Natural Therapies for HIV/Aids

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NATURAL THERAPIES FOR HIV/AIDS IN THE AGE OF DRUG COCKTAILS

essay by Subhuti Dharmananda, Ph.D., Director, Institute for Traditional Medicine, Portland, Oregon

The situation with HIV/AIDS changed dramatically in 1996 with the widespread introduction of protease inhibitors used in polydrug therapy (drug cocktails, combinations of three or more HIV-inhibiting drugs). Many persons with AIDS who were experiencing wasting syndrome and numerous opportunistic infections suddenly began to gain weight and experience improvements in general health. The death rate from HIV/AIDS dropped significantly by 1997, partly because of the success of these drug therapies. Thus far, only one-third of persons infected by HIV have been treated by this new method, and it has been proposed that the drug cocktails be made available to everyone who is able to take them regularly. New drugs that go into the mix are being introduced annually. This should help reduce side effects and improve efficacy for those who are resistant to the earlier drugs (usually as a result of using them in monotherapy, as had been the previous practice). Of course, the battle is not quite over. There are some persons who do not tolerate the drugs, others who are irregular in their use (which makes the drugs essentially ineffective), and others who inadvertently defeat their drug therapy by ingesting other drugs, or even foods, that reduce their effectiveness. In a recent study in San Francisco, about half those using the drug cocktails showed some degree of failure, i.e., rising viral load. It is not yet known if this virus that can grow in the presence of the drugs is particularly virulent: however, rising viral load can trigger immune responses that generate some characteristic symptoms of HIV infection. If the virus growing under these conditions is problematic, a new three drug cocktail (new drugs are already available) or a four drug cocktail may be necessary. Aside from cases of treatment failure, there are others who choose not to use drug therapies, and those who, despite the drug benefits, still display immunological disturbances that lead to opportunistic infections. Further, persons who have regained health to a certain extent by effective inhibition of HIV may still experience other health problems, such as cardiovascular disease and cancer, that affect the general population, as well as residual disorders from the lengthy experience of rampant HIV infection. No one yet knows the consequence of taking the anti-HIV drugs for several years and it remains unknown how far the immune system can recover. Some physicians have expressed optimism that successful long-term inhibition of HIV infection by the drugs may lead to a cure in some individuals, especially those who were infected relatively recently and treated immediately. Following is a review of some natural therapeutic approaches that address the current issues. These are divided into sections: 1. Vitamins/Minerals 2. Proteins/Fats 3. Antioxidants 4. Chinese Herbs The methods to be described are being utilized at the Institutes Immune Enhancement Project (IEP, in Portland, Oregon), which has over 100 patients with HIV infection. The clinic has been providing these types of services for the past five years at the current location. The specific treatment options mentioned here were selected from the broader approach used at the clinic, in consideration of proposed application to clinical situations likely to be encountered elsewhere. For example, at ITMs clinic, patients usually receive weekly acupuncture and moxibustion therapy, bimonthly Oriental massage therapy, and a wider range of Chinese herbs than is described here (prescribed on the basis of the individual patient presentation). For most people, such services are frequently unavailable (mainly to be found in large cities) or are too expensive to be convenient. For example about 75% of our clients receive financial assistance (from Ryan White funds and from ITM) and the remaining 25% participate at the programs standard fees that are below average cost of delivery.

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1. VITAMINS AND MINERALS

It has been known for many years that when persons with HIV/AIDS are tested for serum nutrient levels a high percentage reveal significantly low levels of one or more nutrients. In fact, for virtually every nutrient tested, serum levels appear low in a substantial proportion of HIV infected individuals (the exception is copper levels, which have an inverse relationship with the very low zinc levels). The severity of nutrient deficiency increases with AIDS, compared to that observed in early stages of HIV infection. There are several books that can be consulted for a summary of earlier data, including: Nutrition and AIDS (Watson, CRC Press, 1994), Nutrition and HIV (Romeyn, Jossey-Bass Publishers, 1995), and Nutrition and HIV Infection (FASEB, 1990). To access the latest information about the deficiencies, one can retrieve abstracts from AIDSLINE (a subdirectory of the National Library of Medicine at: http://www.nlm.nih.gov/nlmhome.html) checking each individual nutrient of interest. The causes of the nutritional deficiencies are not fully established. Certainly, in later stages of the disease, malabsorption, diarrhea, and hypermetabolism have been suggested as contributors. In addition, cytokine imbalances may stimulate some mechanisms that more rapidly clear nutrients from the serum. As a further complication to this problem, a higher than usual amount of certain nutrients might be needed by the individual because of the hyperactivation of the immune system and the occasional (or continual) need to repair damage due to infection and inflammation. Some drug therapies affect nutrient levels or require high levels of nutrients to minimize the incidence and severity of side effects. Currently, the demographics of HIV infection are shifting. A larger proportion of infections are experienced by persons who have difficulty maintaining a healthy lifestyle because of drug addiction, homelessness, mental illness, poor education, and other problems. Among this group may be found an even higher proportion of persons with a diet that is lacking in many important nutrients. While the finding of nutrient deficiencies has been a major area of research, the effect of the obvious treatmentadministering extra nutrients in order to overcome lower absorption and higher utilization rateshas been less studied. Nonetheless, in several published reports the impact of short-term (6 weeks to 6 months) nutrient administration has been shown to produce symptomatic and immunological improvements. The evidence that is accumulating for supplementing in cases of deficiency is compelling. The question arises as to what is prudent practice while awaiting results of further clinical trials. What are the benefits, risks, and costs associated with nutritional supplementation? The process of monitoring nutrient status can be quite expensive. There are a large number of nutrients that could be measured. One service, a lymphocyte nutrient status test, is provided by SpectraCell in Houston, Texas. A typical analysis of nutrients (which does not include all the nutrients of potential interest, but, rather, a sampling of vitamins, minerals, and amino acids) has a cost of about $400. Can one give nutrients in the absence of testing for deficiencies? The answer to that question revolves around the issue of safety, since the cost of administering nutrients is not especially high and even having potential benefits can be of interest within the current state of disease management. Administration of nutrients, even in fairly high quantities, has been undertaken for several decades by people having a wide range of ailments, and quite a large number of persons with HIV infection have either self-administered or have been prescribed nutritional supplements. Except in cases of extreme high dosage, adverse reactions are not obvious. A substantial body of evidence has been accumulated regarding the range of dosages that are safe to administer. An excellent compilation of research reports has been gathered by Melvyn Werbach, M.D. and published in his book Nutritional Influences on Illness (Third Line Press, 1993). Since vitamins and minerals provided in nutritional supplements are also found in dietary sources, it is reasonable to expect that they are safe to administer so long as the dosage is not excessive. Those working with natural healing are convinced that if the overall evidence shows a tendency to having a deficiency in nutrients, and if nutrients can be easily and inexpensively provided, and if there is some

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evidence showing benefit, then one might as well administer them while awaiting proof of effectiveness. If this step turns out to have little or no clinical benefit, there will not be much loss; if there is a benefit, it will likely prove to be a cost-effective intervention. It is also thought that negative impacts that have at times been suggested as a result of using high doses of individual nutrients can be avoided by relying on combination therapies at moderate dosage. The supplements should also be taken with a healthful diet whenever possible. Instead of using the RDA (recommended daily allowance) of nutrients as a guide to a reasonable level, the amounts to be used are a reflection of the current state of knowledge derived from studies of nutrient administration to resolve symptoms and diseases. These levels are sometimes considerably higher than the RDA, but not near a toxic level. At IEP, nutrient substances have been provided to patients over a period of four years in response to the growing body of evidence suggesting that it would be a safe and effective intervention, and as an attempt to improve upon the self-administration regimens adopted by individuals not trained in nutrition. A broad spectrum of substances have been provided. Lack of funds has prevented the monitoring of serum levels of individual nutrients to determine whether deficiencies existed and were alleviated by the treatment when they did exist. Evident adverse reactions have not been observed, and long-term monitoring of the patients has suggested (but not proven) that the patients enrolled in this program have fared well. Though obvious benefits (such as dramatic symptom improvement) have also not been observed, individual participants report that they believe the use of the supplements is helpful. The actual cost of nutritional supplementation will depend on what nutrients are delivered, but for the standard vitamins and minerals, the cost is about 80 cents per day. In Portland, nutritional supplements are provided at no extra cost at IEP, and they may be obtained at no cost by using Ryan White Vouchers (available to persons who have an income less than twice the federally defined poverty level; the supplements must be prescribed by a health professional).

PROTEINS AND FATS

Protein and calorie deficiency frequently occurs during AIDS and is part of the cause of AIDS-related weight loss. A good review of the subject is by S.J. Bell, et al., Nutrition support and the human immunodeficiency virus (Parasitology 1993; 107:S53S67). At IEP, body weight monitoring revealed that HIV positive persons who are not classified as having AIDS had an average 20 pound higher body weight than those with AIDS who were not suffering from an acute wasting syndrome. Studies have suggested that persons with AIDS may have a daily caloric need of up to 2,700 kcal compared to a pre-AIDS level of about 2,200 kcal, and may have a protein need of 1.2 grams/kg compared to a pre-AIDS level of 0.8 grams/kg (see, for example, the publication by C.M. Derek, et al., Energy expenditure and wasting in HIV infection, New England Journal of Medicine 1995; 333(2): 8388). Those patients who undertake muscle-building exercise programs, as is recommended to help prevent lean mass wasting, may have even higher protein requirements. Albumin levels in persons with AIDS frequently fall below 4.0, and it has been shown that survival time has a strong relationship with albumin levels, with a high probability of death among persons with albumin at or below 3.0. Glutamine, the main amino acid in the body with reserves stored in the muscle, is often depleted. Glutamine has important functions for the immune system and is needed for gastro-intestinal health. In the absence of adequate protein intake, muscle mass is gradually wasted. As glutamine stores and albumin levels drop, the ability to carry on normal physiological processes is inhibited and the individual becomes highly susceptible to a catastrophic illness. It is not so easy for persons with AIDS to get the protein they need, especially if appetite is reduced as the result of loss of taste for food, feeling bloated soon after beginning to eat, or as a reaction to infections or drug therapies. Protein-wasting diarrhea may also occur as a result of HIV enteropathy. Here is a protein level analysis of several foods considered to be high in protein: two eggs: 12 grams

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eight ounces white chicken meat: 12 grams four ounces halibut or shrimp: 24 grams one cup of yogurt: 8 grams one-half cup of cottage cheese: 13 grams one ounce typical hard cheese: 7 grams two ounces of peanuts: 14 grams one-half cup of cooked lentils: 8 grams If all these items were consumed in one daywhich would be quite a taskthe total protein from them would be 88 grams, about the amount needed by a 160 pound man that required 1.2 grams/kg. Of course, there is some protein in the other foods that might be consumed along with these things, but relatively little. Two methods of protein supplementation that are sometimes suggested are nutrition drinks (e.g., Ensure, Advera, Sustacal, Boost, Peptamen), which provide 1015 grams of protein per can (and about 250 kcal), or protein powders, which can be added to foods or blender drinks, and which provide about 5 grams per scoop (adding only about 22 kcal to the liquid base). At IEP, it is recommended to AIDS patients that they try eating more than three meals per day, focusing especially on high protein foods, such as fish, chicken, eggs, and Japanese style tofu (which has lower fat than Chinese style), and to supplement with protein powder, bee pollen (has 28% protein), and nutrition drinks (up to two cans per day to get the extra 500 calories needed). In addition, glutamine powder (which is tasteless), in the amount of 1030 grams per day is recommended to patients if they have wasting, intestinal distress, or low body weight. The orally-ingested glutamine spares body stores of this amino acid, helps replenish glutathione (an antioxidant that may reduce HIV activation rates), and helps repair damaged intestinal cells (in some cases relieving diarrhea). There is a vast body of literature on glutamine and its potential benefits for persons with bowel disorders; up to 40 grams per day is given by IV drip to persons who have undergone bowel surgery, but oral administration is best for those who are able. Based on the results of a review of patient files at IEP, patients are now instructed to begin special protein-enhancing diet when the albumin level drops below 4.0 (even though normal values are listed as being 3.5 and above). Several studies have shown that low albumin is associated with poor outcomes in recovery from diseases, surgery, and trauma. For further information see Malnutrition, a compilation of abstracts provided by Abbott Laboratories (Ross Products Division), and see Effect of malnutrition on the progression of AIDS, by Donald Kotler, HIV 1994; 3(3): 1723. Dr. Kotler has produced several other excellent reviews on the relationship of nutrition to HIV/AIDS. Fat malabsorption and futile lipid cycling result in abnormal fat levels, which can affect body warmth, fluidity of membranes, and can cause dryness and itching of the skin. In a study carried out at IEP, it was found that while lean mass levels were declining rapidly after onset of AIDS, body fat percentage was also declining. Fat malabsorption reduces the ability to gain necessary calories (as the caloric content of fats is twice that of carbohydrates and proteins), reduces access to fat soluble vitamins, and it can also lead to bloating and diarrhea. Many high protein foods, such as meats and nuts, are high in fat, and may thus prove to be poor dietary sources of protein (fish and chicken are relatively low in fat). It has been shown that medium chain triglycerides (MCT) are an easily absorbed fat. In a study of Ross Nutrition products in persons with AIDS, it was found that persons who regularly used Ensure (which is relatively high in long-chain fat and has some fiber) lost weight, while persons who used Advera (which is high in MCT and has no fiber) gained weight. In order to get the needed lipids and calories, it is important to have meals that contain some fat, but a small enough amount that does not cause adverse reactions due to the unabsorbed component. It may also be valuable to consume products that contain MCT (Mead-Johnson provides an MCT liquid product that can be used as a substitute for other fats in the diet). Small amounts of omega-3 and omega-6 fatty acids have been suggested to be helpful to immune regulation, and are readily available in soft-gel capsules, with the oil
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derived from borage and flax seeds. Fish oils may also be helpful and are best obtained by eating fish to provide high protein at the same time (though capsules are available for persons who do not like to eat fish). Nutrition drinks with high MCT are suggested to be used only can per day mainly because of high cost, unless there is significant bowel disorder, in which case more may need to be used to assure adequate fats and calories). The protease inhibitors Saquinavir and Ritonavir are to be taken with relatively high-fat meals to enhance absorption. While some recommend hamburgers, pizza, sausages, or cream sauce, a more healthful approach would be to use olive oil, fatty fish (e.g., tuna or salmon), eggs, walnuts, and peanuts.

ANTIOXIDANTS
Antioxidants are compounds that help reduce the damage caused by oxygen. The body naturally relies on multiple antioxidant systems, to prevent cellular dysfunction and death, including glutathione, vitamins and minerals, and superoxide dysmutase. Several antioxidants are obtained from the diet, especially from consuming fruits and vegetables, which are rich in vitamins and minerals and which may also contain the natural antioxidant compounds called flavonoids. Lipid peroxidation, which is prevented or reversed by antioxidant systems, is believed to be responsible for a number of pathological conditions, including many cases of cardiovascular disease and cancer. For this reason, it is believed that maintaining a high antioxidant level can have life-prolonging and so-called anti-aging effects. When tested in vitro, virtually every antioxidant inhibits HIV replication. It has been suggested that the mechanism of action includes halting the stimulation of DNA by the nuclear factor NF-kB, which is, in turn, activated by oxidation and inflammation by-products. There have been relatively few clinical tests of antioxidants in persons with HIV infection. The results of the small trials that have been conducted thus far have been positive, but modest. Besides the obvious interest in using such agents to reduce HIV replication rates, antioxidants are attractive because persons with HIV infection are usually in a state of oxidative stress, which means that the existing antioxidant systems are inadequate to meet physiological needs. One of the apparently promising antioxidants tested early on was NAC (N-acetyl-cysteine), which is the active component of the drug Mucomyst (used to thin mucus and to counteract the toxicity of Tylenol). NAC contributes to building up glutathione, one of the key antioxidant systems. The clinical problem with NAC is that it is poorly absorbed, so that to get adequate blood levels, one must consume several grams of the substance; unfortunately, that dosage often causes nausea. Since the original work with NAC, several other antioxidants have shown potential benefit, notably the mineral selenium, vitamin C, the thiol alpha-lipoic acid, and the coenzyme called CoQ10. Each of these has shown some positive benefits in small clinical evaluations. As an example, in Germany, alpha-lipoic acid given to 10 HIV infected patients showed that it could (in the majority of patients) increase plasma ascorbate, total glutathione, total plasma thiol groups, T-helper lymphocytes and helper/suppressor ratio, and reduce the levels of lipid peroxidation products. Another German group reported that First virological data from patients treated with alpha-lipoic acid indicate that antiviral effects are also seen in vivo. A reduction of infectious viral titers was observed as predicted from the in vitro experiments. For more information about alpha-lipoic acid, conduct a search on AIDSLINE, using the common name for the compound, thiotic acid. Naturally-occurring antioxidants are non-toxic and they do not cause side effects when used in modest dosage (in high dosage, several of them can cause digestive disturbance). Their effects are not dramatic (for example, they do not cause decreases in viral load or increases in CD4 levels as much as do combination anti-HIV drug therapies), but appear consistently positive. Antioxidants might be prescribed as a follow-up to oxidative stress measurement that reveals a high level. SpectraCell Laboratories in Houston, Texas offers an oxidative stress evaluation for lymphocytes. However, even if one does not pursue this testing, antioxidants might be given when a person is not tolerating standard anti-HIV drug therapy or the therapy is not having an adequate benefit in terms of viral load, CD4, or clinical

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outcome. One can try antioxidants as a replacement or supplemental therapy. Antioxidants are probably best applied when the viral load is not extreme (so that their impact might have some evident clinical benefit) and when an individuals digestive functions are not too greatly impaired (otherwise, the absorption is likely to be too low). Antioxidant therapy is the main non-drug method of dealing with HIV replication other than herbal compounds. Because of limited clinical testing, it is not well-established which antioxidants function best in relation to HIV infection. For this reason, a broad mixture of the components are offered in the hope of providing a synergistic antioxidant activity. To quote from Suzuki and Packer (Molecular aspects of medicine, 1993; 14(3): 229239), We have examined the effects of vitamin E and alpha-lipoate derivatives on NF-kappa B activation, and have observed that each of these antioxidants behave differently. At the International Conference on AIDS (August 1994), these researchers pointed out that NF-kappa B transcription factor regulates HIV activation. Natural and safe compounds which target NF-kappa B action may, therefore, be useful in AIDS therapy to support the action of antiviral agents.

CHINESE HERBS
The chronic viral infection that has plagued the Orient is hepatitis B. In some areas, 15 to 20 percent of the population is infected. Treatment of hepatitis B is one of the major reasons why individuals in China and Japan visit practitioners that prescribe Chinese herbs. The course of hepatitis B disease is variable, but it frequently manifests as a relatively brief acute illness followed by an extended period of seropositive status but little or no symptoms; then, at some point many years later, a chronic active phase begins, which eventually leads to degeneration of the liver and, not infrequently, liver cancer. This description is not entirely unlike that of HIV infection, except that the liver is not necessarily the organ that experiences the degeneration and neoplasm. Like HIV, hepatitis B virus is a retrovirus. Unlike HIV infection, there are treatments that can cure the disease in about half of those infected: those treatments are herbs and herbal derivatives given orally or by intravenous route. Not surprisingly, when Chinese and Japanese researchers and doctors who had extensive experience with treating hepatitis B learned about HIV, they endeavored to try the same herbs to see if they could get similar results. Ten years ago, Americans infected by HIV who were tuned into the HIV/AIDS treatment news read that Japanese doctors had treated patients, yielding some significant improvements, with the polysaccharide-rich extract (called lentinin) of Lentinus edodes (the shiitake mushroom) and with glycyrrhizin, one of many active components of licorice. Both of these substances had already proven effective for treating hepatitis B. In addition, many Japanese doctors that prescribe traditional Chinese herbal medicines had experience with using a complex formula (with seven herb ingredients) for persons with hepatitis B and also for persons with several other health problems. The formula is known in Japanese as Sho Saiko To (in Chinese: Xiao Chaihu Tang), and it was tested in vitro against HIV, found to be inhibitory, and then further studied to reveal that a major active constituent was the flavonoid baicalin, which proved to be a reverse transcriptase inhibitor. The formula also contains licorice, with its component glycyrrhizin. Follow-up studies with Sho Saiko To have been conducted in France. Lentinin, glycyrrhizin, and Sho Saiko To have all been subjects of small U.S. studies, usually applied in combination with zidovudine. A polysaccharide produced in the U.S. with properties similar to lentinin, called acemannan, has also been the subject of several clinical trials in persons with HIV infection. While Japanese doctors were trying their remedies, researchers from mainland China submitted a list of 27 herbs to test against HIV, mainly from their list of anti-hepatitis B remedies; these were tested in the U.S. at the University of California (Davis). Eleven of the herb extracts showed inhibitory action, and the mechanism of action was mainly to inhibit uptake of the virus by cells. Although these herbs are not practical to use in HIV therapy (the dosage that would be needed to accomplish the task in persons, as opposed to cell culture, is quite high), this work stimulated interest in the potential value of herbal compounds.

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An advantage of these herbs is their very low toxicity and lack of side effects (gastro-intestinal disturbances can occur in some individuals, however); unlike some of the anti-HIV drugs now in use, they do not cause bone marrow suppression (to the contrary, several are known to counteract bone marrow suppression), and they do not cause damage to the pancreas, liver, kidneys, or nerves. One strategy for treatment has been to take several of these anti-viral herb materials and administer them to persons with HIV infection. The reason for using several is that it is presumed that none will individually shut-down HIV replication or infection of new cells, but together they may greatly inhibit the progression of HIV disease by reducing several aspects of the HIV life cycle, an approach similar to using a drug cocktail. Most times the dosage given to persons with HIV infection has been too low to have the desired effect. This is mainly because the cost of the herbs is usually not covered by research grants or insurance and only relatively crude preparations have been readily available, so that the amount of material that needs to be consumed is high. Also, few persons who prescribe Chinese herbs in the U.S. are familiar with the dosage levels used for treating hepatitis B in China and Japan. At this time, the effectiveness of the herbs is not established, but adverse reactions have been very few, and the clinical studies (usually with few patients) have produced positive outcomes. Along another line of inquiry, specialists in Chinese herbs have sought to treat problems characteristic of HIV disease, such as wasting, night sweating, diarrhea, and fatigue, by using herbs that have successfully treated similar symptoms in patients suffering from other diseases, such as tuberculosis (another major health problem in the Orient). Further, herbs that counteract the bone marrow suppressive effects of cancer therapies are considered potentially valuable for those using anti-HIV drug therapies. The herbs selected according to this way of thinking may not inhibit HIV, but it might ward off some of the difficulties encountered secondary to the HIV infection and drug therapies. Chinese doctors working in Los Angeles, New York, Africa, Thailand, and other places have reported favorable outcomes from the use of Chinese herbs. One doctor in Los Angeles, Jin Lin Wang, has been collecting data about his patients for several years and his herbal treatment was recently subject of a double-blind study at the Pacific Oaks Medical Center (where it was shown that P24 antigen levels were significantly reduced in the Chinese herbs group). The Institute for Traditional Medicine (ITM, Portland, Oregon) has compiled a partial listing of journal references related to the application of Chinese herbs to HIV/AIDS, with mention of both clinical and pharmacological investigations. ITM has produced a listing of major HIV treatment centers that provide Chinese herb formulas (as well as acupuncture and other services), and also maintains Practitioner Reference Guide to assist interested persons in finding private practitioners in the U.S. that have access to the information and herbal materials needed to provide Chinese formulas. It is estimated that about 6,000 individuals in the U.S. are receiving professional Chinese medical services in relation to HIV disease, about half of them at the major clinics that serve 12 or more patients (up to 400 at one site). The Institute for Traditional Medicine and the Centers for Disease Control (Tumor Virology Laboratory) worked together to test the effectiveness of Chinese herbs for the treatment of hepatitis B. A formulation similar to Baicalcumin (with licorice, salvia, curcuma, and hu-chang in common) was being used in a double-blind trial (patients are treated in China) against a lentinus-based treatment (representing the earlier standard therapy) and a well-recognized anti-hepatitis preparation currently used in China. The outcomes from the first group of patients revealed substantial inhibition of hepatitis B viral activity and improvement in liver function in those taking the test substance as well as the lentinus preparation. The dosage of dried herb extracts in tablet form administered daily is 23.5 grams. The decision to use this amount was based on information obtained from several previous clinical trials with Chinese herbs in decoction form. COUNTERACTING DRUG SIDE EFFECTS Experience at IEP supports the contention that ordinary tea (black or green; most people use black tea) taken

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with the dose of protease inhibitors can reduce or eliminate symptoms of nausea and/or diarrhea. This suggestion originally derived from the descriptions of protease inhibitor side effects and problems: they tend to cause nausea and diarrhea, should be taken with, or away from, foods to assure absorption (with fatty food being the biggest concern), and tend to cause kidney stones (made up of the drugs). This picture is parallel to what one can find with ingestion of heavy fatty materials. From the traditional Chinese perspective, this can be resolved by taking certain herbs, of which ordinary tea is the most readily available. Translations of Chinese medical literature have been used as the basis of additional steps applied to dealing with drug side effects. A Chinese laboratory animal study indicated that the bone marrow suppressive action of AZT (zidovudine) could be counteracted by epimedium polysaccharides (a preparation of epimedium and lycium fruit extracts is used for this purpose at IEP; the dosage is 3 grams twice daily of dried hot water extract of the two herbs in equal proportions). In a clinical study, herbal treatment was shown to reduce the bone marrow suppressive action of cancer drugs; results of this work might also be applicable to the effects of nucleoside HIV-inhibitors. The herbal therapy was based mainly on use of astragalus, which contains polysaccharides similar to those found in epimedium (the formula is 100 grams astragalus, 20 grams tang-kuei, 15 grams atractylodes, and 15 grams siler). The ototoxicity of antibiotics has been reportedly counteracted by ingestion of drynaria (a kidney tonic herb) and liver toxicity of several drugs was reported to be counteracted by a combination of herbs including scute and hu-chang, two of the herbs frequently recommended for persons with HIV infection. Licorice, another herb often prescribed to persons with HIV infection, was reported by the Chinese to counteract the toxicity of adriamycin. The potential of Chinese herbs, as well as nutrient supplements and antioxidants, to protect against adverse effects of various chemotherapeutic agents, is a relatively new area of research. Since about 1976 in China, numerous attempts have been made to counter the side effects of cancer drugs. Two anti-HIV drugs, AZT and hydroxyurea, have been used for treating cancer (AZT was withdrawn from consideration, but hydroxyurea is still used). But, even in cases where the new drugs differ from those that have been tested in the past, the protective action of the Chinese herbs might still apply. This is because the activity of the Chinese herbs may not be specific for the drug, but rather for the target cellular components. In fact, the original development of Chinese herbal formulas, such as Composition-A, for treating HIV, was based on the immune-restoring aspects of herbs that were being used in China to counter side effects of cancer drugs. October 1997

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