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The ITM has operated
a clinic that provides Chinese medicine to patients with HIV since 1992
in Portland, Oregon. The ITM has
also provided support to similar clinics in San Francisco and elsewhere.
Patients take their prescribed drug cocktails and also use high dosage
protocols involving herbs (St. John’s Wort is not among them) at these
facilities. There have not been any reports of increased viral load or
suspicion of herb-drug interactions despite the participation of several
thousand patients over the past several years. While such informal monitoring
does not provide clear evidence for the absence of such interactions, the
apparent lack of adverse effects is entirely consistent with the findings
mentioned above for formal medical reports: that herb-drug interaction
incidents are infrequent.
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Editor's Note:
In Issue 32 of the HIV Nutrition Update Richard A. Freiberg, DOM, DAc,
AP, Board Certified Diplomate notes that herbal preparations may be pre-prepared
in Chinese Materia Medica to inhibit toxicity. Even with these additional
preparation methods however, herbs need to be administered by a well-trained
practitioner to avoid any serious complications or adulteration.
References
1. Piscitelli SC, Burstein
AH, Chaitt D, Alfaro RM, Falloon J. Indinavir concentrations and St. John’s
wort. Lancet 2000; 355(9203): 547–548.
2. Zhou S, Chan E, Pan
SQ, Huang M, Lee EJ. Pharmacokinetic interactions of drugs with St. John’s
wort. J Psychopharmacol 2004; 18(2): 262–276.
3. Patel J, Buddha B,
Dey S, Pal D, Mitra AK. In vitro interaction of the HIV protease inhibitor
ritonavir with herbal constituents: changes in P-gp and CYP3A4 activity.
Am J Ther 2004; 11(4): 262–267.
4. Kimata M, Inagaki N,
Nagai H. Effects of luteolin and other flavonoids on IgE-mediated allergic
reactions. Planta Medica 2000; 66(1): 25–29.
5. Hosein SR, Lyons L.
Milk thistle, CATIE Supplement Sheet
2000, Revised 2002.
6. Gurley BJ, Gardner
SF, Hubbard MA, Williams DK, et al. In vivo assessment of botanical supplementation
on human cytochrome P450 phenotypes. Clin Pharmacol Ther 2004; 76(5): 428–440.
7. Fugh-Berman A, Ernst
E. Herb-drug interactions: review and assessment of report reliability.
Br J Clin Pharmacol 2001; 52(5): 587-595.
8. Brazier NC, Levine
MA. Drug-herb interaction among commonly used conventional medicines: a
compendium for health care professionals. Am J Ther 2003; 10(3): 163-169. |
