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Complementary and Alternative Therapies in HIV

eeking health promotion and disease prevention
Conventional therapies have been exhausted
Conventional therapies are of indeterminate effectiveness or associated with significant side effects or risk
No conventional therapy known to relieve patients condition
The conventional approach is perceived to be emotionally or spiritually without benefit

Patterns Of Alternative Therapy Use In British Columbia

1019 participants receiving HIV/AIDS-related drug treatments from the provincial program
Invasive (dietary supplements and other) vs non-invasive (tactile and personal) Rx recorded

Thirty-four percent had ever used complementary therapies

53% dietary supps; 43% other Invasive

15% tactile; 30% other personal

Users morn likely to have AIDS, moderate or severe pain, more educational degrees, not currently on ARV Rx

Use of CAM by HIV + Women: Results

CAM use similar in HIV + and HIV - women

Users older, higher education and income, more frequent in whites
Spiritual practices, regular exercise,

Chinese herbs most frequent

70% users did not disclose to their health care provider

Traditional Medicine In Uganda Effectiveness of traditional herbal medicine for treatment of chronic diarrhea and Herpes Zoster compared to best medical therapy available, including acyclovir

387 CD and 272 HZ pts enrolled
HZ lesions healed at same rate whether under herbal or medical Rx, but fewer healer pts with post-herpetic neuralgia (11% vs 44%, p<0.0005)

CD responded significantly morn frequently to herbal then conventional Rx (73% vs 29%. p<0.0005); also faster response (NS)

CD4 cells declined equally in all groups

Meta-Survey Of Plant And Herb Material As Treatment For HIV

• Literature searched from 1982 onwards for all plant and herbal compounds or extracts screened for anti-HIV activity
• Tens of thousands screened; 70 compounds and 76 crude extracts from 123 species reportedly exhibited HIV inhibitory activity in vitro
• 63 of the bioactive ingredients in Chinese Materla Medica
• 29 terpenes, 29 flavonoids, 15 polysccharides, 8 coumarins, 6 tannins, 4 lectins, 4 quinolones, 2 peptides and 7 other alkaloid
• RTI, PI and interference of infection at viral cell entry level
• Dicaffeoylquinic acids from Bolivian medicinal plant extracts now being evaluated as integrase inhibitors
  

Chinese Herbs for Symptomatic H1V

• Safety
• Follow-up complete on 29 subjects
• One refused to return for 2nd and 3rd visits
• One refused meds after 2 wks b/o diarrhea
• One had transient 4-fold increased hepatic transaminases at 6 wits; no recurrence after two week washout
• All three were on placebo

Chinese Herbs for Symptomatic HIV

Source QI^TM

^{Main Components}

Ailanthes (Chun Pi)

• Astragalus (Huang QI)
• Ginseng (Ren Shen)
• Atractylodes (Bai Zhu)
• Dried ginger (Gan Jlang)
• Burpleumm (Chai Hu)
• Fermenta Massa (Shen Qu)

MARROW PLUS for Anemia

Marrow Plus^TM

Main Components

Milletla (di Xue Teng)

• He Shou Wu (Ho Shou Wu)
• Salvia (Dan Shen)
• Astragalus (Huang Ql)
• Rehmannias (Sheng and Shu Di Huang)
• Tang Kwel (Dang Gui)

CPCRA 022 Neuropathy Trial

Primary endpoint

    Change in pain from baseline to wk 6, wk14

Measured by daily pain diaries

• Pain rated using Grecely pain scale based on 13 descriptive words:

            Faint .04

  Mild .74

  Barely strong 1.10

  Extremely Intense t.75

CPCRA 022 Neuropathy Study: Results of the Acupuncture Comparison

• Standardized acupuncture N = 121. Alternate points N = 118
• At 6 wks, effect of acupuncture was 0.01 I.e. alternate points had on average 0.01 units more pain relief; at 14 wks, - 0.08
• For both, 5t% reported at least moderate relief at 6 wks; at 14 wks, 57% acupuncture vs 48% alternate points (13=0.27)
• 20%acupuncture and 25% sham d/c'ed priorto 14wks, c/w 35% and 36% for amitriptyline and placebo
  

Alternative Agents in HIV Infection

Allicin for Cryptospoddium

• Twenty patients with median CD4 of 18/mm3, all on ARV and OI prophylaxis
• Five newly diagnosed; 5 within first month
• Allicin 30 mg bid; once Ix), second dose as a rectal retention enema
• 10/16 evaluable pte with improved stool frequency and consistency; stable or increased wt
• Stools negative for cryptosporidium in 4/8 pts on Rx> 8 wks
  

Malaleuca Oral Solution for Refractory Thrush

• 14 pts with clinical and mycological resistant thrush
• Breathaway~ t5cc qid swish and spit for 2-4 wks
• At 4 wks, 5 cured, $ improved, 2 NR in evaluable pts
• Mycological response seen in 8/t2 (all clinical respenders)
• No relapses at 4 wks off Rx seen
  

Marijuana as Medicine

• Marijuana (cannabis, hemp) is one of the oldest known psychoactive plants

THC and Chemotherapy N & V

• Interest in 70s prompted by anecdotal reports when available antiemetics were inadequate
• In randomized trials, oral THC better than placebo and equivalent or superior to prochlorperazine
• Smoked THC appeared superior to oral
• THC _{<metoclopramide <5-HT3 antagonists}
  

Marijuana and Appetite Stimulation

Mechanism unknown

   ?  enhanced sensory appeal

    ? enhanced hunger

    ? collapse of satiety mechanisms

• Results of chronic dosing studies In nl volunteers in a residential setting indicates marijuana stimulates appetite and increases caloric intake
  

Marijuana Use by Buyer's Club Clients

• Community Consortium survey conducted in San Francisco and Oakland, Summer 97
• 149 anonymous responses analyzed
• 75% HIV + used THC for appetite stimulation compared with 18% HIV negative users
• Majority smoked daily, -3 joints, one gm

HIV RNA via "ultrasensitive" bDNA assay . Indinavir and nelfinavir kinetics + Plasma THC levels