herbal medicine in the management and treatment of hiv-aids - a review of clinical trials
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7/21/2019 Herbal Medicine in the Management and Treatment of HIV-AIDS - A Review of Clinical Trials
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7/21/2019 Herbal Medicine in the Management and Treatment of HIV-AIDS - A Review of Clinical Trials
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Australian Journal of Herbal Medicine 2014 26(3)Article Australian Journal of Herbal Medicine 2014 26(3)Article
© NHAA2014 1010 © NHAA2014
se,ua intercourse& *ood transfusions& !y$odermic
needes& $re'nancy& *reastfeedin' and *ody fuid
e,$osure to sensitive
use of traditiona medicine is es$eciaycommon in
deveo$in' countries (i"e" Africa& Asia and
atin/Sout! America)" In deveo$in' countries&
an estimated 0 to 506 of t!e $o$uation use
traditiona medicines %!ic! mainy serve t!eir $rimary !eat!care needs" n t!e ot!er !and& in
deveo$ed countries (i"e" Austraia& 7uro$e and
8ort! America) traditiona medicine is commony
used in $arae %it! ao$at!ic medicine (i"e" !i'!y
active antiretrovira t!era$y (HAA9#))"2 #!e
use of com$ementary and aternative medicines is
%ides$read in c!ronic conditions& incudin' HIV-
AIDS infection" 7ven t!ou'! !er*a medicine is
one of t!e most commony used traditiona
medicines& statistics on t!e utiisation of !er*a
medicine in t!e treatment and mana'ement of HIV
amon' t!e Austraian $o$uation are ar'ey
unavaia*e" Accordin' to a :S study& 26
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of HIV-infected $eo$e use !er*a medicine as $art of
t!eir treatment"3 A 7uro$ean study s!o%ed t!at !er*a
medicines are used *y a$$ro,imatey 2;6 of HIV-
infected $eo$e"4
#!e $rimary reason for t!e use of traditiona
medicines in t!e treatment of HIV& es$eciay in
deveo$in' countries& is t!e !i'! cost and/or t!eunavaia*iity of HAA9#"; Her*a medicines are more
i+ey to *e used in HIV-AIDS treatment in %estern
countries as an adunct t!era$y to su$$ort t!e immune
system& reduce t!e side-effects of medication (for
e,am$e nausea and de$ression)& reduce vira
re$ication and im$rove 'enera %e*ein' (i"e" act as an
ada$to'en)" Her*a medicines may function in different
%ays in HIV infection and associated conditions" In
many cases t!e mec!anisms of action are not cear and
t!e %!oe !er*s or s$ecific $!ytoc!emicas require
furt!er researc!" < 7mer'in' evidence su''ests t!e
$ossi*iity of immune-moduatory and anti-vira
$ro$erties conferred *y various !er*a s$ecies and t!eir
e,tracts" #!ere are !o%ever concerns reated to unsafe
or erroneous $ractices as %e as t!e increasin'
frequency of caims of a cure %!en t!ere is insufficient
evidence to su$$ort suc! caims"; In addition& !er*s or
t!eir $!ytoc!emicas may dis$ay adverse effects in
conunction %it! anti-retrovira dru's and may *e
contraindicated for use %it! t!ese medications" A ist of
commony used !er*s in HIV-AIDS adunct t!era$y is
s!o%n in #a*e 1"
$ethodolog*
A revie% of cinica trias avaia*e on t!e use of !er*a medicine in t!e treatment of HIV-AIDS or in
conunction %it! conventiona anti-retrovira dru's %as
conducted usin' =u*>ed and ?oo'e Sc!oar data*ases"
#!e ourna artices %ere o*tained usin' res$ective
onine ourna data*ases" #!e seection criteria %ere
restricted $rimariy to cinica trias e,aminin' !er*a
medicine in HIV-AIDS treatment& and !uman !eat!
surveys of A> use from @ anuary 15B0 - 30t!
Se$tem*er 2013" In vitro studies %ere incuded if t!ey
su$$orted t!e e,$anations of o*servations made in t!e
cinica trias to ea*orate on t!e moecuar mec!anisms
and e,$ain t!e o*served efficacy of t!e $articuar !er*amedicine"
#!e searc! terms incuded t!e foo%in' strin' of
terms in com*inationC
HIV Her*& AIDS Her*& HIV Her*a&
AIDS Her*a& HIV AIDS Her*a& HIV
AIDS Her*"
=u*ications %ere seected if t!e term(s) a$$eared
in t!e $u*ication tite" Aso a num*er of $u*ications
%ere o*served in muti$e or a of t!e searc! terms and
t!eir res$ective com*inations" Du$icates %ere removed"
9esuts of t!ese searc! terms can *e seen in #a*e 2"
Her*a medicines revie%ed incuded estern !er*amedicine s$ecies& #!ai& !inese and aso African
s$ecies" At!ou'! t!ere %as some an'ua'e restriction
t!e revie% attem$ted to incude !er*a medicines from
$u*ication in an'ua'es ot!er t!an 7n'is! %!ere t!e
!er*a s$ecies is found to *e ceary identified" #%o of
t!e aut!ors read >andarin (Han c!aracter scri$t) and
%ere a*e to determine t!e 'enus and s$ecies of some of
t!e !er*a medicines used in !inese medicine
treatments" #!e revie% aso focused on t!e safety andefficacy of !er*a medicine" After researc! $u*ications
and revie%s %ere com$ied %it! res$ective searc! terms&
ony !uman cinica trias and e$idemioo'ica studies
%ere used for t!e revie% (=u*>ed data*ase)" it!
res$ect to ?oo'e Sc!oar& t!e searc! term(s) %ere
required to *e incuded in t!e tite of t!e artice" Artices
re$eated %it! different searc! terms& data*ases& as %e
as some studies %it! no maor reevance to HIV-AIDS
%ere deeted from t!e revie%" =u*ications %ere
accessed directy from t!e $u*is!er %e*sites" 9esuts
from studies %ere e,amined suc! as num*er of
o*servations& ty$e of researc! desi'n& and maor
outcomes of t!e study" A discussion of t!ese resuts and
concusions %as conducted& sometimes usin' in vitro
studies as references to inter$ret t!e resuts s!o%n in t!e
researc! artices"
,es#lts
As #a*e 2 de$icts& t!ere %as a !i'! num*er of
cinica trias re$eated for different searc! terms (426)
t!at %ere deeted" Eurt!er& t!ere %ere anot!er 15"<6 of
$u*ications %!ic! !ad no direct reevance to HIV-AIDS
(#a*e 2) and su*sequenty deeted from t!is revie%"
#!ere %ere 33 cinica studies and e$idemioo'ica
studies finay seected and ta*uated for t!e revie% %it!maor outcomes of t!e researc! isted (#a*e 3)"
Disc#ssion
,ole of herbal medicinein HIV-AIDS
treatment
ny a fe% cinica trias are avaia*e on t!e use
of !er*a medicine in HIV-AIDS" #!ey are often
administered due to t!eir o% cost %ide avaia*iity in
t!ird %ord and deveo$in' nations %!ere anti-retrovira
dru's are not easiy accessed" ne issue is t!e mis'uided
!eat!care $rovided *y uneducated and unquaified
!er*aists misuse of !er*a t!era$y in t!e treatment of
HIV-AIDS in t!e t!ird %ord and deveo$in' nations&B
at!ou'! t!is may re$resent traditiona use of t!e !er*a
medicines for infection and infammatory conditions"
In t!e deveo$ed %ord A> treatment a$$ears to
*e %idey used in conunction %it! HIV conventiona
treatment suc! as anti-retrovira dru's" Her*a medicines
are used in com*ination %it! anti-retrovira dru's to
reduce adverse effects of nausea and de$ression and
for immune su$$ort/moduation" In t!e #!ird ord
and deveo$in' nations& due mainy to t!e cost of anti-
retrovira dru's& !er*a medicines a$$ear to *e more
%idey used& es$eciay in mana'ement of associated
conditions suc! as immune su$$ression and o$$ortunistic
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infections" A study in >e,ico reveaed t!at of 253 HIV
$atients& <3"46 used A> of %!ic! 25"<6 %ere !er*a
$roducts" #!e correation of t!e use of A> %as !i'!est
in o%er income earners due to t!e $rice of anti-
retrovira treatment"5 In #an.ania& due to cost
restrictions& HIV sufferers resorted to t!e use of an
array of < ; !er*a medicine s$ecies& mosty eaf e,tracts and consumed as decoctions for t!e treatment of
associated infections suc! as tu*ercuosis and ora
candidiasis"F In :'anda& !er*a medicine treatment !as
*een o*served as a *eneficia treatment o$tion for
!er$es .oster virus (i"e" reduced $ain severity) in HIV
$atients"11
S#rve* of herbal medicine #sed in
treatmentof HIV-AIDS in &hailand
A study from #!aiand indicated t!at 31 6 of t!e
$o$uation re$orted usin' !er*a medicine" it! re'ard
to 'overnment su$$ort for modem treatment& t!e
study s!o%ed t!at $eo$e ivin' %it! HIV tended to
see+ assistance from !eat! care services for o*tainin'
treatment" Ho%ever& femaes ivin' in u$-country
areas received ess modem treatment *ut found !er*a
remedies more accessi*e for treatment" 9es$ondents
from $rovincia to%ns %ere found to use !er*a remedies
more often t!an t!ose from Gan'+o+ or !i'!y ur*ani.ed
areas& and t!e most commony used !er*a remedy (*y
21 6 of res$ondents) %as *itter cucum*er
(Momordica charantia).12
val#ation of herbal medicines #sed
for treatingHIV-AIDS in So#th AfricaIn a descri$tive& $ros$ective& foo%-u$ study in
Sout! Africa& 33 HIV-$ositive vounteers (< men and 2
%omen *et%een 22 and 43 years of a'e) %ere evauated
re'ardin' t!e effectiveness of commony used
traditiona !er*a medicines in t!e mana'ement of HIV-
AIDS" #!e study evauated t!e treatment efficacy
ofusin' !er*a medicines *y a num*er of quaitative
$arameters" #!e study %as conducted over a $eriod of
one year" =artici$ants s!o%ed si'nificant !eat!
im$rovement B06 of t!e $atients dis$ayed a *etter
$!ysica a$$earance& ;6 !ad increased a$$etite& <06
!ad disa$$earance of s+in mar+s/ esions&1006 !ad disa$$earance of uro'enita esions& and B06
of $artici$ants !ad 'ained *ody %ei'!t& at!ou'! *ody
com$osition %as not s$ecified" #!ere %as a si'nificant
decrease in vira oads %it! a corres$ondin' si'nificant
increase *y 2"; fod in D4 #-ce counts" ver 06 of
$atients resumed %or+$ace duties" #!e study stron'y
su''ested t!e effectiveness of t!ese traditiona Sout!
African !er*a medicines as su$$ementary or aternative
medicine in HIV-AIDS treatment& and t!e im$rovement
in vira oad su''ested t!ey !ad an anti-vira action" #!e
aut!ors su''ested t!e anti-vira activity may *e due to
t!e $!ytoc!emica com$osition of aendua officinaisor A'astac!e ru'osa& 13 %!ic! are used traditionay for
t!eir anti-s$asmoytic and anti-*acteria actions"
$od#lation of the imm#ne s*stem with
astragal#s
Astra'aoside II& a +ey $!ytoc!emica $resent in
Astragalus spp. , at a concentration of 1 nmo/&!as
*een s!o%n to initiate #-ce activation in $rimary murine
ce cuture (in vitro study)" #!e s$ecific mec!anism is
t!rou'! t!e re'uation of D4 ces via ; $rotein tyrosine
$!os$!atase activity (re'uates $!os$!oryation state of
various si'nain' moecues)& and may *e t!e s$ecific
mec!anism *y %!ic! astra'aus moduates t!e immune
system durin' disease& 14 incudin' HIV-AIDS"Astra'aus
(Astragalus spp.) %as traditionay used as a tonic for
dia*etes and as an ada$to'en for !eain' in !inese
medicine"
Assessment of lmm#no.el in treatmentof
&/ among HIV-AIDS atients
#!e !er*a medicine (Immuno,e) %as administered
%it! anti-#G t!era$y (A##) amon' HIV-AIDS $atientssufferin' from tu*ercuosis" Eorty $atients %ere divided
into t%o arms of t!e studyC arm A %as treated %it! A##
and arm G %it! Immuno,e ; A##" Immuno,e com$rises
of 2< immunoo'ica moduatin' !er*a s$ecies" #!ese
incudeC aoe (Aloe arborescens), centaury (Erythraea
centaurium ) , $arsey root (Petroselinum crispum),
rose!i$ (Rosa laevigata), !i'!*us! cran*erry fruits
(Viburnum opulus) , !y$ericum (ypericum per!oratum),
!inese a'rimony (Agrimonia pilosa), sea *uc+t!om
*erries (ippophae rhamnoides), sa'e ("alvia
o!!icinalis), *irc! eaves (#etula s$")& mari'od fo%er
($alendula o!!icinalis) ,
$antain (Plantago ma%or) ,
Si*erian 'insen' (Eleutherococcus senticosus), common
%orm%ood (Artemisia absinthium), inden (&ilia
cordata), uni$er *erries ('uniperus communis), rose root
(Rhodiola rosea), 'round ivy ( lechoma hederacea),
ore'ano (riganum vulgare), nette eaf (*rtica dioica),
icorice (lycyrrhi+a s$")& conefo%er (Echinacea
purpurea), %id t!yme
( &hymusserpyllum), equisetum (Euisetum arvense),
%id stra%*erry (-ragaria vesca), c!a'a mus!room
(Inonotus obliuus) and 'reen tea (&hea sinensis). :t %as
o*served t!at addition of Immuno,e reduced
o$$ortunistic infections as %e as im$roved cinica
efficacy of A##"1<
?iven t!e %ide array of !er*a s$ecies it is uns$ecified
%!ic! $!ytoc!emicas are $resent and t!us $ossi*y
active to stimuate t!e immune system eit!er in isoation
or in com*ination %it! ot!er $!ytoc!emicas"
ong term treatmentof 0aediatricAIDS
with herbal remedies in ,omania
In 9omania& 10 c!idren ivin' %it! AIDS %!en
treated %it! natura !er*a remedies (!an Gai San)
s!o%ed im$rovement in D4 count& decrease in
mortaity rate and 'ood maintenance of quaity ofife"#!ese !eat! *enefits %ere s!o%n for t!ose %!o +e$t
ta+in' t!e !er*a medicines for 3 years& %it!out any
side-effect of t!e !er*a medicine usa'e"1E
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&able 1+ Commonl* #sed herbs in HIV-AIDS treatment
S%in imm#nit* Circ#lator*stim#lantF Aloe $era (Aloe vera) F @in*er (Zingiber officinale)
Adatogen F @inG*o (Ginkgo biloba)
F @insen* (Panax s,) De#rativeF ?ithania (Withania somnifera) F @arlic (Allium sativum)
Anti-bacterialF @raefruit seed (Citrus , ereaist!
F 'roolis Diahoretic
Anti-inflammator*F /o>7ood ("uxus semervirens)
F Atract%lodes (Atract#lo$es macrocehala) Digestive carminativeF Cli$e tree (%lea euroaea) F 'eerint (&entha , ierita)
F "ea tree (&elaleuca alternifolia) .ectorantF "ureric (Curcuma longa) F H%sso ('#ssous officinalis)
Anti-viralactivit* He0ato0rotectiveF @olden Seal ('#$rastis cana$ensis)
F @reater celandine (Cheli$onium maus)F /iscuit root (omatium s*)
F iDuorice (Gl#c#rrhi+aglabra),
F Nee tree (A+a$irachta in$ica) F MilG thistle (-il#bum marianum)F St, John=s 7ort ('#ericum erforatum)
Anti-carcinogenF %er=s 7oad (.satis tinctoria)
Also denotes anti<$iral acti$it%,
Soe indications sho7n abo$e differ fro ".M theor%,
Adated fro (%ons et al, 200B),
&reatment with anti-o.idantherbs
ou$ed %it! immune status& anti-o,idant status
a$$ears to *e in+ed %it! ym$!ocyte eves in HIV"
In a 24-mont! $ros$ective study of 30 aduts %it!
sym$tomatic HIV and no anti-retrovira t!era$y& +!a+i
%eed Alternanthera pungens (A=) anti-o,idant !er*a
e,tract %as $rovided as a tea t!rice %ee+y (A= ?rou$)
vs" no tea contro (it!out A= ?rou$)"1 Venous *ood
sam$es reveaed reduced o,idative dama'e (i"e" as
evidenced *y reduced maondiade!yde concentration
and a reduction in advanced o,idation $rotein end
$roducts)& si'nificant increase ($ 0"001) of D4 and
DS ym$!ocytes and t!e ac+ of *ioo'ica !e$atic and
rena to,icity in t!e A= ?rou$"
idovudine (a nuceoside anao'ue reverse-transcri$tase in!i*itor) %as administered *efore and
after an American 'insen' e,tract (Pana uinue!olius)
%as administered to a study 'rou$ com$risin' of 10
!eat!y vounteers& for t%o %ee+s" #!e study found a
decrease in o,idative stress *iomar+ers (E2-iso$rostane
ratio I 0"<5C 0"<2-0"B at = 0"001 and B-!ydro,y-
deo,y'uanosine ratio I 0"<4C 0";5-0"52 at = I 0"02)
after 'insen' e,tract administration" E2-iso$rostane is a
meta*oite $roduced from t!e $ero,idation of essentia
fatty acids (7EA) ($rimariy arac!idonic acid)& %!ereas
B-!ydro,y-deo,y'uanosine is indicative of in vivo D8A
o,idative dama'e" #!e e,$eriment aso re$orted t!at'insen' e,tract did not interfere %it! $!armaco+inetics
of .idovudine" 1
$ental health benefits from herbal
medicine treatmentof HIV-AIDS
>enta !eat! is aso a +ey issue in HIV-AIDSsufferers& %!o are often sociay sti'matised" A study
conducted in #!aiand su''ested t!at !er*a medicines
can im$rove t!e menta !eat! as$ect of quaity of ife
(Jo) amon' HIV-AIDS infected su*ects" In t!is study&
132 HIV-$ositive aduts %ere 'iven a sef-administered
questionnaire to assess dimensions of $!ysica function
(=E) and menta !eat! (>H) in Jo" #!e data %as
aso coected on t!e use of !er*a medicine and socio-
demo'ra$!ic and $syc!osocia c!aracteristics reated to
HIV" Si'nificanty *etter >H %as o*served amon'
!er*a medicine users vs. non-users& %!ereas& !er*a
medicine did not !ave a statisticay si'nificant
association %it! =E scores" #!is im$rovement in >Hscore %as !i'!er amon' t!e sociay vunera*e
$o$uation"@ A $ace*o effect cannot *e rued out as a
cinica tria of s$ecific !er*a e,tracts %it! standardised
$!ytoc!emica concentrations is necessary to ma+e a
concusive recommendation on t!e use of s$ecific !er*a
medicine e,tracts in HIV-AIDS"
Actionof a derivative of St ohn3s wort
(Hypericum perforatum)
An isoated $rotein fraction& $2<(S)& derived from St
o!ns %ort (ypericum per!oratum) (usuay $rescri*ed
for de$ression and some anti-vira activity)& reducedt!e transcri$tion of t!e HIV-1 'enome in $rimary
cuture of micro'ia and astrocytes" #rans-Activator
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of #ranscri$tion (#at) is a $rotein res$onsi*e for t!e
en!anced efficiency of vira transcri$tion (HIV dsD8A)
and causes a$o$tosis in #-ces t!us e,acer*atin'
HIV disease state" #!e $2<(S) is associated %it! t!e
transcri$tion factor /7G== and aso #at& c!an'in'
t!eir su*-ceuar ocation ( accumuation of /7G==
and #at in t!e $eri-nucear cyto$asmic com$artment)&affectin' D8A *indin' and !ence transcri$tiona
activity"21 In conunction %it! conventiona medication&
!er*a medicines $roved to re'uate transcri$tion
factors associated %it! HIV re$ication *ut aso
moduate immune function in HIV $atients" St o!ns
%ort traditionay is used for de$ression *ut aso s!o%s
efficacy as an anti-vira& $ossi*y via ateration of cyto$astic ocation of /7G= 2 and aso #at"
se of traditionalherbalmedicinewith
HIV-AIDS 0atientsin So#th
AfricaIn a descri$tive& $ros$ective and foo%-u$ study of33
HIV-$ositive $atients& t!e vira oad decreased and D4
counts increased after t!e consum$tion of traditiona
Sout! African !er*a medicines $rior to meas in
conunction %it! conventiona anti-retrovira dru's" #!e
$atients %ere a*e to increase t!eir socia activities suc!
as %or+ and !ad reduced $revaence of AIDS cac!e,ia"13
#!is su''ests t!at t!e com*ined t!era$y may *e usefufor
t!e treatment and mana'ement of immune su$$ression
and systemic infammation durin' HIV infection"
se of &C$ treatmentsfor HIV-AIDS
Studies !ave aso s!o%n t!at some #> !er*a
formuations are usefu in t!e mana'ement of HIV-AIDS
reated sym$toms"
val#ation of .iaomigran#les
ne e,$eriment evauated efficacy of ,iaomi 'ranues
(/0 KL3Af3) lycyrrhi +a glabra, Pinellia ternana ,
"cut ellaria baicalensi s, $odonopsis pilo sula, $opti s
chinensis, Astragalus membranaceus, $oi lacryma
%obi var" ma yuen, 1ithospermum s$$") in 40 HIV-AIDS
$atients %it! ora candidiasis" #!e study !ad t%o 'rou$sC
one treated %it! ,iaomi 'ranues (n M 40) and contro
'rou$ treated %it! anticandine" In *ot! 'rou$s t!ere %ere
im$rovements in sym$toms of ora 'reasy-stic+y& t!irst&
ast!enia& a*domina distension and anore,ia ($0"0;)"
om$ared to t!e contro 'rou$& t!ere %as si'nificant
im$rovement in sym$toms of ora 'reasy-stic+y and
t!irst in t!e ,iaomi 'rou$ ($0"0;)" 7fficacy rates %ere
aso muc! !i'!er in t!e ,iaomi 'rou$ t!an in t!e contro
'rou$ (50"06 vs" <2";6) and t!e 11"1 6 rea$se rate in
t!e ,iaomi 'rou$ %as o%er t!an t!e 31 6 in t!e contro"1
val#ation of Chinese herbal 0ills
In a dou*e-*ind $ace*o study of B HIV-infected
out$atients %it! a D4 ce count 0"; , 10(5)/& a
treatment usin' !inese !er*a $is %as investi'ated
for o*served c!an'es in HIV-1 98A $asma oads&
D4& DS ce counts and aso quaity of ife scores"
#!e $atients ta+in' !inese !er*s re$orted si'nificanty
more 'astrointestina distur*ances (<56 versus 3B6C $
M "003) t!an t!ose receivin' $ace*o& %it! no difference
in HIV disease $ro'ression"22 :t is %ort! notin' t!at t!e
aut!ors stated t!e *aseine eves of *ot! t!e contro and
treatment 'rou$ to *e equivaent& even t!ou'! t!emedian D4 counts %ere 2;6 o%er in t!e treatment
'rou$ at *aseine and t!e median HIV-1 $asma vira
oads 406 o%er& creatin' a +no%n *ias in t!e study"
val#ation of 5hong*an-4
Anot!er study e,amined t!e !inese !er*a
com*ination !on'yan-4 (N-4)& (iMAMiH:Af-46)C a !er*a
$rescri$tion containin' Oorean 'insen' (Pana ginseng),
astra'aus (Astragalus membranaceus) , 'oi *erry fruit
(1ycium barbarum), tric!osant!es root (&richosanthi s
2irilo3iii , !inese vioet (Viola mandshurica) and t!e
root of red-rooted sa'e or dans!en ("alvia miltiorrhi+a),
s!o%ed $ositive resuts" #!e randomised dou*e-*ind&
$ace*o-controed study conducted amon' <2 $atients
s!o%ed a ;6 increase in D4 vs" $ace*o (246
decrease)"23 #!e !er*s in N-4 are a +no%n for t!eir
ada$to'enic $ro$erties" At!ou'! t!e efficacy of 'insen'
!as not *een tested as a sin'e $rescri$tion in HIV& t!e
'insenoside 9!2& %!ic! is an active $!ytoc!emica in
'insen'& !as *een s!o%n to dis$ay immunore'uatory
and anti-infammatory $ro$erties in #-2 cesC and
t!e DS() cytoto,ic #-ce ine %!ic! !ave $rotective
effects a'ainst vira infection"24 :t %as o*served t!at
9!2-G 1 stimuated #-2 ce $roiferation and
aso IE8-y $roduction and t!us anti-vira activity&24
e,$ainin' $ossi*e anti-vira activity seen in t!e tria
usin' N-4" Sufated 1ycium barbarum $oysacc!arides
(sG=Ss) !ave *een s!o%n to increase cutured c!ic+en
$eri$!era ym$!ocytes" Eurt!er& an in vivo tria usin'
14-day-od c!ic+ens (nM 100) vaccinated %it! 8e%caste
disease vaccine s!o%ed t!at in t!e treatment 'rou$
t!e c!ic+ens inected %it! t!e various sG=Ss !ad
si'nificanty !i'!er ym$!ocytes $roiferation and
serum anti*ody titer&2; conferrin' immunoo'ica
moduatin' ca$a*iities" An et!anoic e,tract of Viola
mandshurica " Gec+er (V>) !as *een s!o%n in t!etreatment of *ronc!ia ast!ma in an ova*umin (VA)-
induced ast!matic GAG/c mouse mode to !ave
si'nificanty in!i*ited increases in tota immuno'o*uin
7 (I'7) and cyto+ines I-4 and I-13 eves in serum
and *ronc!oaveoar ava'e fuid (GAE)& and t!us may
*e of *enefit for #G-reated !y$ersensitivity of t!e un's
and *ronc!us"2 Severa e,tracts of "alvia miltiorrhi+a
(Dans!en) !ave *een s!o%n to dis$ay a neutraisin'
effect on enterovirus <1 induced cyto$at!ic condition in
Vero ces& r!a*domyosarcomaces (mai'nant tumour
from striated musce) and >9-; ces in vitro2< and
$er!a$s *e res$onsi*e for t!e anti-vira effect seen in $atients treated %it! N-4"
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&able 2+ &ab#lation of literat#re search res#lts and differentiation 0rocess
Search &erm6s7
P Combinations
8o9 :#blications
6:#b$ed7
=H:&= ; =Herb= 11 106 7
=A:S=; =Herb= 4 61
=H:&= ; =Herbal= 60 449 27
=A:S=; =Herbal= 4 61 1B
=H:&=; =A:S=; =Herbal= 3 211 12
=H:&=; =A:S=; =Herb= 14 34
"otal Nuber of 'ublications 66
C$erlain* or eleted 'ublications 33
-e$ie7ed 'ublications 33
val#ation of fo#r
differentcombinations of &C$ herbsIn a study investi'atin' four different com*inations
of #> !er*s administered to 0 AIDS or AIDS-
reated com$e, (A9) $atients %!o %ere individuay
$rescri*ed one of four different com*inations of #>
!er*s& a decrease in vira oad& an increase in D4 and
an increase in #-ym$!ocyte counts %ere re$orted"@
:sin' a #> a$$roac!& $atients %it! AIDS or A9
%ere o*served to !ave 4de!iciencies4 of t!e un' or of
t!e s$een and stomac!C 4insu!!iciency4 of *ot! t!e s$een
and +idneys& or menta confusion due to $!e'm %it!
e,cessive !eat"@
val#ation of ;ian-%#n-ninA !inese !er*a formuation +no%n as 5ian2unnin
.Jt8f 8K1L)! %!ic! consists of 14 !er*s incudin' $optis
chinensis, astra'aus (Astragalus membranaceus),
asmine ('asminum o!!icinale), %ofi$oria fun'us
(6ol!iporia etensa) (syn" Poria cocos)& *ur-reed
("parganium stoloni!erum), Polygonatum odoratum
and "crophularia buergeriana is traditionay used for
its anti-infection& anti-tumour and immune-en!ancin'
$ro$erties" In in vitro trias& 5ian2unnin dis$ayed
HIV-'ro%t! in!i*ition and immunomoduation effects"
In a sin'e *ind $iot study over 24 %ee+s& t!is formua
si'nificanty decreased $asma virus oad at t!e end of %ee+s 12 and 24 ($ 0"01)& %it! increased $asma D4
count ($ 0"01) and %it! no adverse effects" =asma
virus oads %ere aso measured after four %ee+s from
ceasin' treatment& %it! vira oads sti o*served to *e
decreased" #!ese resuts su$$ort caims t!at 45ian7un8
9in4 !as t!e t!era$eutic $otentia to treat HIV-$ositive
$atients"2B
ne in'redient of 5ian7un9in: astra'aus
(A stragalus membranaceus) contains triter$ene
'ycosides ( e"'"& astra'aosides I-VII) and acts
as an ada$to'en and immune moduator" Eurt!ermore&
Polygonatum odoratum, contains sa$onin and favonoid
com$onents %!ic! e,!i*it *ot! anti-dia*etic effect and
anti-o,idant effects&25 and is traditionay used as a food
*y t!e 8u et!nic minority $eo$e of ="9" !ina"30 In
addition& "crophularia buergeriana (SG) moduates t!eimmune res$onses via cyto+ine $roduction" #raditionay&
SG %as used for fever and s%ein'& and in a !uman #-
ce ine (>#-4 ces)& mouse $eritonea
macro$!a'es cyto+ines %ere increased after e,$osure
to SG e,tract& via increase in t!e eve of intereu+in
(I)-2& I-4 and interferon (IE8)-y $roduction"31 #!us&
5ian7un9in contains !er*s t!at infuence D4 count
via immune moduation and cyto+ine $roduction& %!ic!
accords %it! its traditiona use"
Im0actof herbal medicineon adherence
to conventionatlhera0*
At!ou'! !er*a medicines are seen as A> t!era$iesin t!e est& in #!ird ord and deveo$in' nations& due
to t!e cost of conventiona anti-retrovira dru's& !er*a
medicines are a mainstay for t!e mana'ement and
treatment of HIV-AIDS" #%o studies e,amined t!e
im$act of com$ementary t!era$y on ad!erence to
conventiona t!era$ies32 and %!et!er t!e com$ementary
medicine !as an im$act on ad!erence to !i'!y active
anti-retrovira t!era$ies (HAA9#) amon'st HIV-
$ositive African- American %omen"33 #!e study incuded
3 %omen %!o %ere ta+in' one of t!e com$ementary
t!era$ies incudin' !er*a medicine at enroment"
omen %ere considered non-ad!erent if t!ey missedany dose of HAA9# in 30 days foo%in' *aseine"
Accordin' to a o'istic re'ression mode of assessment&
%omen on com$ementary medicine %ere 1"5 times
more i+ey to re$ort missin' t!eir dose of HAA9# over
t!e ast 30 days vs. %omen not ta+in' com$ementary
medicine"33 Simiary& erne%a et . al. 32 conducted a
study amon'st 1;2 HIV-$ositive atino 'ay and *ise,ua
men" In t!is t!e study& t!ose $atients usin'
com$ementary medicines %ere ess i+ey to attend t!eir
doctors a$$ointments& to foo% t!e advice of t!e doctors
or to ad!ere to $!armaceutica medicines $rescri*ed"32
In a study usin' a semi-structured intervie%er-administered questionnaire of Sout! African
individuas %it! HIV infection or AIDS& it %as reveaed
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t!at a ar'e $ro$ortion of t!e $o$uation consut %it!
traditiona !eat! $ractitioners" Eurt!er & t!e maority
e,$erience ne'ative interactions %it! anti-retroviras
(A9Vs)" Interestin'y& !er*a $ractitioners (H=) %ere
intervie%ed& %it! 206 ma+in' a caim t!at t!ey %ere
a*e to cure t!e disease& %it! BB6 manufacturin' t!eir
o%n medications as aqueous $ant e,tracts" In addition&of t!e H=& ony 3B6 !ad received HIV-AIDS reated
trainin'& %it! many *eievin' t!at ony traditiona
and !er*a medicines s!oud *e used for HIV-AIDS
treatment& %!ie ot!ers *eieve t!ere is no !arm in
ta+in' *ot! concurrenty"34
Safet* and efficac*of herbs #sed in HIV-
AIDS treatment
#!ere are fe% cinica trias avaia*e usin' !er*s in
t!e co-treatment of HIV-AIDS" #!ere are aso a num*er
of safety issues re'ardin' co-administration t!at !ave
*een raised in t!e iterature"
Alternantherapungens
In a study of t!e use of Alternanthera pungens
!er*a tea t!e treatment of HIV& a si'nificant
decrease in $asma eves of *iomar+ers of o,idative
stress ($0"001) (A== and >DA) and a si'nificant
increase in D4 and DB ym$!ocytes ($0"001) %ere
s!o%n" #!ere %ere no to,icities reated to +idney or
iver in t!is
24-mont! $ros$ective study consistin' of 30 aduts %it!
sym$tomatic HIV and not receivin' HAA9#"1
ing*#an%ang
In a randomised dou*e-*ind tria ( mont!s)
on in'yuan+an' a$sue (NO) ; euco'en anao' ;
HAA9# dru's (nM;B) and euco'en ; NO anao' ;
HAA9# dru's s!o%ed t!at J increases eu+ocyte as
effectivey as euco'en ta*et"3; A ist of !er*s in t!is
formua is found in #a*e 3"
Chinese herbal 0ills
7ven t!ou'! t!e quaity of ife %as im$roved in many
of t!e studies invovin' t!e use of !er*a medicines in
HIV-AIDS& in some instances it may $ose a ne'ative
effect" In a $ace*o-controed dou*e-*ind study of a
!inese !er*a medicine (un-named $ractitioner devised
$i com$risin' of 3; !inese !er*s) %!ic! %as caimed
to reduce t!e sym$toms and aso to im$rove t!e quaity
of ife for HIV-infected $ersons over mont!s" A
num*er of t!e !er*a s$ecies are aso used in estern
!er*a medicine" #!e ar'e maority of actions dis$ayed
*y t!e ist are reated to t!eir anti-o,idant action
#!e formua contained t!e foo%in' !er*s
Iin'.!i or reis!i (anoderma lucidum), %oad (Isatis
tinctoria ), >iettia reticuate& astra'aus (Astragalus
membranaceus), Sno% fun'us (&remealla !uci!ormis),
Andro'ra$!is (Andrographis paniculata) , a$anese!oneysuc+e (1onicera%aponica) , a'ar%ood
(Auilaria agallocha) , !orny 'oat%eed (Epimedium
macranthum),
odenandia ( ldenlandia di!!usa ), cistanc!e (
$i stanche salsa) , #i*et 'oi *erry (1ycium chinen se) ,
sea tan'e (1aminaria %aponica), don' quai (Angelica
sinensis), a$anese +not%eed (Polygonum
cuspidatum),American 'insen' (Pana ,uin,ue!olius) ,
sc!i.andra ("chirandra chinensi s ), !inese $rivet
(1igustrum lucidum), Gai !u (Atractylodesmacrocephala ), re!mannia (Rehmannia glutinosa),
dans!en ("alvia miltiorrhi+ai, tumeric ($urcuma
longa) , vioet !er* (yedoensi s ), >andarin oran'e
( $itrus reticulatereticulata ), $aeonia (Paeonia
lacti!lora) , $oy'onum (Polygonum multi!iorum),
eucommia (Eucommia ulmoides), amomum
(Amomum villosum ), !inese iquorice
(lycyrrhi+a uralensis ), sef-!ea (Prunella vulgari s ) ,
cordyce$s ($ordyceps sinen sis) , $atc!oui $ant
(Pogostemon cablin), a$anese !a%t!orn ($rataegus
cuneata), Massamedicata!ermentata , *arey (ordeum
vulgare), rice ( ry+a sativa) %it! fiers suc! asmicrocrystaine ceuose (fier)& ma'nesium stearate
(anti-ad!erent)& siicon dio,ide ( desiccant)& and 'um
acacia" Interestin'y& 'astrointestina distur*ances
%ere t!e ony effect of t!is !inese !er*a mi,ture
%it! no si'nificant differences in $asma vira oads&
D4 counts& sym$toms& and $syc!ometric $arameters
or HIV-1 98A eves"122
I<$-1
In a fuy-randomised& dou*e-*ind $ace*o&
cinic-controed study revie%in' t!e s!ort-term (12
%ee+) safety and efficacy of a !inese medicina !er*
$re$aration (I?>-1) to treat HIV& t!ere %as reveaed
no si'nificance differences *et%een t!e $ace*o and t!e
!inese !er*a medicine e,ce$t for some reduction in
sym$toms (i"e" ife satisfaction& $erceived !eat!& socia
function& and menta !eat!)"36 #!e s$ecies $resent
in t!e !inese I Oam$o medicina !er* $re$aration
incuded !er*s $re$ared *ased on AIDS sym$tomoo'y"
f 31 !er*a in'redients in t!e ;0-m' ta*et& t!ose
$resent in si'nificant concentration incuded in'.i or
reis!i ( anoderma lucidum), %oad (Isatis tinctoria
), astra'aus (Astragalus membranaceus), andro'ra$!is
(Andrographis paniculata), a$anese !oneysuc+e
(1onicera %aponica), ever'reen %isteria (Milletiareticulata), odenandia ( ldenlandia di!!usa ),
and das!i +om*u (1aminaria %aponica). #!ese !er*s
!ave a ran'e of immunomoduatin'& anti-vira& anti-
cancer $ro$erties" 7ven t!ou'! t!ere %as an
im$rovement in sym$toms& t!is aone coud not *e
inter$reted as a on' term success %it! t!e use of t!is
s$ecific !inese >edicine I Oam$o !er* formuation as
$resented for t!e treatment of HIV" >easures suc! as
quaity of ife can *e su*ective and o$en to *ias suc!
as $ace*o effect" Actua im$rovements in quantitative
$arameters suc! as D4 counts %ere not recorded
and/or not si'nificant and t!us it is un+no%n %!et!er immune function !ad *een affected or im$roved"
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&able '+ Details and ma=oro#tcomesof reviewed research articlesand e0idemiologicasl t#dies
Abbreviations+ A:S8 AcDuired :unodeficienc% S%ndroe A-.8 A:S<related cole>! A-"8 Anti<retro$iral treatentthera%!
H8 Heres Ooster (Shin*les)! HAA-"8 Hi*hl% Acti$e Anti<-etro$iral "hera%! NAS8 No ad$erse side effects! '&8 lasa $iral
loads! "/8 "uberculosis! t I ; < increaseNdecrease! '*'8 '<*l%corotein,
Herbal Secies Ar5ano$a et al,L 200 Cen label stud% A (n I 20) and
/ (n I 20)<"/H:&
first<line anti<"/ thera%
(A"") or A": ; luno>el
(Oherelo)! resecti$el%
Oherelo had ositi$e iact on the
"/ dru*s and it ; incidence of ne7
oortunistic infections
/lonG et al,45 2012 Cen<label!
randoised! t7o<
eriod! crosso$er
hase : trial
1E health%
$olunteers
Ginkgo bi.oba e>tract;ralte*ra$ir
Althou*h there 7as ar*inal
increase in .a> of ralte*ra$ir! it 7as
of inor si*nificance,
/uracG et al,3 16 -andoised
controlled trial
30 Adults 7ith
s%toatic
H:&
'rearation of 31 .hinese
herbs
:ro$eents in Dualit% of life and
s%tos
No chan*e in .4; count
.olebunders
et al,4
2003 "7o Duestionnaire
based sur$e%s
uroean
oulation
Assessed the use of anti<
retro$irals! coleentar% or
alternati$e edicines
&itainsinerals 7ere ost
coonl% used follo7ed b%
hoeoath% and herbal roducts,.oleentar% edicines are
coonl% used desite a$ailabilit%
of haraceutical edicine,
5ohan et al,1 200 24 onth
rosecti$e stud%
30 Adults 7ith
s%toatic
H:&! no A-"
Alternanthera ungens
(GhaGi 7eed) e>tract as drinG
tea anti<o>idant containin*
herbal e>tract) thrice 7eeGl%
or lacebo
; o>idati$e daa*e! t T-.4 and
.E l%hoc%tes (0,001)
No heatic and renal to>icit% in A'
*rou
u**an et al, 3 2001 Sur$e% (#SA
based)
11<H:&
ositi$e out<
atients
#se of $arious herbal
edicines sur$e%ed and
recorded
6PQ used .AM at soe oint of
tie
40Q 7ere recei$in* .AM at the tie
of sur$e%,
>ercise(43Q) 7as the ostcoon .AM used follo7ed b%
lifest%le chan*es! dietar%
suleents! counsellin*! herbal
edications! e*a$itains!and
ra%er thera%,
P4Q used a rotease inhibitor
edication! 1BQ used a rotease
inhibitor sarin* re*ie! and 11 Q
had no current or rior anti<
retro$iraluse,
Han1; 200P &arious
treatents
60 cases of
A:S or A-.
our different ".M forulae
deendin* on resentation,
E6,PQ atients ; $irus loadin*
t .4 " l%hoc%te count,
Henness% et
al,4s
2002 0,1BQ St John=s
?ort! 600 *thrice dail% 16
da%s
nI1B SJ?
nIP lacebo
St John=s 7ort ('#ericum
erforatum)
t '*' e>ression (4,2 fold) fro
baseline in SJ? *rou! e$idenced b%rhodaine efflu>,
'*' efflu> 7as inhibited in both
*rous b% -itona$ir (B RM),
Herrera<
Arellano et al, 5200 .ross<sectional
stud% of H:&
atients I sur$e%,
23 #se of $arious herbal
edicines sur$e%ed and
recorded
2,PQ usin* herbal edicine
ercei$ed benefit of Dualit% of life
Hos% et al,11 1 Non<randoised!
non<lacebo
controlled!
obser$ational
stud% (2 hases),
'hase 18 3 o
follo7 u! 'hase
28 3 o follo7 u,
'hase 18 B2
cc
'hase 28 1B4
cc
Herbal treatent accordin*
to healers= rescritions
'hase 18 H suer<infection (1EQ $s,
42Q! 0,02) and Geloid foration
less coon in herbal edicine $s,
control,
'hase 28 aster ain resolution 7ith
herbal atients $s, control,
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&able '+ Details and ma=oro#tcomesof reviewed research articlesand e0idemiologicaslt#dies (cont.)
Herbal Secies
JandoureG etal,43
1E 'rosecti$e!
sin*le centre!
oen<labelled
stud%
12 atients
7ith A:S
and oral
candidiasis
1Bl "ea tree oil
(&elaleuca alternifolia)
oral solution four ties
dail%
At 2 7eeGs8 P iro$ed! none 7ere
cured and B 7ere unchan*ed,
At 4 7eeGs8 E resonded (2 cured
and 6 iro$ed)! 4 did not resond,
P atients sho7ed %colo*ical
resonse,
Jerne7all et al32 200B Sur$e% 1B2 H:&<
ositi$e
atino *a%
and bise>ual
en
#se of $arious herbal
edicines sur$e%ed and
recorded
E0Q reorted to use .AM,
Asian .AM and herbal edicines
coonl% used, Adherence to
haraceutical treatent 7as lo7er
in those usin* .AM,
Jian* et al,16 200 Cen label
inter$entional
stud% (@r A8
anticandine!
@r /8 >iaoi
*ranules)
n I 40
atients I
*rou
/iaomi granules(( f012JJMfifl,)8
Gl#c#rrhi+a glabra) ( tt 3 ))
Pinellia ternana2
-cutellaria baicalensis( 4( 4f* )
Co$onosis ilosula (=Jt)
Cotis chinensis( 4i a )
Astragalus membranaceus(JiNM)! Coix lacr#ma5obi
var* ma#uen (C11#)QRM)&
ithosermum s* ( 33 )
Anticandine (anti< candidiasis
haraceutical)
"here 7as iro$eent in
s%tos of oral *reas%<sticG%!
thirst%! asthenia! abdoinal
distension and anore>ia in both
the *rous, Cral *reas%<sticGiness !
thirst% and relase rate 7ere better in
>iaoi *rou vs* control *rou,
Jian* et al,3B 2011 -andoised
double<blind trial
(6 onths)
Jin*%uanGan*
.asule (Abbre$,
J+) (lBiMJlJ1Jt)
n I BE
"reatent (")
n I BE .ontrol
(.)
(") Jin*%uanGan* .asule
(lJBiMJlSl=>=8ii)
Panax ginseng( 67*3 )
Astragalus membranaceus
(JiNM)
igustrum luci$um (--A," #58*9 -Mf )
:ioscorea oosita( ' % SLJ);ehmannia glutinosa (root) (
MilS) Ammomum s fruit
.li=J81I) <ime$ium s, T1 UK818)
Angelica sinensis (3 +,3)
euco*en analo*
and HAA-" dru*s
(.) euco*en(euco*en)
and HAA-" dru*s
J+ enhances leuGoc%te le$el as
effecti$el% as euco*en tablet (*rade
:! 11 leuGoenia)! V euco*en (*rade
:ll leuGoenia), NAS,
Note8 both *rous 7ere on HAA-"
isan*au eta1,10
200P Sei<structured
Duestionnaire
30 herbal
ractitioners
&arious African herbal
edical secies described,
Most coon H:&<A:S
oortunistic infections 7ere "/ and
oral candidiasis
usu et al,3P 2004 Cen<label stud% 2E Gl#c#rrhi+a glabra
Artemisia caillaris
&arus alba
Astragalus membranaceus
Carthamus tinctorius
-eduction of lasa H:&<1 -NA iV 0,B lo* (treatent) and follo7 ueriod 4<10 (14,2<3B,PQ), Ne*ati$e
resonse t lasa H:&<1 -NA V 0,Blo* 7ere 2<4 (0<14,2Q),
No t .4 cell count,
ee et al,1A 200E 'haracoGinetic
stud%
1 C health%
$olunteers
300 * Oido$udine orall%
before and after 2 7eeGs
of treatent 7ith
Aerican *insen* (Panax
=uin=uefo.ius) e>tract 200
* b,i,d,
@insenosidedoes not alter theharacoGinetics of Oido$udine,
i o>idati$e stress bioarGers
T2<isorostaneratioI 0,P 0,P2<0,E6
,001M E<h%dro>%<deo>%*uanosine
ratio I 0, P4M 0,B<0,2M I0,02),
MaeG<a<nanta7at etal,3s
2003 'rosecti$e oen
stud% (6 onth)
21
as%toatic
H:& atients
Jin Huan* corises of
Curcuma longa2 artificial
Calculus bovis2 Panax
notoginseng 2 Aucklan$ialaa2 ;heum* officinale2
>ritillaria cirrhosa2/orneolu S%ntheticu
No chan*es to $iral load or .4
count
Ad$erse reactions increased bo7el
o$eents! $a*ue taste,
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&able '+ Details and ma=oro#tcomesof reviewed research articlesand e0idemiologicaslt#dies (cont.)
Herbal Secies
MaeG<a<
nanta7at et
al,L
200 Cen<labelled
trial
1E
as%toatic
H:& atients
./M<A01! a .hinese
herbal edicine forulation
coosed of Panax
ginseng -chisan$ra
chinensis2 Zi+ihus uube2
Crataegus innatifi$a2
?igna ra$iata2 Gl#cine
max2
-accharom#ces cerevisiae2
No si*nificant chan*es in lo* $iral
load or .4 cell counts
Ad$erse reactions interittent
diarrhoea! sGin rashitchin*!
increased bo7el o$eent
Mbah et al,41 200P lnter$entional
stud%
60 H:&<A:S
atients
Acetone<7ater A+a$irachta
in$ica (nee) leaf e>tract
(:-A/)
B0Q had si*nificant (1BQ) increase
in ean .4 cells i5@ 0,001),
Molt6 et al,4P 2012 Cen<label! fi>ed<
seDuence stud%
1B H:&
infected
atients
1B00*d <chinacea
ururea root and 400*
etra$irine,
@eoetric Mean -atio of etra$irine
co<adinistered 7ith E. ururea I
1,0PM safe for co<adinistration,
Molt6 et al,46 2011 Cen<label! fi>ed<
seDuence stud%(4 7eeGs)
1B00*d <chinacea
ururea root and 200*
daruna$ir<ritona$ir (rotease
inhibitor)
Herbal edicine co<adinistered
7ith daruna$ir< ritona$ir resulted in
sli*ht decrease in the concentration
of daruna$ir
C7en<Sith etal,33
200P Cbser$ational
stud%
366 H:&<
ositi$e!
ostl%
African<
Aerican
7oen! a*ed
1E<B0 %ears
.AM (.hinese herbs!
ushroos! *arlic! *insen*
or al*ae or ulti$itains or
reli*iouss%chic health or
bod%7orG) use and HAA-"
adherence aon* H:&;
7oen
?oen usin* .AM 7ere 1,6 ties
ore liGel% to reort issin* HAA-"
doses
Su*ioto eta1,20
200B Sur$e% 132 H:&<
ositi$e "hai
adults
Herbal edicine Si*nificant iro$eent in ental
health but no effect on h%sical
health,
"ani et al,1E 2002 on* ter stud%
7ith herbalinter$ention (%ear
12<2000)
10 children
7ith ediatric A:S
.han /ai San < a
forulation of 30 herbsundefined
:ro$eent in .4 counts!
ortalit% rates and Dualit% of life,"reatent sho7ed ositi$e results
after 1 to 3 %ears and du* resistant
H:& strains did not eer*e
"shiban*u etal,13
2004 12<onth
follo7<u stud%,
33 H:&<
ositi$e
atients
"raditional South African
herbal edicines undefined,
Anti<$iral acti$it% resent
&anlandin*ha
et al,12
2006 Anal%sis of data
collected durin*
the %ear 2000
412 H:&<A:S
atients
/itter .ucuber (&omor$ica
charantia) and other secies
used
P4Q reorted usin* alloathic
edicine 7ith 31 Q reorted usin*
herbal treatents (3Q o$erla)
&aODueO et al,42 2002 'rosecti$e!
sin*le<centre!
oen<label stud%
2P A:S
atients 7ith
oral candidias
Alcohol<based or alcohol<
free &elaleuca alternifolia
oral solution
60Q of atients sho7ed clinical
resonse in 4 7eeGs,
?al7%n et al,34 2010 Sei<structured
Duestionnaire
Herbal
ractitioners
&arious aDueous lant
e>tracts
Cnl% 3EQ had recei$ed H:&<A:S
related trainin*
?an* et al,23 2006 -andoised
double<blinded
and lacebo<
aral: el<control
led trial
P2 atients
di$ided into
treatent
(nI36) and
control (nI36)
hon*%an<4 (+<4)! a
.hinese herbal rearation
t .4 count (+<4)*rou (BQ) $s,
24Q ; in lacebo *rou, t .(4B)
-A(;)! W .(E)(;)count! H:& $irusload! W t b,7,
?eber et al,22 1 'rosecti$e!
lacebo<
controlled
double<blind
stud% (6 ths),
6E H:&<
infected
adults
4 > P ills dail% containin* a
standardised rearation of
3B .hinese herbs (listed in
te>t abo$e) $ersus lacebo,
Ad$erse reactions *astrointestinal
disturbances,
No si*, t H:&<1 -NA le$el!
'&! .4 cell counts!
s%choetric
araeters,
Median .4 cell counts ( ; 0,0B >
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&able '+ Details and ma=oro#tcomesof reviewed research articlesand e0idemiologicaslt#dies (cont.)
Herbal Secies
?u5is*ulen* et 2012 thnobotanical na Pol#gonatum macroo$ium2 aten as salad! *reen tea ethanolal,3o re$ie7 P c#tonema2 P filies e>tract is used as adato*en, :n
".M P o$oratum reinforces LDiL!
nourishin* L%inL and oistenin* the
lun*s! stren*thenin* Gidne% and
sleen
han et al,2B 2000 'ilot stud%! sin*le E atients Xian<Gun<Nin casules Si*, t lasa $irus load 7eeG 12 Wblind lacebo Cotis chinensis 7eeG 24! W V4 7eeG after cessationstud% (24 7eeGs) Astragalus membranaceus2 of treatent cf" baseline,
Gar$enia asminoi$es2 t blood .4 cell counts! W NAS
Poria cocos! -arganium
stoloniferum
>ral s#sension SH
A study *y Ousum et a3< %!o e,amined ora
sus$ension SH& a com*ination of five !inese !er*s&
native to Asia& near-Asia and 7uro$e" #!ese !er*s&
namey icorice ( lycyrrhi+a glabra ), ca$iary%orm%ood (Artemisia capillaris) %!ite mu*erry
(Marus alba), astra'aus (Astragalus membranaceus ),
saffo%er ( $arthamus tinctorius) %ere eit!er $rovided
as ;' soid or 30 m tincture& divided into t!ree doses
daiy" #!ese !er*s !ave $!ytoc!emicas $resent t!at
dis$ay efficacy as anti- infammatory& adrena tonic&
anti-o,idant& anti-vira& immune en!ancement&
ada$to'enic and $ost$randia" #!e com*ination %as
administered daiy in t!ree divided doses $ost-mea
amon'st 2B su*ects %it! HIV-
AIDS" #!e $artici$ants aso received sufamet!o,a.oe/
trimet!o$rim (anti*iotic $!armaceutica seectivea'ainst Pneumocy stispneumonia in $atients %it! HIV)&
400/B0 m' after *rea+fast %it! treatment $rovided for
12 %ee+s" #!e com*ination %as s!o%n to *e safe and
s!o%ed satisfactory outcomes in terms of vira oad&
%!ereas immunoo'ica res$onse measured in terms
of increase of D4 ce count did not demonstrate a
satisfactory outcome"3<
in H#ang
in Huan' a !inese !er*a medicine com*ination
s!o%ed no anti-vira effect at!ou'! $atients descri*ed
a certain im$rovement in $ersona %e-*ein'"3B Suc!
measures as %e-*ein' are su*ective and o$en to *iason t!e $art of t!e o*server&35 !o%ever in t!e conte,t of
t!e #> o*ective to re-*aance t!e !eat! status of
t!e $atient t!ere is room in t!e treatment mana'ement
for a $ace*o-i+e effect of t!e qi& an unquantifia*e
com$onent& simiar to vis medicatri naturae. #!is
re-*aancin' $rocess is not readiy transated into
numerica terms& so #> utiises quaitative descri$tions
to c!aracterise !eat! status" #!e formuation of in
Huan' com$rises of turmeric ($urcuma longa), artificia
cacuus *ovis (i"e" dried o, 'astonesC c!oestero/
*ie sats)& tien-c!i 'insen' (Pana notoginseng) , mu
,ian' (Auc2landia =appa), Rheum o!!icinale, fritiaria(-ritillaria cirrhosa ) , *in' $ian (Gomeoum
Synt!eticum)
as s!o%n in #a*e 3& and t!e in'redients a$$ear to !ave
anti-infammatory and anti-o,idant actions"
C)/$-A01
vera& t!e $eer-revie%ed iterature su''ests t!ate,ce$t for Jian-Oun-8in& various !inese !er*a
medicine formuations s!o%ed no& or ony imited&
effectiveness for t!e treatment of HIV-AIDS& %it! some
dis$ayin' adverse effects" #!is %as aso s!o%n in a
study on t!e use of a !inese medicina com*ination
+no%n as OG>-A& %!ic! !ad no effect on D4 ce
counts or HIV vira oadin'& *ut !ad im$rovement in
cod and fu sym$toms su''estin' an immune-
stimuant effect& *ut %it! intermittent diarr!oea
o*served in over !af of t!e $atients& to'et!er %it!
s+in ras!es and increased $eristasis as side effects"@
8eem eaf
A study@ assessed t!e efficacy of a neem eaf e,tract
(A+adirachta indica) amon'st 0 HIV-AIDS su*ects
(HIV I or II $ositive& D4 ce count 300 ces/& and
anti-retrovira naive)" #raditionay A. indica !as *een
used& amon'st ot!er actions& for its anti-vira activity"
In a study& t!e effect of an acetone-%ater neem eaf
e,tract (I9AG)& of 1"0 ' daiy for 12 %ee+s& on immunity
and vira oad %ere monitored" f t!e 0 $artici$ants&
;0 (B3"336) %ere com$iant" #!ere %as si'nificant
im$rovement in D4 ce count in t!ese ;0 $atients
($0"001) at 12 %ee+s" #!ere %as im$rovement in t!e
eryt!rocyte sedimentation rate ( 4 mm/!r at *aseineto 1 mm/!r at %ee+ 12)" #!ere %as aso a decrease in
HIV-AIDS-reated $at!oo'ies (120 at *aseine to ; at 12
%ee+s)" Eurt!er& t!ere %as a si'nificant increase in mean
*ody%ei'!t& !aemo'o*in concentration and ym$!ocyte
differentia count o*served" 8o maor adverse effects
%ere re$orted in t!e study"41
$elale#ca
#%o studies evauated t!e efficacy of oi derived
from t!e 'enus meaeuca in fucona.oe-refractory
(anti-fun'a $!armaceutica resistant) ora candidiasis
amon'st AIDS $atients"42T
43
An aco!o-*ased and
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aco!o-free meaeuca ora soution %as evauated
for t%o to four %ee+s amon'st AIDS $atients %it!
fucona.oe-refractory oro$!aryn'ea candidiasis
(%it!in mout! cavity) in a $ros$ective& sin'e-centre&
o$en-a*e study"42 #%enty-seven $artici$ants randomy
received eit!er aco!o-*ased or aco!o-free meaeuca
ora soution four times daiy at a 1H 1 e,tract ratio"#!e $rimary study aim %as t!e resoution of cinica
esions" 7vauation of cinica si'ns and sym$toms of
ora candidiasis and quantitative yeast cutures %ere
In a revie% of HIV-infected individuas& seenium %as
su''ested to *e *eneficia due to its in!i*itory effect in
HIV in vitro and for increasin' D4 counts in vivo, and
it !as *een o*served as a deficient nutrient in co!orts
%it! HIV infection"4; #!us& *ra.i nuts (#ertholletia
ecelsa), and *urdoc+ root (Arctium s$$")& %!ic! contain
!i'!er eves of seenium& may *e a *eneficia incusionin t!e diet of HIV-AIDS sufferers"
Im0actof CA$ on the 0harmaco%ineticsof $erformed at t%o and four %ee+s" At %ee+ four& cinica conventiona
mledicine
res$onse %as demonstrated in 06 of t!e $artici$ants
su''estin' efficacy in ora candidiasis refractory to
fucona.oe in AIDS $atients"42 Eurt!er & in a $ros$ective&
sin'e-centre& o$en-a*eed study (no *indin') %!ic!
evauated 12 $atients %it! AIDS and ora candidiasis
resistant to fucona.oe"43 #!e $atients %ere treated
usin' a 1; m meaeuca ora soution four times a day&
administered as a mout! %as!& for a $eriod of t%o to
four %ee+s" #!e $artici$ants %ere evauated %ee+y
*ot! cinicay and %it! quantitative yeast cutures" A
tota of B of t!e 12 $atients res$onded $ositivey in four
%ee+s (2 cured& im$roved %it! 4 not res$ondin') to
t!e $rescri*ed t!era$y" Seven $atients s!o%ed
mycoo'ica res$onse" inica rea$se %as not o*served
amon'st cured $atients durin' a foo%-u$ of t!e
co!ort after a t%o to four %ee+ $eriod after fina
evauation"43
Americanginseng
Heat!y $atients consumin' 200m' of a 'insenoside-enric!ed American 'insen' (Pana uinue!olius)
e,tract for t%o %ee+s !ave *een o*served to induce
$!ase 2 (i"e" :D=-'ucuronosytransferases&
sufotransferases& 8-acetytransferases& 'utat!ione S-
transferases and met!ytransferases) and antio,idant
en.ymes in vitro and t!ou'!t to increase t!e cearance
of .idovudine& an anti-retrovira dru' at a 300 m'
dosa'e"15 earance is t!ou'!t to *e due to increased
quinone reductase activity" Ho%ever t%o %ee+s of t!e P.
uinue!olius e,tract inta+e did not adversey ater
.idovudine $!armaco+inetics& *ut %as s!o%n to reduce
o,idative stress mar+ers& and t!us a $ositive outcome
for treatment of HIV-AIDS $atients usin' t!e e,tract for
its $resumed ada$to'enic $ro$erties"15
$icron#trients
Interestin'y& in a study of su*-Sa!ara African HIV-
$ositive $atients& it %as o*served t!at micronutrient
deficiencies (i"e" micronutrients incudin' vitamins
A& & and 7& K-carotene& seenium& .inc& and food/tea
$oy$!enos) are common" Due to HIV infection& t!ere
is an increased 'eneration of reactive o,y'en s$ecies
(9S)" #!ese anti-o,idant nutrients can *e $rovided via
an anti-o,idant ric!-diet (i"e" fruit and ve'eta*e *ased
diets) or via dietary anti-o,idant su$$ements and may!ave a $ositive effect on D4 and vira oad in HIV-
$ositive $atients t!at are inei'i*e for anti-retrovira
t!era$y"44
In traditiona estern !er*a medicine St o!ns
ort (ypericum per!oratum) is used for t!e treatment
of mid de$ression and Echinacea s$$" for t!eir
immunomoduation action"
In a study investi'atin' t!e safety of t!e use of
ec!inacea (Echinacea purpurea) and its interaction
%it! etravirine (non-nuceoside reverse transcri$tasein!i*itor of HIV)& $atients received 400 m' once daiy
of etravirine and aso E. purpurea root (;00 m' every B
!) over a 14 day $eriod" #!e etravirine $!armaco+inetic
$arameters suc! as 'eometric mean ratio s!o%ed t!at
t!e co-administration of E. purpur ea %it! etravirine %as
safe and %e-toerated in HIV-infected $atients"4 #!is
o*servation %as aso noted in a study of co-
administration of E. purpurea %it! darunavir-ritonavir
($rotease in!i*itor& anti-retrovira dru')& *ut t!ere %as
a minor decrease in darunavir concentrations& %!ic!
%arranted t!e monitorin' of darunavir concentrations in
$asma to ensure t!e $atient %as receivin' adequatedosa'e"4<
onversey& St o!ns %ort (ypericum per!oratum)
!as *een s!o%n to increase t!e activity of $-'yco$rotein
(='=)& %!ic! is a trans-mem*rane $rotein t!at e,cretes
,enoto,ins (i"e" $!armaceutica com$ounds or t!eir
conu'ates) from ces suc! as anti-vira conu'ates&
es$eciay indinavir and cycos$orine %!ic! are +no%n
su*strates for cytoc!rome =4;0 3A4 (N=3A4)& and
%!ic! t!eoreticay may $ose a t!reat to t!e efficacy of
an anti-retrovira dru'" Anot!er $ace*o-controed study
aso s!o%ed utiity of St o!ns %ort to increase ='=
e,$ression (4"2 fod) from *aseine"4B#!e co-administration of in2go biloba e,tract
mar'inay increased cma, (ma,ima $asma dru'
concentration in a tested area $ost-administration) of
rate'ravir& !o%ever t!ere %as no effect on rate'ravir
e,$osure" #!e c!an'e in 111a, of rate'ravir %as
considered of minor si'nificance o%in' to t!e ar'e
inter- su*ect varia*iity ofrate'ravir"45
#!us& some !er*a medicines a$$ear to *e safe
for co-use %it! anti-retrovira medicine& and $rovide
immune-su$$ortive action in t!e treatment of HIV-AIDS
and $resent a vaua*e com$ementary treatment o$tions
for $atients& *ut t!ere are sti questions a*out ot!ersdue to $ossi*e interaction %it! anti-retrovira dru's and
reduction in t!eir efficacy i"e" reduction of cma,U
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Concl#ding remar%s
Her*a medicines are commony used a over t!e
%ord in *ot! deveo$in' and deveo$ed countries&
es $eciay in t!e mana'ement of c!ronic conditions"
#!ey are used for t!e treatment of HIV-AIDS and
associated conditions suc! as o$$ortunistic infections"
7mer'in' evidence su''ests some *enefits of !er*amedicines for immune moduatin' effects& *ut t!ere are
some concerns reated to its use for e,am$e t!e
$ossi*e reduced efficacy of antiretrovira dru's" Her*a
medicines may *e suited to immune-su$$ort *y
increasin' D4& rat!er t!an treatment of HIV-AIDS"
Ho%ever& t!ere !ave not *een an e,tensive num*er
cinica trias (i"e" randomised cinica trias) carried out
on t!e utiity of !er*a medicine as a direct treatment or
in com*ination %it! anti-retrovira dru's& as reveaed in
our iterature searc! for t!is revie%"
Studies indicate t!at some !er*a medicines (sin'e
e,tracts and com*ination formuas) are safe andefficacious !o%ever in some instances safety issues
arose& es$eciay in reation to t!e a*iity of $ractitioners
to administer a $!ytoc!emicay reevant !er*a e,tract
or mi,ture" #!ere is aso t!e dan'er of contamination or
aduteration %it! ot!er materias suc! as !eavy metas&
$esticides& *acteria or $!armaceutica com$ounds %!ic!
is a +no%n concern for !inese !er*a medicines" Some
studies s!o%ed efficacy of !er*s in terms of
immunoo'ica $arameters& vira oad and
sym$tomatoo'y !o%ever since t!e studies %ere not
conducted on ar'e $o$uations and %ere not of a
on'itudina co!ort desi'n& t!ey are not concusive
enou'! to create a definitive ans%er reatin' to t!e use of
!er*a medicines in HIV-AIDS"
#!e main actions of !er*a medicine for t!e treatment
of HIV-AIDS are via immune moduation& anti-o,idant
activity and some anti-retrovira activity of isoated
fractions" onsiderin' t!e $rimary evidence of efficacy
from t!ese sma trias& and aso seected in vitro ce
cuture& conductin' furt!er in vitro for mec!anistic
understandin'& as %e as cinica studies may *e
*eneficia and may ead to a cearer recommendation on
!o% and %!ere in t!e treatment $an to use !er*a
medicines in HIV-AIDS treatment" Eurt!er &
standardisation of e,tracts and vaidation usin' dou*e- *ind cinica trias are required %it! formaised
com$ementary treatment $rotocos co-administered
%it! anti-retrovira dru's"
Anot!er issue t!at %as reveaed in t!is revie% is t!e
si'nificant incidence of $eo$e %it! HIV-AIDS usin'
!er*a medicine and not ad!erin' to conventiona
medica treatment" #!is may *e due to com$iance
issues or t!e avaia*iity and cost of modem anti-
retrovira dru's" #!us& t!ere is a need to educate $atients&
as %e as !er*a medicine $ractitioners across t!e 'o*e&
of t!e im$ortance of conventiona medicine and t!e need
for e,tensive study of !er*/dru' interactions" !inese!er*a medicine& usin' com*inations of u$ to 40 !er*s&
'ave resuts su''estin' minima success ot!er t!an
immune su$$ortive functions& as did African !er*a
medicine" In t!ese traditiona
systems of medicine& %!ic! aso a$$ear as art forms
rat!er t!an scientific $ractices& t!e $ractitioner reies on a
static em$irica *eief system %it!out considerin' a
scientific understandin' of t!e $atients !eat!"
onversey& t!is is aso true of $!armacoo'ica
intervention of HIV-AIDS" #!e main focus of traditiona
systems is to re-*aance $atient !eat! and *odiysystems rat!er t!an to contro or im$ede vira activity"
Simiary& estern !er*a medicine& *ot! traditiona and
modem (as $!armaco'nosy)& a$$ears to *e of *enefit in
immune su$$ort rat!er t!an curin' t!e condition per se.
inica trias usin' $!ytoc!emicay vaidated !er*a
medicines in conunction %it! $!armacoo'ica
intervention suc! as anti-retroviras are required to
assess $otentia *enefits in suc! a com$e, condition
%!ic! often !as many confoundin' co-mor*idities"
#!ere is $otentia for an inte'rative medicine system&
ena*in' t!e $atient to eect for eit!er sin'e or
com*ined treatment from a $!armacoo'ica&
$!armaco'nosy and traditiona $ers$ective and to incude
muti$e modaities in t!e treatment $an %!ic! %oud
incude t!e use of !er*a medicines"
In concusion& !er*a medicines are %idey used in t!e
treatment of HIV-AIDS and associated conditions" #!ere
are studies su''estin' t!e safety and a de'ree of efficacy
for some !er*a medicines %it!& some studies su''estin'
a $ositive im$act on vira oad and immunoo'ica
$arameters" Her*a medicines may !ave 'reat $otentia
in t!e mana'ement of HIV-AIDS !o%ever ri'orous
researc! is required to determine safety and efficacy"
Conflictof InterestStatement
#!e aut!ors !ave no confict of interest to decare"
,eferences1" Do!an N& amara & >onde A& Ooffi ?& 8iam+ e ?& Dere &
#ia!ou ?& Dessou =& Sess D" 2005" Interest of antio,idants in t!e
care of t!e $atients infected *y t!e HIVH t!e e,$erience of on'
term administration of Aternant!era $un'ens !er* tea" Ann #iol
$lin (P aris). <(;)H;3-;B"
2" ord Heat! r'anisation (H) 2002" #raditiona medicine -
'ro%in'needs and $otentia"H =oicy =er s $ectives on
>edicines"
3" Du''an & =eter son S& Sc!ut. >& O!uder S& !ar +r a *orty "
2001" :se of com$ementary and aternative t!era$ies in HIV-
infected $atients" AI>" Patient $ ar e "&>". 1;(3)1;5-1<"
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