Managing HIV: an integrative perspective

by Dr. Jacki Hart

People with HIV and AIDS need standard medical care, but there are many alternative therapies that can complement and perhaps enhance standard treatments.

Many people with the human immunodeficiency virus (HIV) turn to complementary and alternative therapies in an effort to reduce symptoms of the virus, lessen side effects from standard medical treatments, improve overall health and well-being, enhance immune function, and reduce the likelihood of developing opportunistic infections. Often, the use of complementary medical therapies gives the user a sense of empowerment—an important feeling for someone with HIV, which can make a person feel very powerless.

Surveys show that people with HIV turn to several alternative therapies:

52-68% take vitamins, herbs or supplements

64% do aerobic exercise

33% do other exercises such as yoga or strength-training

56% use prayer and 38% use other spiritual practices

22-54% obtain bodywork (such as massage), energy healing, acupuncture or other "hands-on" therapies

46% practice meditation

42% attend support groups

33% practice breathing techniques for relaxation

24% use medicinal marijuana available in tablet form called marinol to reduce pain, diminish nausea or stimulate appetite.

I will discuss some of these therapies and how they can be integrated into medical care for people with HIV.

People with HIV have used acupuncture to improve general well-being, alleviate symptoms such as fatigue, insomnia, headache, and night sweats, and to minimize side effects from medications. This last factor is important because making medications more tolerable allows people to continue taking medicines they may have otherwise stopped taking.

A small study published in 1999 showed that acupuncture improved nerve function in people with peripheral neuropathy, which can be caused by some medications used to treat HIV. Participants reported less pain, increased strength, and improved sensation, and these results were confirmed by nerve conduction studies that showed measurable improvement in nerve function. The number of people in the trial was small, but the results are intriguing.

Acupuncture has also been used to treat diarrhea, a common problem for people with HIV. In China, acupuncture and moxibustion (a heat treatment performed by the acupuncturist over points where the needles are placed) are the standard treatments for HIV-related diarrhea.

Herbs have been used to treat certain symptoms of HIV. In a study in Uganda, 154 patients with HIV who received individualized herbal treatments for Herpes zoster—a skin infection characterized by extreme pain and sensitivity on the surface of the skin together with blisters in the location of the pain—improved more quickly than 55 patients who received standard treatment with the drug acyclovir. In other words, both groups got better, but the group receiving the individualized herbal remedies experienced reduced pain and resolution of the blisters more quickly than the group receiving acyclovir.

Although the use of herbs is standard in traditional Chinese medicine, and despite some promising test-tube and animal studies, human research in the United States of traditional Chinese medicinal herbs to help reduce levels of circulating HIV in the bloodstream have been, in my opinion, inconclusive, showing no definitive help but no obvious harm.

Test-tube studies of St. Johns Wort, an herb frequently used for depression, suggest that it may also be helpful against HIV. St. Johns Wort given to people with the virus, however, led to intolerable side effects in one study, such that very few people were willing to complete the study. In addition, information from an article in the prestigious medical journal The Lancet published in February 2000 shows that St. Johns Wort may lower levels of indinavir, a medication used to treat HIV.

Test-tube studies of other herbs in the treatment of HIV, including licorice root, Calendulus officinalis flowers, and ginseng, have yielded some provocative results. Ginseng has also shown some possible benefits in human studies. More research is necessary, however, before definitive conclusions about these herbal remedies for HIV can be drawn.

In addition, I would caution against using echinacea and astragalus, two substances touted to enhance immune function in people with HIV, because echinacea and astragalus may actually enhance replication of the HIV virus, leading to what is commonly called increased "viral load."

Weight loss has historically been a serious problem for people with HIV. This symptom may begin early in the course of the disease and can increase the risk for developing opportunistic infections. Weight loss is exacerbated by other common symptoms of HIV and AIDS, including lesions in the mouth and esophagus, diarrhea, and poor appetite.

Over the last several years, weight loss has become less of a problem, thanks to new medications called "protease inhibitors" used for treatment of HIV; reduction of muscle mass, however, remains a significant concern. Working with a registered dietitian to develop a meal plan to prevent weight loss and muscle breakdown is also helpful.

Perhaps the most interesting information about supplements for people with HIV comes from an article published in the scholarly journal Nutrition in November 1999. In a well-designed study comparing the use of a daily supplement regimen that included the amino acid glutamine (40 grams per day), vitamin C (800 milligrams), vitamin E (500 International Units), beta-carotene (27,000 International Units), selenium (280 micrograms), and N-acetylcysteine (2400 milligrams) to placebo, people who took the supplements gained significantly more weight after 12 weeks than did those who took the placebo.

Vitamins C and E may reduce the oxidative stress of HIV and reduce viral load; this was suggested by a study published in the journal AIDS in September 1998, although it was not definitively proven. If true, it would support the fact that many people with HIV seem to have lower levels of antioxidants such as vitamins C and E in their blood than those without HIV. Related to vitamin C, grapefruit juice may enhance the absorption of protease inhibitors.

The generally recommended amounts of these supplements for people with HIV are 1000 milligrams vitamin C and 400-800 International Units vitamin E per day. Selenium in amounts of 100-400 micrograms and a vitamin B complex of 75-100 milligrams per day may also be useful because of the physical stress of HIV. People with HIV may also have low levels of vitamin B12, in which case monthly injections of this nutrient are necessary.

Exercise is another way to help develop a general sense of well-being, improve mental attitude, decrease depression, diminish weight loss and increase lean body mass. Resistance or weight-training is particularly useful to increase strength and enhance lean body mass.

Many people believe that prayer or other spiritual practices may be quite helpful for people living with HIV. Although there is no definitive evidence in terms of a spiritual ritual changing the course of the disease, I do agree with proponents of spiritual approaches who say that these practices may help people with HIV and AIDS more comfortably manage their condition.

Some say that a spiritual practice may even foster a changed perspective, opening up new thoughts, ideas, and possibilities for treatment approaches. I would just caution people to choose carefully—find a non-judgmental philosophy and practice that is in sync with your personal belief system and values. Also, remember that spirituality does not necessarily mean religion and that helpful and healthy spiritual practices should not encourage the setting of unattainable goals, unrealistic expectations, or belief in false promises.

I believe that the most definitive information about HIV and complementary medical approaches is due to come from Bastyr University in Washington state where researchers set up an AIDS research center in 1994 through a cooperative grant from the National Institutes of Health (NIH) Office of Alternative Medicine (OAM), now known as the National Center for Complementary and Alternative Medicine (NCCAM).

Upon concluding, I also want to stress the importance of communication with your doctor. Although medical doctors should take more initiative in asking about use of alternative and complementary medical treatments (only 26% of those caring for patients with HIV ask about use of alternative treatments), you too can take responsibility in offering the information regarding use of alternative medical therapies. Try not to be concerned about being met with opposition, because, according to surveys, 63% of medical doctors believe that complementary approaches are a helpful adjunct for treatment of HIV.