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Managing Side Effects of HIV TreatmentManaging Side Effects of HIV Treatment
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Herbal Side Effects and Medicines JB
Nov 6, 2000

I am HIV positive and on Sustiva, Epivir, Zerit, and Ziagen. I have a T-cell count of 1008 and a viral load of 337 that has remained relatively stable over the last several months (about 5 months now). I did a lot of research on various supplements that may provide some benefit to me...such as NAC, a multivitamin (taken twice a day with Selenium, Vitamin C, Vitamin E, beta ceratene, Twin Labs), a separate supplement of magnesium, and L-Carnitine. My concern is with the other supplements I bought.

1) Milk Thistle...I heard it can help protect the liver from all the synthetic medicines and vitamins I take...and Garlic...I heard it can help the immune system. Now I read a recent article from the Project inform Perspective date August 2000 that says both have reported effects on the p450 enzymes that also process protease inhibitors and most NNRTIs. It says this may or may not increase the side effects of my medicines. Do the benefits outweigh the risks? If I am healthy right now...should I stay away from them? I was only trying to be proactive and protect my liver by taking precautionary measures.


Response from Dr. Bartlett

As you are well aware, many persons living with HIV infection pursue complementary treatment with herbal medications and vitamins. For many of these medications, the full effects, including HIV activity, drug interactions, and side effects, have not been thoroughly studied. Therefore, it is tricky to feel completely confident about the balance of all of these issues. I would strongly suggest reviewing all of the things you are taking with your health care provider. It may be worth taking a break from the herbal and vitamin treatments for a short period to see if your viral load falls a little bit further.

John A. Bartlett, M.D.

Sustiva Woes JB
Managing gastric adverse reactions. JB

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