Herbal medicines for treating HIV infection and AIDS

  • Review
  • Intervention

Authors


Abstract

Background

HIV-infected people and AIDS patients often seek complementary therapies including herbal medicines due to reasons such as unsatisfactory effects, high cost, non-availability, or adverse effects of conventional medicines.

Objectives

To assess beneficial effects and risks of herbal medicines in patients with HIV infection and AIDS.

Search methods

Electronic searches included the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, LILACS, Science Citation Index, the Chinese Biomedical Database, TCMLARS; plus CISCOM, AMED, and NAPRALERT; combined with manual searches. The search ended in December 2004.

Selection criteria

Randomized clinical trials on herbal medicines compared with no intervention, placebo, or antiretroviral drugs in patients with HIV infection, HIV-related disease, or AIDS. The outcomes included mortality, HIV disease progression, new AIDS-defining event, CD4 cell counts, viral load, psychological status, quality of life, and adverse effects.

Data collection and analysis

Two authors extracted data independently and assessed the methodological quality of trials according to randomization, allocation concealment, double blinding, and drop-out.

Main results

Nine randomized placebo-controlled trials involving 499 individuals with HIV infection and AIDS met the inclusion criteria. Methodological quality of trials was assessed as adequate in five full publications and unclear in other trials. Eight different herbal medicines were tested.

A compound of Chinese herbs (IGM-1) showed significantly better effect than placebo in improvement of health-related quality of life in 30 symptomatic HIV-infected patients (WMD 0.66, 95% CI 0.05 to 1.27). IGM-1 appeared not to affect overall health perception, symptom severity, CD4 count, anxiety or depression (Burack 1996a). An herbal formulation of 35 Chinese herbs did not affect CD4 cell counts, viral load, AIDS events, symptoms, psychosocial measure, or quality of life (Weber 1999). There was no statistical difference between SPV30 and placebo in new AIDS-defining events, CD4 cell counts, or viral load (Durant 1998) although an earlier pilot trial showed positive effect of SPV30 on CD4 cell count (Durant 1997). Combined treatment of Chinese herbal compound SH and antiretroviral agents showed increased antiviral benefit compared with antiretrovirals alone (Sangkitporn 2004). SP-303 appeared to reduce stool weight (p = 0.008) and abnormal stool frequency (p = 0.04) in 51 patients with AIDS and diarrhoea (Holodniy 1999). Qiankunning appeared not to affect HIV-1 RNA levels (Shi 2003), Curcumin ineffective in reducing viral load or improving CD4 cell counts (Hellinger 1996), and Capsaicin ineffective in relieving pain associated with HIV-related peripheral neuropathy (Paice 2000).

The occurrence of adverse effects was higher in the 35 Chinese herbs preparation (19/24) than in placebo (11/29) (79% versus 38%, p = 0.003) (Weber 1999). Qiankunning was associated with stomach discomfort and diarrhoea (Shi 2003).

Authors' conclusions

There is insufficient evidence to support the use of herbal medicines in HIV-infected individuals and AIDS patients. Potential beneficial effects need to be confirmed in large, rigorous trials.

摘要

背景

以草藥治療人類免疫缺乏病毒感染與愛滋病

被人類免疫缺乏病毒感染的人和愛滋病患者經常由於一些因素而尋求包含藥草在內的輔助醫療, 譬如令人不滿意的效果、高費用、無法利用, 或傳統醫學的副作用

目標

評估草藥在感染人類免疫缺乏病毒感染和人類後天免疫缺乏症候群的利益和風險。

搜尋策略

子查尋包括Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, LILACS, Science Citation Index, the Chinese Biomedical Database, TCMLARS;和CISCOM 、AMED, 和NAPRALERT; 以及與手工查尋結合。查尋在2004 年12月結束

選擇標準

有關草藥的隨機臨床試驗在人類免疫缺乏病毒感染者、人類免疫缺乏病毒相關疾病患者及愛滋病患者三者中與不治療,安慰劑或抗病毒藥物做比較。結果包括死亡率、HIV相關疾病的惡化、新愛滋病證據、CD4細胞數目、病毒量、精神狀態、生活品質、及副作用等。

資料收集與分析

二個作者獨立取得資料並根據隨機與否、隱瞞分配與否、雙盲與否及中斷與否來評估試驗的品質 。

主要結論

九個隨機安慰劑控制的試驗裡包含了499位HIV感染及愛滋病病患符合了納入的條件。試驗的方法品質有五個是適合的,其他則未明。試驗包含八種不同的草藥。一種中藥的成份IGM1顯然比其他安慰劑在促進30名有症狀的HIV患者在健康有關的生活品質上顯出更好的效果(WMD 0.66, 95% CI 0.05 to 1.27)。IGM1 似乎不影響整體健康、症狀嚴重性、CD4 細胞數、憂慮或消沉(Burack 1996.a)。一個包含35種中藥配方的處方對CD4 細胞數、病毒量、愛滋病病徵、症狀、心理社會的措施, 或生活品質並無影響。(Weber 1999) 。雖然一個較早的先期試驗顯出SPV30在CD4細胞數目上有幫助但SPV30與安慰劑在新的愛滋病病徵、CD4細胞數目或病毒量上無統計學上的差異。結合中藥成份SH與抗病毒藥物顯示抗病毒的成效與單獨使用抗反轉錄病毒藥物有幫助。(Sangkitporn 2004). 在有腹瀉的51 名愛滋病人, SP303 似乎可以減少糞便重量(p = 0.008) 和不正常的排便頻率(p = 0.04)(Holodniy 1999). Qiankunning似乎不會影響HIV1RNA的量(Shi 2003), CURCUMIN在減少病毒量或是改善CD4細胞數目上沒有效(Hellinger 1996), 而CAPSAICIN在減湲因HIV神經病變引起的疼痛上沒有效果。(Paice 2000) 。在35 個中國草本配方(19/24) 和安慰劑(11/29)比較發生副作用的機率是較高的 (79% versus 38%, p = 0.003) (Weber 1999) 。Qiankunning 和胃部不適以及腹瀉是有關聯的(Shi 2003)。”

作者結論

證據不足以來支持草藥治療HIV感染的個人和愛滋病患者。可能的有利作用需要在更大, 嚴謹試驗來證實。

翻譯人

本摘要由臺北榮民總醫院簡志翔翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

在這個治療HIV感染與愛滋病患的回顧中,沒有確切的證據支持在這樣的病人使用草藥治療。HIV感染的病人與愛滋病患常尋求另類或是替代療法來治療他們的疾病。雖然有許多試驗,但這些試驗很少符合科學標準以致於無法支持它們自己宣稱的療效。這個回顧顯示九個隨機臨床試驗,在HIV感染的病患與腹瀉的愛滋病患中測試了八種不同的草藥,並與安慰劑做比較。這個結果顯示SPV30可能在延緩在無症狀的HIV感染者的疾病的進展上有幫助。一種中藥IGM1似乎可以改善有症狀的HIV感染者的生活品質。另一種草藥成份SH在與抗反轉錄病毒藥物併用時可以增加抗病毒的效果。一種南美草藥SP303可以減少腹瀉愛滋病患的大便頻率。其他被測試的草藥並沒有顯出較安慰劑更好的效果,然而效果的評估需特別謹慎因為這些試驗的規模都很小。在其中,一個醫用草藥會引起腸胃不適的副作用譬如食道不適。結論:在這治療HIV感染與愛滋病的回顧裡,沒有確切的證據顯示使用草藥是有效的。需要更大且更嚴謹設計的試驗來證實我們的假設。

Plain language summary

There is no compelling evidence to support the use of the herbal medicines identified in this review for treatment of HIV infection and AIDS.

People with HIV infection or AIDS frequently seek alternative or 'complementary' therapies for their illness. Although many trials of these therapies exist, very few meet the scientific standards necessary to support the claims of beneficial effects in the therapies studied. This review identified nine randomized clinical trials, which tested eight different herbal medicines, compared with placebo, in HIV-infected individuals or AIDS patients with diarrhoea. The results showed that a preparation called SPV30 may be helpful in delaying the progression of HIV disease in HIV-infected people who do not have any symptoms of this infection. A Chinese herbal medicine, IGM-1, seems to improve the quality of life in HIV-infected people who do have symptoms. Another herbal compound ,SH, showed an increase of antiviral benefit when combined with antiretroviral agents. A South American herb preparation, SP-303, may reduce the frequency of abnormal stools in AIDS patients with diarrhoea. Other herbs tested were no better than placebo; however, the beneficial effects need to be considered with caution because the number of patients in these trials was small and the size of the effects quite moderate. In one trial the use of medicinal herbs was related to adverse effects such as gastrointestinal discomfort. Conclusion: No compelling evidence exists to support the use of the herbal medicines identified in this review for treatment of HIV infection and AIDS. To ensure that evidence is reliable, there need to be larger and more rigorously-designed trials.

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