elderberry, aloe, schisandra, spirulina, reishi, propolis, and astragalus. However, the evidence that they work is primarily limited to test tube and animal studies; whether these results translate into real improvement among people with HIV has yet to be determined.
The herb St. John's wort contains a substance called hypericin which has been investigated for possible anti-HIV effects. However, contrary to popular belief neither hypericin nor St. John's wort are at all useful for treating HIV. In addition, St. John's wort seriously impairs the activity of standard HIV medications, and might lead to treatment failure. (See Treatments to Avoid, below.) Fighting Weight Loss Weight loss is a frequent symptom of HIV and AIDS. Sometimes weight loss is so extreme that the person seems to \"waste away\"—hence the name \"AIDS wasting syndrome,\" which is technically defined as the loss of more than 10% of body weight combined with either chronic diarrhea or weakness and fever. Many factors can contribute to this weight loss, including loss of appetite, nausea, malabsorption of nutrients, and mouth sores.
Supplemental MCTs and glutamine, as well as whey protein, may be helpful for this symptom, although there is no definitive evidence as yet that they work. MCTs Fat malabsorption is particularly common in HIV infection, and can lead to both diarrhea and weight loss. A particular type of fat known as MCTs (medium-chain triglycerides) is more easily absorbed than ordinary fats (long-chain triglycerides) and may help decrease diarrhea and wasting. Two small double-blind studies have found that MCTs are more easily absorbed than long-chain triglycerides in people with HIV or AIDS. However, there is no direct evidence as yet that MCTs actually help people gain weight.
In both of the studies described above, participants consumed nothing but a special nutritional formula containing MCTs. Taking MCTs in this way requires medical supervision to determine the dose.
People with HIV or diabetes should not use MCTs (or any other supplement) without a doctor's supervision. For more information, including dosage and safety issues, see the full MCTs article. Glutamine Another promising treatment for wasting is the amino acid glutamine, a substance that plays a role in maintaining the health of the immune system, digestive tract, and muscle cells. Although research is still preliminary, one double-blind placebo-controlled study found that a combination of glutamine and antioxidants (vitamins C and E, beta-carotene, selenium, and N-acetyl cysteine) led to significant weight gain in people with HIV who had lost weight.
Another small double-blind trial found that combination treatment with glutamine, arginine, and beta-hydroxy beta-methylbutyrate (HMB) could increase muscle mass and possibly improve immune status. Other Herbs and Supplements for fighting Weight Loss Whey protein is sometimes recommended for weight gain in HIV, but evidence that it works is preliminary at best. One study found that while exercise improved weight gain, whey protein alone or in combination with exercise offered no benefit. Fish oil might be helpful. Enhancing the Immune System In test tube studies, a number of substances have been found to improve measures of immunity in HIV infection, for example, by elevating CD4+ counts, changing the ratio between CD4+ cells and other immune cells, increasing amounts of other immune chemicals, or enhancing the body's ability to attack invading substances. However, there is relatively little information on whether they can actually help people with HIV infection. NAC One of the natural substances most widely used by people with HIV in hopes of enhancing immune system function is the antioxidant NAC (short for N-acetyl cysteine), but evidence that it helps is somewhat conflicting.
NAC is a specially modified form of the dietary amino acid cysteine. In the body, it helps make the important antioxidant enzyme glutathione, which is sometimes used as a supplement itself. Early human trials, including a double-blind study of 45 people, suggest that NAC may increase levels of CD4+ cells in healthy people and slow CD4+ cell decline in people with HIV. Another study of NAC combined with selenium had mixed results, affecting t-cell counts in some people but not others. However, preliminary results of yet another study found that NAC had no effect on CD4+ counts or the amount of HIV virus in the blood. Other Proposed Herbs and Supplements for Enhancing the Immune System Other natural treatments that are sometimes recommended to boost immunity in HIV include: andrographis, trichosanthin (compound Q), lipoate, coenzyme Q10, maitake, a component of licorice known as glycyrrhizin, the herb Momordica charantia (also called bitter melon), echinacea, ginseng, omega-6 fatty acids, carnitine, DHEA, and proteolytic enzymes. However, there is no real evidence as yet that these treatments actually work. Garlic is sometimes recommended as well; however for safety reasons it should be avoided in HIV infection. (See Treatments to Avoid, below.)
Fish oil is also sometimes recommended for enhancing immunity in HIV infection. However, one 6-month double-blind study found that a combination of the omega-3 fatty acids in fish oil plus the amino acid arginine was no more effective than placebo in improving immune function in people with HIV. Treating Symptoms and Opportunistic Infections Besides the treatments mentioned earlier, a number of natural remedies have been proposed for symptoms of HIV or common opportunistic infections.
Bovine colostrum has been suggested as a treatment for the chronic diarrhea that commonly occurs in people with HIV or AIDS, but the evidence that it works is weak at best.
Tea tree oil and cinnamon have been suggested as treatments for thrush (oral Candida infection).
Dehydroepiandrosterone (DHEA) is a hormone that seems to decrease in people with AIDS, possibly because of malnutrition and/or stress. One small double-blind trial suggests that DHEA (50 mg per day) may improve mood and fatigue scores in individuals with HIV;104 another small trial found inconclusive results.
A standardized mixture of Chinese herbs including astragalus, andrographis, and more than 30 other herbs was no more effective than placebo in reducing HIV symptoms in a pilot study, or in a larger double-blind study. Treating Medication Side Effects Several natural treatments have been proposed to treat side effects from two drugs used in HIV: AZT, an antiretroviral drug; and TMP-SMX, a commonly prescribed antibiotic. Zinc, Carnitine, and Vitamin B12: Might Be Helpful With AZT Taking AZT can lead to zinc deficiency, which may interfere with immune function. One partially blinded study found that zinc supplements may benefit people on AZT. In the zinc-treated group, body weight increased or stabilized, CD4+ count rose, and participants had significantly fewer opportunistic infections.
Carnitine has also been proposed as a treatment for AZT side effects, based on very early evidence that it may keep AZT from damaging muscle cells.
Based on highly preliminary evidence, vitamin B12 has been suggested as a preventive for blood abnormalities caused by AZT. NAC: Proposed for Side Effects of TMP-SMX It has been suggested that the supplement NAC might help prevent side effects from the antibiotic TMP-SMX (trimethoprim-sulfamethoxazole). However, two controlled studies found that NAC did not significantly decrease adverse reactions to TMP-SMX. General Nutritional Support People infected with HIV may be particularly vulnerable to malnutrition because of decreased appetite, poor absorption, or possibly increased requirements for specific nutrients. Studies have found deficiencies of vitamins A, B1, B6, B12, E, beta-carotene, choline, folate, selenium, and zinc to be common among people with HIV infection. Many deficiencies become more common as the disease worsens. This suggests, but does not prove, that taking supplements of these nutrients may be helpful. Vitamin A/Beta-Carotene Vitamin A and beta-carotene are described together here because the body uses beta-carotene to produce vitamin A.
Vitamin A deficiency may be linked to lower CD4+ counts as well as higher death rates among people infected with HIV. A few preliminary studies have raised hopes that beta-carotene supplements might increase or preserve immune function or decrease symptoms among people with HIV. One small double-blind study suggested that taking beta-carotene might raise white blood cell count in people with HIV. However, two subsequent larger controlled trials found no significant differences between those taking beta-carotene or placebo in white blood cell count, CD4+ count, or other measures of immune function.
Two observational studies lasting 6 to 8 years suggest that higher intakes of vitamin A or beta-carotene may be helpful, but they also found that caution is in order with regard to dosage. This group of researchers generally linked higher intake of vitamin A or beta-carotene to lower risk of AIDS and lower death rates, with an important exception: people with the highest intake of either nutrient (more than 11,179 IU per day of beta-carotene; or more than 20,268 IU per day of vitamin A) did worse than those who took somewhat less.
Note: Keep in mind also that excessive dosages of vitamin A can be toxic to the liver. Consult with your physician on the right dose for you. For other dosage and safety issues, see the full articles on beta-carotene and vitamin A.
Despite hopes that vitamin A given to pregnant, HIV-positive women might decrease the infection rate of their babies, two double-blind studies have found no significant differences between babies whose mothers took vitamin A compared to those whose mothers took placebo. In any case, vitamin A is not considered safe in pregnancy; beta-carotene is preferred. B-Vitamins An observational study found that HIV-positive men with the highest intakes of vitamin B1, B2, B6, and niacin had significantly longer survival rates, while a similar study found that those taking the most B1 or niacin had a significantly lower rate of developing AIDS.
Vitamin B12 deficiencies in people infected with HIV have been linked to neurological symptoms, including slower processing of information in studies of cognitive functioning; early research suggests that restoring B12 levels to normal may decrease these symptoms. B12 deficiency has also been linked to lower CD4+ counts and more rapid development of AIDS.
Vitamin B6 deficiency has been linked to impaired immune function in one study of people with HIV infection.
Note: Excessive intake of vitamin B6 can cause neurological problems. Consult with your physician on the right dose for you. For other dosage and safety issues, see the full vitamin B6 article. Vitamins C and E Massive doses of vitamin C have at times been popular among people with HIV infection based on highly preliminary evidence. An observational study linked high doses of vitamin C with slower progression to AIDS. High intake of vitamin E was also linked to decreased risk of progression to AIDS in a different observational study.
However, a double-blind study of 49 people with HIV who took combined vitamins C and E or placebo for 3 months did not show any significant effects on the amount of HIV virus detected or the number of opportunistic infections. It has been suggested that vitamin E may enhance the antiviral effects of AZT, but evidence for this is minimal. Choline The substance choline has been newly added to the list of essential nutrients. Evidence suggests that individuals with HIV who are low in choline may experience more rapid disease progression. Iron A study of 71 HIV-positive children noted a high rate of iron deficiency. One observational study of 296 men with HIV infection linked high intake of iron to a decreased risk of AIDS 6 years later.
Note: Do not take iron supplements unless you know that you are iron-deficient. Selenium Selenium is required for a well-functioning immune system. Observational studies have linked higher levels of selenium in the blood with higher CD4+ counts and reduced risk of mortality from HIV disease. Selenium deficiency may also increase the infectiousness of women with HIV.
One open study suggested that selenium supplements might raise blood levels of selenium in people with serious HIV disease. However, in a controlled study of 52 people with HIV, selenium did not improve the clinical conditions or raise CD4+ counts any more than no treatment. A study of selenium combined with NAC had mixed results, affecting t-cell counts in some people but not others.
Selenium has also been proposed as a preventive or treatment for cardiomyopathy, a disorder of the heart muscle that can affect people with AIDS, but evidence so far is weak. Zinc Some, but not all, studies have found that HIV-positive individuals tend to be deficient in zinc, with levels dropping lower in more severe disease. But does this mean that taking zinc will help? The answer is not clear.
Higher zinc levels have been linked to better immune function and higher CD4+ cell counts, whereas zinc deficiency has been linked to increased risk of dying from HIV. One preliminary study among people taking AZT found that 30 days of zinc supplementation led to decreased rates of opportunistic infection over the following 2 years.
However, other research has linked higher zinc intake to more rapid development of AIDS. In another study of HIV-positive individuals, those with higher zinc intake or those taking zinc supplements in any dosage had a greater risk of death within the following 8 years. Multivitamins Because so many nutrients are affected by HIV infection and treatments multivitamin supplements are a logical choice.
Researchers interviewed 296 men with HIV, but not AIDS, about their diets and multivitamin use, then followed their progress for 6 years. Those who took a daily multivitamin had a significantly lower risk of developing AIDS during the study. In a similar study, HIV-positive men who took supplements of vitamin B1, B2, or B6, at levels higher than the Recommended Dietary Allowance, early in the course of their disease had lower death rates 8 years later.Treatments to Avoid Combination of St. John's wort and protease inhibitors is highly dangerous and should be avoided. In a study of healthy volunteers, St. John's wort was found to decrease the blood concentration of indinavir, one of the most widely used protease inhibitors, by 49 to 99%! This could lead to treatment failure as well as the emergence of resistant strains of the HIV virus. To make matters worse, St. John’s wort also appears to interact with another category of drugs used for HIV, non-nucleoside reverse transcriptase inhibitors (NNRTIs), such as nevirapine.
Garlic, also, may combine poorly with certain HIV medications. Two people with HIV experienced severe gastrointestinal toxicity from the HIV drug ritonavir after taking garlic supplements, and another study found that garlic might interfere with the action of the HIV drug saquinavir, reducing blood levels of the medication.
If you have HIV, talk with your doctor before using any herb or supplement, no matter how harmless it may seem. A number of common herbs may cause interactions with medications. Given the large numbers of drugs, herbs, and supplements taken by many people with HIV, the possibility of interactions is high.
Among the many proposed natural treatments for HIV, none has more than preliminary evidence. Inhibiting Viral Replication Currently, no natural remedies rival the effectiveness of antiretroviral drugs for inhibiting HIV replication in the body. However, preliminary research suggests that an extract of the leaves and stems of the boxwood shrub may delay the progression of HIV disease. Many other herbs and supplements have been proposed as well, but there is little evidence as yet that they work. Boxwood In a double-blind, placebo-controlled study of 145 people with HIV, French researchers studied the effects of two doses of a preparation made from the evergreen boxwood (Buxus sempervirens). The preparation was given in doses of 990 mg and 1,980 mg per day for periods ranging from 4 to 64 weeks.
When participants started the study, they had no symptoms of HIV and had never taken antiretroviral drugs. They were kept off anti-HIV drugs during the study (this was before the use of anti-HIV drugs became widespread). At the end, researchers found that among those taking the lower dose, fewer people developed AIDS, symptomatic HIV, or CD4+ counts below 200 compared to those taking the higher dose or placebo. Additionally, by the end of their treatment period, fewer people in the low-dose group had a large increasein the amount of HIV virus they carried compared to the other two groups.
The researchers had originally planned the study to continue for 18 months (78 weeks). However, as the study progressed, a review committee decided to halt the study early when the average participant had taken boxwood or placebo for only 37 weeks. They felt it was unethical to continue to have some people take placebo, given the positive results among those taking the extract. Nonetheless, further research is necessary to confirm the effectiveness of boxwood extract for HIV, particularly in combination with proven anti-viral drugs which have now become the standard of care for HIV infection.
No severe side effects were reported in this study, and the people taking boxwood had the same overall rate of side effects as those taking placebo.
However, there are some safety concerns with this herb. A substance called cycloprotobuxine is believed to be one of the active ingredients in boxwood. High doses of this substance can cause vomiting, diarrhea, muscular spasms, and paralysis.
Warning: For this reason, the herb should only be taken under medical supervision! Safety in pregnant or nursing women, young children, or people with liver or kidney disease has not been established. In addition, touching fresh boxwood leaves can occasionally cause skin irritation.
Note: Only a special boxwood extract has been studied as a treatment for HIV infection. Do not try to use raw boxwood leaf, as it might not be safe. Other Proposed Herbs and Supplementsfor Inhibiting Viral Replication Other substances that have been investigated for possible HIV suppression include bacailin, curcumin, elderberry, aloe, schisandra, spirulina, reishi, propolis, and astragalus. However, the evidence that they work is primarily limited to test tube and animal studies; whether these results translate into real improvement among people with HIV has yet to be determined.
The herb St. John's wort contains a substance called hypericin which has been investigated for possible anti-HIV effects. However, contrary to popular belief neither hypericin nor St. John's wort are at all useful for treating HIV. In addition, St. John's wort seriously impairs the activity of standard HIV medications, and might lead to treatment failure. (See Treatments to Avoid, below.) Fighting Weight Loss Weight loss is a frequent symptom of HIV and AIDS. Sometimes weight loss is so extreme that the person seems to \"waste away\"—hence the name \"AIDS wasting syndrome,\" which is technically defined as the loss of more than 10% of body weight combined with either chronic diarrhea or weakness and fever. Many factors can contribute to this weight loss, including loss of appetite, nausea, malabsorption of nutrients, and mouth sores.
Supplemental MCTs and glutamine, as well as whey protein, may be helpful for this symptom, although there is no definitive evidence as yet that they work. MCTs Fat malabsorption is particularly common in HIV infection, and can lead to both diarrhea and weight loss. A particular type of fat known as MCTs (medium-chain triglycerides) is more easily absorbed than ordinary fats (long-chain triglycerides) and may help decrease diarrhea and wasting. Two small double-blind studies have found that MCTs are more easily absorbed than long-chain triglycerides in people with HIV or AIDS. However, there is no direct evidence as yet that MCTs actually help people gain weight.
In both of the studies described above, participants consumed nothing but a special nutritional formula containing MCTs. Taking MCTs in this way requires medical supervision to determine the dose.
People with HIV or diabetes should not use MCTs (or any other supplement) without a doctor's supervision. For more information, including dosage and safety issues, see the full MCTs article. Glutamine Another promising treatment for wasting is the amino acid glutamine, a substance that plays a role in maintaining the health of the immune system, digestive tract, and muscle cells. Although research is still preliminary, one double-blind placebo-controlled study found that a combination of glutamine and antioxidants (vitamins C and E, beta-carotene, selenium, and N-acetyl cysteine) led to significant weight gain in people with HIV who had lost weight.
Another small double-blind trial found that combination treatment with glutamine, arginine, and beta-hydroxy beta-methylbutyrate (HMB) could increase muscle mass and possibly improve immune status. Other Herbs and Supplements for fighting Weight Loss Whey protein is sometimes recommended for weight gain in HIV, but evidence that it works is preliminary at best. One study found that while exercise improved weight gain, whey protein alone or in combination with exercise offered no benefit. Fish oil might be helpful. Enhancing the Immune System In test tube studies, a number of substances have been found to improve measures of immunity in HIV infection, for example, by elevating CD4+ counts, changing the ratio between CD4+ cells and other immune cells, increasing amounts of other immune chemicals, or enhancing the body's ability to attack invading substances. However, there is relatively little information on whether they can actually help people with HIV infection. NAC One of the natural substances most widely used by people with HIV in hopes of enhancing immune system function is the antioxidant NAC (short for N-acetyl cysteine), but evidence that it helps is somewhat conflicting.
NAC is a specially modified form of the dietary amino acid cysteine. In the body, it helps make the important antioxidant enzyme glutathione, which is sometimes used as a supplement itself. Early human trials, including a double-blind study of 45 people, suggest that NAC may increase levels of CD4+ cells in healthy people and slow CD4+ cell decline in people with HIV. Another study of NAC combined with selenium had mixed results, affecting t-cell counts in some people but not others. However, preliminary results of yet another study found that NAC had no effect on CD4+ counts or the amount of HIV virus in the blood. Other Proposed Herbs and Supplements for Enhancing the Immune System Other natural treatments that are sometimes recommended to boost immunity in HIV include: andrographis, trichosanthin (compound Q), lipoate, coenzyme Q10, maitake, a component of licorice known as glycyrrhizin, the herb Momordica charantia (also called bitter melon), echinacea, ginseng, omega-6 fatty acids, carnitine, DHEA, and proteolytic enzymes. However, there is no real evidence as yet that these treatments actually work. Garlic is sometimes recommended as well; however for safety reasons it should be avoided in HIV infection. (See Treatments to Avoid, below.)
Fish oil is also sometimes recommended for enhancing immunity in HIV infection. However, one 6-month double-blind study found that a combination of the omega-3 fatty acids in fish oil plus the amino acid arginine was no more effective than placebo in improving immune function in people with HIV. Treating Symptoms and Opportunistic Infections Besides the treatments mentioned earlier, a number of natural remedies have been proposed for symptoms of HIV or common opportunistic infections.
Bovine colostrum has been suggested as a treatment for the chronic diarrhea that commonly occurs in people with HIV or AIDS, but the evidence that it works is weak at best.
Tea tree oil and cinnamon have been suggested as treatments for thrush (oral Candida infection).
Dehydroepiandrosterone (DHEA) is a hormone that seems to decrease in people with AIDS, possibly because of malnutrition and/or stress. One small double-blind trial suggests that DHEA (50 mg per day) may improve mood and fatigue scores in individuals with HIV;104 another small trial found inconclusive results.
A standardized mixture of Chinese herbs including astragalus, andrographis, and more than 30 other herbs was no more effective than placebo in reducing HIV symptoms in a pilot study, or in a larger double-blind study. Treating Medication Side Effects Several natural treatments have been proposed to treat side effects from two drugs used in HIV: AZT, an antiretroviral drug; and TMP-SMX, a commonly prescribed antibiotic. Zinc, Carnitine, and Vitamin B12: Might Be Helpful With AZT Taking AZT can lead to zinc deficiency, which may interfere with immune function. One partially blinded study found that zinc supplements may benefit people on AZT. In the zinc-treated group, body weight increased or stabilized, CD4+ count rose, and participants had significantly fewer opportunistic infections.
Carnitine has also been proposed as a treatment for AZT side effects, based on very early evidence that it may keep AZT from damaging muscle cells.
Based on highly preliminary evidence, vitamin B12 has been suggested as a preventive for blood abnormalities caused by AZT. NAC: Proposed for Side Effects of TMP-SMX It has been suggested that the supplement NAC might help prevent side effects from the antibiotic TMP-SMX (trimethoprim-sulfamethoxazole). However, two controlled studies found that NAC did not significantly decrease adverse reactions to TMP-SMX. General Nutritional Support People infected with HIV may be particularly vulnerable to malnutrition because of decreased appetite, poor absorption, or possibly increased requirements for specific nutrients. Studies have found deficiencies of vitamins A, B1, B6, B12, E, beta-carotene, choline, folate, selenium, and zinc to be common among people with HIV infection. Many deficiencies become more common as the disease worsens. This suggests, but does not prove, that taking supplements of these nutrients may be helpful. Vitamin A/Beta-Carotene Vitamin A and beta-carotene are described together here because the body uses beta-carotene to produce vitamin A.
Vitamin A deficiency may be linked to lower CD4+ counts as well as higher death rates among people infected with HIV. A few preliminary studies have raised hopes that beta-carotene supplements might increase or preserve immune function or decrease symptoms among people with HIV. One small double-blind study suggested that taking beta-carotene might raise white blood cell count in people with HIV. However, two subsequent larger controlled trials found no significant differences between those taking beta-carotene or placebo in white blood cell count, CD4+ count, or other measures of immune function.
Two observational studies lasting 6 to 8 years suggest that higher intakes of vitamin A or beta-carotene may be helpful, but they also found that caution is in order with regard to dosage. This group of researchers generally linked higher intake of vitamin A or beta-carotene to lower risk of AIDS and lower death rates, with an important exception: people with the highest intake of either nutrient (more than 11,179 IU per day of beta-carotene; or more than 20,268 IU per day of vitamin A) did worse than those who took somewhat less.
Note: Keep in mind also that excessive dosages of vitamin A can be toxic to the liver. Consult with your physician on the right dose for you. For other dosage and safety issues, see the full articles on beta-carotene and vitamin A.
Despite hopes that vitamin A given to pregnant, HIV-positive women might decrease the infection rate of their babies, two double-blind studies have found no significant differences between babies whose mothers took vitamin A compared to those whose mothers took placebo. In any case, vitamin A is not considered safe in pregnancy; beta-carotene is preferred. B-Vitamins An observational study found that HIV-positive men with the highest intakes of vitamin B1, B2, B6, and niacin had significantly longer survival rates, while a similar study found that those taking the most B1 or niacin had a significantly lower rate of developing AIDS.
Vitamin B12 deficiencies in people infected with HIV have been linked to neurological symptoms, including slower processing of information in studies of cognitive functioning; early research suggests that restoring B12 levels to normal may decrease these symptoms. B12 deficiency has also been linked to lower CD4+ counts and more rapid development of AIDS.
Vitamin B6 deficiency has been linked to impaired immune function in one study of people with HIV infection.
Note: Excessive intake of vitamin B6 can cause neurological problems. Consult with your physician on the right dose for you. For other dosage and safety issues, see the full vitamin B6 article. Vitamins C and E Massive doses of vitamin C have at times been popular among people with HIV infection based on highly preliminary evidence. An observational study linked high doses of vitamin C with slower progression to AIDS. High intake of vitamin E was also linked to decreased risk of progression to AIDS in a different observational study.
However, a double-blind study of 49 people with HIV who took combined vitamins C and E or placebo for 3 months did not show any significant effects on the amount of HIV virus detected or the number of opportunistic infections. It has been suggested that vitamin E may enhance the antiviral effects of AZT, but evidence for this is minimal. Choline The substance choline has been newly added to the list of essential nutrients. Evidence suggests that individuals with HIV who are low in choline may experience more rapid disease progression. Iron A study of 71 HIV-positive children noted a high rate of iron deficiency. One observational study of 296 men with HIV infection linked high intake of iron to a decreased risk of AIDS 6 years later.
Note: Do not take iron supplements unless you know that you are iron-deficient. Selenium Selenium is required for a well-functioning immune system. Observational studies have linked higher levels of selenium in the blood with higher CD4+ counts and reduced risk of mortality from HIV disease. Selenium deficiency may also increase the infectiousness of women with HIV.
One open study suggested that selenium supplements might raise blood levels of selenium in people with serious HIV disease. However, in a controlled study of 52 people with HIV, selenium did not improve the clinical conditions or raise CD4+ counts any more than no treatment. A study of selenium combined with NAC had mixed results, affecting t-cell counts in some people but not others.
Selenium has also been proposed as a preventive or treatment for cardiomyopathy, a disorder of the heart muscle that can affect people with AIDS, but evidence so far is weak. Zinc Some, but not all, studies have found that HIV-positive individuals tend to be deficient in zinc, with levels dropping lower in more severe disease. But does this mean that taking zinc will help? The answer is not clear.
Higher zinc levels have been linked to better immune function and higher CD4+ cell counts, whereas zinc deficiency has been linked to increased risk of dying from HIV. One preliminary study among people taking AZT found that 30 days of zinc supplementation led to decreased rates of opportunistic infection over the following 2 years.
However, other research has linked higher zinc intake to more rapid development of AIDS. In another study of HIV-positive individuals, those with higher zinc intake or those taking zinc supplements in any dosage had a greater risk of death within the following 8 years. Multivitamins Because so many nutrients are affected by HIV infection and treatments multivitamin supplements are a logical choice.
Researchers interviewed 296 men with HIV, but not AIDS, about their diets and multivitamin use, then followed their progress for 6 years. Those who took a daily multivitamin had a significantly lower risk of developing AIDS during the study. In a similar study, HIV-positive men who took supplements of vitamin B1, B2, or B6, at levels higher than the Recommended Dietary Allowance, early in the course of their disease had lower death rates 8 years later.Treatments to Avoid Combination of St. John's wort and protease inhibitors is highly dangerous and should be avoided. In a study of healthy volunteers, St. John's wort was found to decrease the blood concentration of indinavir, one of the most widely used protease inhibitors, by 49 to 99%! This could lead to treatment failure as well as the emergence of resistant strains of the HIV virus. To make matters worse, St. John’s wort also appears to interact with another category of drugs used for HIV, non-nucleoside reverse transcriptase inhibitors (NNRTIs), such as nevirapine.
Garlic, also, may combine poorly with certain HIV medications. Two people with HIV experienced severe gastrointestinal toxicity from the HIV drug ritonavir after taking garlic supplements, and another study found that garlic might interfere with the action of the HIV drug saquinavir, reducing blood levels of the medication.
If you have HIV, talk with your doctor before using any herb or supplement, no matter how harmless it may seem. A number of common herbs may cause interactions with medications. Given the large numbers of drugs, herbs, and supplements taken by many people with HIV, the possibility of interactions is high.