HIV and "Natural" Therapies: A Bad Blend

Half of U.S. patients infected with HIV use alternative therapies while taking powerful AIDS cocktails, and nearly one in four choose alternative treatments that could interfere with conventional AIDS therapy. And many never share that information with their doctors, researchers have found in a recent study.

Patients often believe that so-called natural treatments are helping to keep them healthy and diminishing the unpleasant side effects of prescription drugs. But megadoses of vitamins, homeopathic remedies and some herbs can reduce the effectiveness of antiretroviral drugs. For example, the herbal antidepressant St. John's wort lowers blood levels of protease inhibitors, including indinavir (Crixivan) and ritonavir (Norvir). As a result, the medication can stop working and HIV can become resistant to antiretrovirals. Garlic can have similar effects on AIDS drugs, warned Dr. Charles Farthing, medical director of the AIDS Healthcare Foundation in Los Angeles.

"The simplest thing is to understand one drug and one herb, but the reality is most people are taking more than that," said Dr. An-Fu Hsiao, lead author of the study. Hsiao's study was sparked by his longtime interest in alternative medicine and his experiences with HIV patients, some of whom were reluctant to discuss their use of alternative therapies because other doctors had "looked down upon them."

Hsiao, a University of California-Los Angeles internist, and colleagues at UCLA and RAND Corp. analyzed data from a national survey of 2,466 HIV-positive adults, all of whom had received care for HIV-related illnesses in 1996. The researchers found that 53 percent of study participants used some form of alternative medicine; nearly 26 percent used forms that might be harmful; and 3 percent substituted alternative treatments for prescribed antiretroviral therapy.

While AIDS care providers strongly support alternative therapies like acupuncture, relaxation, massage and hypnotherapy, along with sensible use of multivitamins, they recommend patients avoid herbal remedies or megadoses of vitamins, which can damage the kidneys and other organs. The full study, "Complementary and Alternative Medicine Use and Substitution for Conventional Therapy by HIV-Infected Patients," is published in the June 1 issue of Journal of Acquired Immune Deficiency Syndromes (2003;33(2):157-165).

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