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available alternative to CCR5 inhibitors?
Jun 5, 2005

Since the question of CCR5 and CXCR4 have come up repeatedly in this forum I wanted to comment once again on the chinese herb, ZiCao.It contains 30% w/w shikonin. Here is a link to the paper http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12936978

In cell culture Shikonin has been shown to reduce the number of CCR5 receptor sites on the surface of various cell types at nanomolar concentrations. I used it (9-15g /day as tea decoction) during acute infection while waiting to start meds and continued use for three months solid. I then used it as needed to help with side effects from my other meds. I noticed it makes me feel better, dropped my viral load from 3 consecutive reads of 1,000,000 to less than 350,000 before starting Haart. This is not statistically meaningful such that one can make the conclusion that the tea did anything at all. However I belive it did (which is powerful placebo on its own). Although there is no clinical evidence to support these assertions I want people to know about it. If I were not eligible for medications and was monitoring my progress, I would be drinking this tea, taking a good multi vitamin and taking Curcumin or Turmeric to reduce NF-Kappa B. The tea doesn't taste all that good and there is no convenient supplement or pill form. So it takes alot of work and adherence is challenging. There are some side effects such as with immune reconstitution syndrome, and possibly toxicity to the liver. There is the caveat of a whole set of unknown resistances arising and perhaps limiting my use of CCR5 inhibitors in the future but I would argue this risk is less than with other CCR5 inhibiotrs which block the receptor rather than with Shikonin whhich putatively reduces it's expression. There is no clinical data to present to contest or support the scientific data as there is no profit in promoting this tea and thus no funding for such an endeavor. If the NIH institute for Alternative Medicine were not so impeded by bickering and political special interests we might have known about any number of potentially helpful herbs teas and other techniques in appropriate clinical settings, but I hold out little hope for a fair assesment. I believe it helped me and my lab results may back it up. I went from near AIDS at 15% CD4 279,CD4/CD8 of .24 and viral load over 1 million in Dec,2003. My most recent labs in march were 39 % CD4 741, CD4/CD8 of 1.26 and viral load less than 7. This is not unheard of with simple Haart treatment alone, but may represent significant assistance due to the tea. If drinking this tea allows CD4 cells to evade infection or become more robust in fighting infection and thus help someone on haart become undetectable or pre-haart avoid meds altogether (ie. increase the incidence of long term non progression) then that would be a good thing. This herb is available for $3/lb (one months supply) from a chinese herb store which is significantly less that the $400 to $700 my insurance pays for each drug/month. Zi Cao is classified as a superior herb in the chinese materia medica, which means it is considered non toxic by hundreds of years of use. I would work with a trained herbalist to secure a regular supply, but realize there is as much resistance to western scientific data among acupuncturists and herbalists as there is against alternative methods in western medicine. If you go this route you are mostly on your own as Docs will decline to comment and herbalists will push you to what they know ( and understand) which may be different and confusing. Though I wouldn't keep secrets from my doctors hold your ground if you want to try new things. You will most likely encounter skepticism and resistance but it is your body.

Response from Dr. Pierone

It is difficult to ever know if a supplement is helping or not given the natural fluctuation that is seen with viral load levels and CD4 counts. It would be nice to have a non-toxic supplement for management of early HIV infection, but there is minimal economic incentive for investment in the scientific studies needed to prove benefit. The yearly budget of the NIH program for alternative medicine is probably less than what big pharma spends in a week on free pens for doctors (I really wish they would stop with the pens). Given their limited budget and all the potential areas to study, I would not expect much impact on HIV science.

One concern is that if a supplement like Shikonin did possess meaningful antiretroviral activity in humans, its use as monotherapy would probably lead to development of resistance as with other agents. I can't see much downside to using it as an adjunct to HAART. Thanks for posting.



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