Note: None of these treatments has been proven effective as yet for the uses cited above.
Human immunodeficiency virus (HIV) is the virus responsible for AIDS (acquired immunodeficiency syndrome). This virus progressively destroys or damages cells in the immune system, making its host vulnerable to certain cancers and infections. Opportunistic infections—caused by microorganisms that do not ordinarily cause illness in healthy people—can have serious or even fatal effects in people with AIDS.
Within a month or two of exposure, infection with 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 collectively called symptomatic HIV infection. This condition is increasingly rare in the developed world due to the success of pharmaceutical treatments, and, for many people, HIV infection is a manageable, if challenging, chronic illness.
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 breastfeeding.
The most effective treatment for HIV is called HAART, or highly active antiretroviral therapy. This approach generally involves the combined use of three or more drugs, taken from various families of antiretroviral drugs, including non-nucleoside reverse transcriptase inhibitors (NNRTIs), nucleoside reverse transcriptase inhibitors (NRTIs), fusion inhibitors, and protease inhibitors. Taken together, these medications can prevent the development of AIDS indefinitely. HAART, however, causes numerous side effects. Surveys have shown that people with HIV often take natural remedies in addition to conventional medications, in hopes of reducing side effects and enhancing efficacy. 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, people with HIV should not use St. John's wort or garlic. Even vitamin C may pose risks. (See Natural Treatments to Avoid below.)
Among the many proposed natural treatments for HIV, none has more than preliminary supporting evidence.
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 have at least some efficacy.1 Many other herbs and supplements have been proposed as well, but there is little evidence as yet that they work.
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).2 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 with 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 increase in 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. The review committee 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 antiviral 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.3
However, there are some safety concerns with this herb. A substance called cycloprotobuxine is believed to be one of the active ingredients in boxwood.4 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.5
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 Natural Treatments
One of the constituents of the herb aloe, acemannan, has shown some promise in test tube and animal studies for stimulating immunity and inhibiting the growth of viruses, including the HIV.107-109 These findings have led to trials of acemannan (or whole aloe) for the treatment of HIV infection. However, a double-blind, placebo-controlled trial of acemannan failed to find any benefits for people with severe HIV infection.111 (Interestingly, there is some question whether the effects seen in these studies were actually due to acemannan itself or a contaminant called aloeride.110 )
Other substances that have been investigated for possible HIV suppression include bacailin (Chinese skullcap), curcumin, elderberry, schisandra, spirulina, and reishi. However, as with aloe, 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.6 In addition, St. John's wort seriously impairs the activity of standard HIV medications and might lead to treatment failure. (See Natural Treatments to Avoid below.)
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.
One of the natural substances most widely used by people with HIV in hopes of enhancing immune system function is the antioxidant N-acetyl cysteine (NAC), but evidence that it helps is somewhat conflicting.
NAC is a specially modified form of the dietary amino acid cysteine. NAC supplements help the body make the important antioxidant enzyme glutathione. 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.13,14 Another study of NAC combined with selenium had mixed results, affecting T-cell counts in some people but not others.15 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.16 Whey protein also contains cysteine and may increase glutathione levels, but there is no evidence as yet of any meaningful benefit.
Other Proposed Natural Treatments
Other natural treatments that are sometimes recommended to boost immunity in HIV include:
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 Natural 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.17
Study results are mixed on whether massage therapy can improve measures of immune function in people with HIV.112-114 A careful review of 35 randomized trials found that relaxation therapies may be generally helpful at improving the quality of life of HIV-positive patients and in reducing their anxiety, depression, stress, and fatigue.129 These interventions, though, had no significant effect on the growth of the virus, nor did they influence immunologic or hormonal activity. Subsequently, however, a small study involving 48 HIV patients found that mindfulness meditation—a popular method for inducing the relaxation response—slowed the loss of the specific immune cells destroyed by the virus, though more research needs to be done to confirm this result.132
Immune support for people with HIV is also discussed in the Homeopathy Database, under the HIV support chapter.
Besides the treatments mentioned earlier, a number of natural remedies have been proposed for symptoms of HIV or common opportunistic infections.
Tea tree oil and cinnamon have been suggested as treatments for thrush (oral candida infection).21,22 There is some evidence that capsaicin cream applied topically is beneficial for limb pain due to peripheral neuropathy associated with HIV.130, 131
Dehydroepiandrosterone ( DHEA ) is a hormone that seems to decrease in people with AIDS, possibly because of malnutrition 23 and stress.24 One small double-blind trial suggests that DHEA (50 mg per day) may improve mood and fatigue scores in people with HIV;104 another small trial found inconclusive results.25 A more substantial (145-participant) double-blind study found that DHEA at a dose of 100 to 400 mg daily improved symptoms of dysthymia (minor depression) in people with HIV, without significant adverse effects.120
Note: DHEA does not appear to provide general benefits for people with HIV, such as improving immunity, suppressing virus levels, or aiding weight maintenance.126
Chinese herbal combinations have been investigated for the treatment of HIV, but the results have not been very promising. In a 12-week, double-blind, placebo-controlled trial, 30 HIV-infected adults with CD4+ counts of 200 to 500 were given a Chinese herbal formula containing 31 herbs.26 The results hint that use of the herbal combination might have improved various symptoms compared to placebo, but none of the differences were statistically significant. Interestingly, people who believed they were taking the real treatment showed significant benefit regardless of whether they were in the placebo group or the real treatment group.
In another double-blind, placebo-controlled trial, 68 HIV-infected adults were given either placebo or a preparation of 35 Chinese herbs for a period of 6 months.27 The results indicate that use of Chinese herbs did not improve symptoms or objective measurements of HIV severity. In fact, people using the herbs reported more digestive problems than those given placebo.
Undesired 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 medium-chain triglycerides (MCTs), a particular type of fat, and glutamine may be helpful for this symptom, although there is no definitive evidence as yet that they work.
Fat malabsorption is particularly common in HIV infection and can lead to both diarrhea and weight loss. MCTs medium-chain triglycerides , which are more easily absorbed than ordinary fats (long-chain triglycerides), 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.7,8 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.
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.9
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.10
Other Natural Treatments
Whey protein is sometimes recommended for weight gain in HIV, but evidence that it works is preliminary at best.11 One study found that while exercise improved weight gain, whey protein alone or in combination with exercise offered no benefit.105 Fish oil might be helpful for weight gain, however.12
Several natural treatments have been proposed to treat side effects from various medications used in the treatment of HIV.
Reverse transcriptase inhibitors, such as lamivudine and zidovudine, may damage mitochondria, the energy-producing subunits of cells. The supplement CoQ10 has been tried for minimizing side effects attributed to mitochondrial damage. In one study, use of CoQ 10 improved sense of well-being in asymptomatic people with HIV infection; however, it actually worsened pain symptoms in people with peripheral neuropathy.115
Taking AZT can lead to zinc deficiency, which may interfere with immune function.28 One partially-blinded study found that zinc supplements may benefit people on AZT.29 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.30,31 Other weak evidence hints that the acetyl form of carnitine might reduce nerve-related side effects caused by HIV drugs in general.128
In one well-designed, double-blind study, use of the amino acid glutamine at a dose of 30 g daily significantly reduced the diarrhea caused by the protease inhibitor nelfinavir.116 Presumably, glutamine would be helpful for other protease inhibitors as well.
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.33,34 Note, however, that TMP-SMX is known to decrease folate levels in the body, and folate supplements might, therefore, be useful.
The herb milk thistle is sometimes recommended for preventing liver problems related to use of HIV medications. While there is no direct evidence that it is helpful for this purpose, there is fairly good evidence, at least, that use of milk thistle does not adversely affect blood levels of indinavir.
In one study, 130 HIV patients on highly active antiretroviral therapy (HAART) were randomized to receive 1 of 4 treatments: acupuncture plus relaxation therapy, acupuncture plus health education, sham acupuncture plus relaxation therapy, or sham acupuncture plus health education.87 After 4 weeks of treatment, the people in the acupuncture plus relaxation group experienced a greater improvement in their GI symptoms compared to the other groups.
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, and E, beta-carotene, choline, folate, selenium, and zinc to be common among people with HIV infection.35-49 Many deficiencies become more common as the disease worsens. This suggests, but does not prove, that taking supplements of these nutrients may be helpful.
Note: One study evaluated whether use of a multivitamin tablet might reduce infectivity of African women with HIV. Researchers unexpectedly found the opposite: multivitamin tablets increase the levels of HIV virus present in the genital area.117 The reason for this surprising finding is unknown. It is not clear whether the same response would occur among people living in developed countries who, presumably, have better underlying nutrition.
Vitamin A, Beta-carotene, and Mixed Carotenoids
Vitamin A and beta-carotene are described together here because the body uses beta-carotene to produce vitamin A. Substances called carotenoids are closely related to vitamin A; this family includes lutein and lycopene.
Vitamin A deficiency may be linked to lower CD4+ counts as well as higher death rates among people infected with HIV.50 A few preliminary studies have raised hopes that beta-carotene supplements might increase or preserve immune function or decrease symptoms among people with HIV.51-54 One small, double-blind study suggested that taking beta-carotene might raise white blood cell count in people with HIV.55 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.56,57
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.58,59 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, 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.
At one point it was thought that vitamin A supplements might decrease the rate of transmission of HIV from a pregnant mother to her newborn. However, it now appears that the reverse may be true: vitamin A may increase chance of such transmission.127
One double-blind study found statistically weak evidence that use of mixed carotenoids by AIDS patients might prolong life.121
An observational study found that HIV-positive men with the highest intakes of vitamin B1, B2, B 6, and niacin had significantly longer survival rates, while a similar study found that those taking the most B 1 or niacin had a significantly lower rate of developing AIDS.62,63
Vitamin B12 deficiencies in people infected with HIV have been linked to neurologic symptoms, including slower processing of information in studies of cognitive functioning; early research suggests that restoring B 12 levels to normal may decrease these symptoms.64,65 B 12 deficiency has also been linked to lower CD4+ counts and more rapid development of AIDS.66
Vitamin B 6 deficiency has been linked to impaired immune function in one study of people with HIV infection.67
Note: Excessive intake of vitamin B 6 can cause neurologic 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 based on highly preliminary evidence.68,69 An observational study linked high doses of vitamin C with slower progression to AIDS.70 High intake of vitamin E was also linked to decreased risk of progression to AIDS in a different observational study.71
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.72 It has been suggested that vitamin E may enhance the antiviral effects of AZT, but evidence for this is minimal.73
A study of 71 HIV-positive children noted a high rate of iron deficiency.75 One observational study of 296 men with HIV infection linked high intake of iron to a decreased risk of AIDS 6 years later.76
Note: Do not take iron supplements unless you know that you are iron-deficient.
Selenium is required for a well-functioning immune system.77 Observational studies have linked higher levels of selenium in the blood with higher CD4+ counts 78 and reduced risk of mortality from HIV disease.79,80 Selenium deficiency may also increase the infectiousness of women with HIV.81
In a double-blind, placebo-controlled study of 450 people with HIV, use of selenium supplementation at a dose of 200 mcg per day appeared to reduce measures of viral load.14 However, the statistical method used in this study is somewhat questionable. Previous smaller studies using more standard statistical methods failed to find such effects.83-84 And, as part of a larger systematic review, researchers found that selenium (compared to placebo) did not improve outcomes in pregnant women with HIV or their infants.134
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.85,86
Some, but not all studies, have found that HIV-positive people tend to be deficient in zinc, with levels dropping lower in more severe disease.87-92 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.93-95 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.96
However, other research has linked higher zinc intake to more rapid development of AIDS.97 In another study of HIV-positive people, those with higher zinc intake or those taking zinc supplements in any dosage had a greater risk of death within the following 8 years.98 And, as part of systematic review analyzing the use of supplementation in pregnant women with HIV, researchers did not find evidence to support the use of zinc for improving outcomes in mothers or their infants.134
One study found that use of zinc supplements could reduce diarrhea symptoms in people with HIV.123
Because so many nutrients are affected by HIV infection and treatments, multivitamin supplements are a logical choice.
A double-blind study of 40 people on HAART found that use of a multinutrient supplement improved CD4 counts and possibly improved neuropathy symptoms.122
However, as noted above, one study evaluated whether use of a multivitamin tablet might reduce infectivity of African women with HIV, and unexpectedly found the opposite: multivitamin tablets increase the levels of HIV virus present in the genital area.
People using HIV medications should not take St. John's wort. 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%.101 This could lead to treatment failure as well as the emergence of resistant strains of the HIV virus. St. John’s wort also appears to interact with non-nucleoside reverse transcriptase inhibitors (NNRTIs) such as nevirapine.106
Garlic may also combine poorly with certain HIV medications. Two people with HIV experienced severe gastrointestinal toxicity from the protease inhibitor ritonavir after taking garlic supplements,102 and another study found that garlic might interfere with the action of the protease inhibitor saquinavir, reducing blood levels of the medication.103
Other possible harmful effects discussed elsewhere in this article include worsening of peripheral neuropathy symptoms by CoQ10 and increase of infectivity attributable to use of multivitamins. If you have HIV, talk with your doctor before using any herb or supplement, no matter how harmless it may seem. Given the large numbers of drugs, herbs, and supplements taken by many people with HIV, the possibility of interactions is high.
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