Those wicked herbs

Devan Nambiar, an AIDS activist and researcher, is an informed, sophisticated stakeholder in the HIV community.

The powerful drugs he puts into his body three times a day tax his system. So Nambiar is also an avid follower of alternative health practices. Raised in Malaysia by a father who is a doctor of naturopathic medicine, he’s no stranger to the world of natural therapies.

But recent research into the effect of herbs on the livers of people taking the AIDS cocktail, or combination therapy, suggests that herbal supplements can be a dangerous practice.

St John’s Wort (hypericum perforatum), for example, is generally considered an effective, natural alternative to chemical anti-depressants. It the past, it was also might also have antiretroviral properties. But recent studies have shown that not only does St John’s Wort have no effect as an antiretroviral agent in HIV-infected adults, but that it caused significant levels of toxicity in patients studied.

Is the relationship between St John’s Wort and HIV therapies an anomaly? How do other herbal agents work with, or against antiretrovirals? The answer remains elusive.

Dr Read Schusky is assistant professor at the Canadian College Of Naturopathic Medicine, and co-ordinator of a student practicum at the AIDS Committee Of Toronto in conjunction with the People With AIDS Foundation. He’s cautious about natural medicines being taken with HIV medication.

Schusky says that research by Health Canada suggests, “HIV drugs get altered in the liver, making them more, or less, active. Drugs, botanicals and even food can change the way the liver does that.”

Schusky says naturopaths like himself do use herbs when working with people with a variety of conditions. But he’s more cautious when it comes to people on combination drug therapy.

“I look forward to the day that we have access to therapeutic drug monitoring, so that we can know what the levels of drugs are in our patients while they’re using my treatment,” says Schusky.

Naturopath Ken Luby has been working with conventional doctors for seven years.

“Patients who were seeing me were doing better than expected without taking meds,” says Luby. “Their physicians asked them what they were doing and then they invited me to join their practice.”

Still, Luby worries about the use of herbs by people who are taking antiretrovirals.

“Herbs have a pharmaceutical effect when introduced into the body, “he says. “There are factors in herbs that can interfere with protease inhibitors.”

Dr John Goodhew, who consults with naturopath Luby, says patients considering using herbal supplements shouldn’t depend on their medical doctor or themselves for information. They need to go to the appropriate professional. Conventional MDs “don’t have that in our training.”

With all these red flags, why would an informed consumer like Nambiar continue with what could be the dangerous practice of combining herbs with chemicals?

Nambiar, who has co-authored three treatment manuals for the Community AIDS Treatment Information Exchange (CATIE), including two on herbal medicines, says it’s a question of doing things in moderation: “How much of the stuff are you taking?”

I mention to Nambiar the possibility of natural products interfering with the liver’s ability to maintain the desired level of retroviral medication, resulting in an increase of HIV in the blood. Nambiar tells me that “98 percent of the body is not measured for HIV.” He says he continues to take vitamins and herbs because, “in my personal experience there has been no negative effect. I also feel that I am making an informed choice.”

While the consensus seems to be that herbal supplements can be dangerous in combination with HIV medication, there’s also agreement that not enough hard science has been done. Herbs can be detrimental in certain cases, but no one would say that physician-prescribed HIV medication is a walk in the park for the human body. Comparing HIV cocktails to cancer treatment, Nambiar points out that, “Chemotherapy isn’t given to cancer patients three times a day for life.”

Karen Robin is media relations director for Herbalgram: The Journal Of The American Botanical Council And The Herb Research Foundation. She says that medicine today is shaped around pharmaceuticals and that how they combine with food and herbs has not been studied much.

“People are willing to accept toxicity in chemicals,” Robin says, “while there seems to be a campaign going on to discredit herbals.”