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Original / Research A Retrospective Study of an Ayurvedic Herbal Combination in the Management of HIV/AIDS

AA Mundewadi* 55 HIV positive patients were treated with an Ayurvedic Herbal Combination during 1999-2004. All OpportunisticInfections were treated with appropriate modern drugs. Regular clinical assessment was conducted and laboratoryinvestigations were done as possible. The overall results proved the Ayurvedic medicine to be highly effective as anti-viral and immuno-stimulant, and safe on long-term use. A nutritious diet, Ayurvedic baseline therapy, timely allopathic

treatment of Opportunistic Infections and regular counselling support appears to be an ideal combination in themanagement of HIV / AIDS patients. INTRODUCTIONAt present, there is no scientifically proved cure for HIV /AIDS. Globally, the number of infected HIV /AIDS patients is increasingat an alarming rate; with a current estimate of 39.4 million people who are living with HIV.1 At the end of 2003, India wasestimated to have around 5.1 million HIV positive people.2 Hence, there is a dire need to search for a safe, effective andeconomical treatment for HIV/AIDS.

In a retrospective study in 55 patients, Ayurvedic treatment has proved to be very promising in the management of HIV/AIDS.

Methods

This is a retrospective study of 55 adult patients who desired, and were given Ayurvedic treatment for HIV/AIDS, during theperiod from April 1999 to November 2004. Each patient had tested positive for HIV/AIDS on at least 2 different occasions. Nopatient was taking anti-retroviral drugs at the time of commencing Ayurvedic treatment. All patients were started on treatmentafter written, informed consent.

The Ayurvedic Herbal Combination (AHC) comprises eleven different herbs in different dosage strengths, based upon theirrespective potencies, reported anti-viral and immunomodulatory properties, and their traditional usage according to Ayurvedicprinciples of medicine .3-5

The constituents of AHC with their respective dosages are as follows:-Terminalia arjuna: 250 mg.Zinziber officinale: 250 mg.Phyll anth us niruri :1 gm.Glycyrrhiza glabra:1 gm.

Withania somnifera:1gm.Eclipta alba: 250 mg.Centella asiatica: 250 mg.Boerhavia diffusa: 250 mg.Emblica officinalis: 250 mg.Tinospora cordifolia: 250 mg.Rubia cordifolia: 250 mg.

This AHC was dispensed in a combined dose of 5 gms. t.i.d. , to be taken with water after meals. Aqueous herbal extracts of allthe medicines were used, in tablet form.

All patients were advised to eat a well -balanced, nutritious diet. Therapeutic counselling sessions were conducted regularly tohelp the patients achieve mind relaxation, to modify their risk behaviour , and to increase adherence and compliance to

therapy.All patients were followed up at monthly intervals. Detailed clinical examination was done at each visit and significant findingswere recorded. In addition, in affording and willing patients, investigations like CBC, Hb, Liver and Renal functions, X-ray chest,Western Blot, CD4 count and Viral Load were done wherever possible. Other investigations were done, if required, forOpportunistic Infections (O.I.). All O.I. were promptly and aggressively treated with modern medicines. A close watch was keptfor adverse reactions of the drugs.

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Therapeutic outcome was assessed by overall clinical examination, change in Karnofsky score, change in weight, occurrenceand response to O.I., and change in CD4 and Viral Load values.

Results

The overall age-wise distribution of patients was as follows:-20-29 years, n = 23(42%)30-39 years, n = 21 (38%)40-49 years, n = 10 (18%)50-59 years, n = 1 (2 %)

Thus, maximum number of patients were in the age ranging from 20 - 39 years (80%). Of the total number of 55 patients, 39were male (71%) and 16 were female (29%), with the male : female ratio being 2.4: 1. There were 7 couples who tooktreatment together.

Of the 55 patients, 5 patients died, 42 patients took treatment for varying periods and then stopped treatment, while 8 patientsare still continuing treatment. The 5 patients who died were critically ill at the time of presentation, and died mostly within thefirst two months of starting Ayurvedic treatment. The cause of death varied; 1 patient died from cirrhosis of the liver, 3 died ofextensive Pulmonary Tuberculosis (multi-drug resistant) and 1 died of a combination of Pulmonary Tuberculosis anddemyelination disease of the brain.

In the 50 patients who were alive till the time of their last follow-up , there was an average weight-gain of 2.3 kgs. (range = - 4 to+ 7.5 kgs), usually within the first 3 months. In those patients who took continuous treatment for more than 3 months, the

Karnofsky score increased from an average of 75.9 at the commencement of treatment to 87.4 at the last follow-up.

Almost all the patients had1-3 O.I. at the time of presentation. Other than Tuberculosis, all the O.I. cleared up rapidly within thefirst 2 months of treatment.

Long-term administration of Ayurvedic medicines (upto 30 months) did not seem to have any major adverse effects. In fact, in afew patients, the tests for liver and renal function appeared to normalize further, with treatment. Haemoglobin readingsgradually improved in those patients taking regular, prolonged treatment.

The most striking effect of the Ayurvedic medicines was on the Viral Load and CD4 counts. Because of financial constraints,only 15 patients (27 % ) agreed to do either the Viral Load or the CD4 count, or both. In most patients, there was a definite andsteady decrease in the Viral Load, and an increase in the CD4 cell counts. The actual Viral Load and CD4 counts are given inTable 1. The mean, time-related changes in the Viral Load and CD4 are given in Fig. 1 and Fig. 2 respectively.

Duration in weeks*Fig 1: Chart showing change in viral load wi th ayurvedictreatment.**Figures represent the mean actual viral load/10. 4 Viralload **

Fig. 2 : Chart showing the mean change in CD4 count. Mean CD4 count




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Discussion

Antiretroviral medicines are the mainstay in the modern treatment of HIV/AIDS. However, a plethora of side-effects,development of resistance to drugs and escalating treatment costs are serious concerns. In the absence of a definite cure forHIV/AIDS, Ayurvedic medicines may provide a useful alternative for long-term management of patients, since these medicinesare economical and devoid of serious side-effects. However, scientific research is necessary to determine efficacy of thesemedicines. This retrospective study is one such effort to assess long-term therapeutic effects of an Ayurvedic Herbalcombination in the management of HIV/AIDS.

In this study, 4 patients died within the first 2 months of commencing treatment. Onset of probably could not benefit fromAyurvedic treatment. This emphasizes the need to start treatment as early as possible in immuno-compromised patients. Thecauses of death indicate that Tuberculosis and CNS involvement are major killers in HIV patients. Multi-drug resistance toTuberculosis is also a major concern.

16 patients (29%) did not come back after just one (11%) or two (18%) visits. The reasons cited were, a complete inability topay for treatment, or a search for a better or a guaranteed cure. Fortunately, perceptions have changed in the last two years.Even illiterate patients from the lower socio-economic strata are no longer asking for a guarantee or a cure. Long-termmanagement with minimum expenses is a mantra being readily accepted by the HIV positive patient of today.

All the patients who took medicines regularly, had a high-protein die t and kept themselves busy, improved very well and put onweight. Even 2 to 3 years after stopping Ayurvedic treatment, most of the patients are doing very well, some inspite of very lowCD4 counts. This is probably one of the biggest long-term advantages of taking Ayurvedic medicines for HIV/AIDS. However,patients with socio-economic difficulties and a lot of psychological pressure who could not have access to regular treatment,started losing weight after initially improving with treatment. A comprehensive management of each patient thus needs toaddress several issues relevant to each individual patient.




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This study also brought forth some interesting results. One patient who subsequently died, had severe demyelinating diseaseof the brain (as diagnosed in a major hospital), and had lost most of his motor control and sensory senses, since severalmonths. After being given Ayurvedic treatment for about 11/2 months he became alert, and could speak clearly, albeittemporarily, for 1 week. Another patient with Nephrotic syndrome resulting in long-standing generalized oedema (2 years) hadcomplete regression of the oedema after 2 months of Ayurvedic treatment without any other treatment. One HIV positive patientwith suspected malignancy of lung in the right upper lobe was steadily losing weight. After starting Ayurvedic treatment, hestarted putting on weight. This patient later underwent a CT-guided FNAC, the results of which are awaited. Another patientwith history suggestive of HIV Encephalopathy was semi-conscious at presentation. He was passively fed on liquid diet and acombination of both modern drugs and Ayurvedic treatment. This patient became ambulatory within 2 weeks, and after 2

months of treatment he is faring well, even with a CD4 count of just 6.The above 4 instances indicate that the Ayurvedicmedicines may have multi-faceted properties and need further evaluation.

Conclusion

The retrospective study of 55 HIV positive adult patients treated with an Ayurvedic Herbal combination from April 1999 toNovember 2004 proved the Ayurvedic medicines to be considerably effective as anti-viral and immuno-stimulant,and safe onlong-term use. A nutritious diet, Ayurvedic baseline therapy, timely allopathic treatment of Opportunistic Infections and regularcounselling support appears to be an ideal combination in the management of HIV/ AIDS patients.

Acknowledgement

The medicines used in this study were purchased from Chaitanya Pharmaceuticals, Nasik and Nahar Pharmaceuticals,Gujarat.

References

1. UNAIDS. Global Summary of the AIDS Epidemic. Update. December 2004.

2. UNAIDS. Epidemiological Fact Sheets on HIV/AIDS. India . Page 2. 1/9/2004.

3. Foundation for Integrative AIDS Research. Potential Anti-HIV Herbs. 15/9/2002.

4. Sharma PV. Vegetable Drugs. IV Edition. Chaukhamba Publications.1978:2.

5. Dahanukar S A, Kulkarni RA, Rege NN. Pharmacology of Medicinal Plants and Natural Products. Indian JPharmacology 2000; 32 : S81 - S118.

*Ayurvedic Physician, T.M.C. Office Bldg., 1st Floor, Mumbra, Thane 400612.

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