Since the very beginning of the HIV/AIDS epidemic, many patients have turned to complementary and integrative medicine (CIM) to treat or prevent complications of their diagnosis. According to the NIH National Center for Complementary and Integrative Health (NCCIH), more than 30% of American adults use health care approaches that fall outside the scope of mainstream Western medicine. Of these approaches, the most commonly used are “natural products,” which include botanicals, vitamins and minerals, and probiotics.
But are these products safe? And are they effective? Adriana Andrade, MD, MPH, FACP is an Associate Professor of Medicine at Johns Hopkins University, and she is currently working on two studies investigating the use of two natural products for individuals with HIV/AIDS. “Dietary supplements are often perceived as natural and thus, safe and not like FDA-approved ‘drugs’ because they often derive from botanicals/herbals,” Dr. Andrade explains. “However, natural does not necessarily mean safe and/or lacking pharmacological effect. In fact, studies have shown that some herbals/botanicals can significantly lower the levels of antiretroviral drugs and potentially lead to treatment failure. In addition, some of these agents can also cause clinically important toxicity.”
Dr. Andrade’s first study looks at American ginseng and the role it might play in lessening HIV-associated fatigue. This study was sponsored by NCCIH and is a collaboration between several Hopkins investigators, including Drs. Todd Brown, Craig Hendrix and Adrian Dobs, as well as collaborators from the Mayo Clinic and University of Chicago. The CFAR supported the ginseng study by helping Dr. Andrade and the study team identify potential participants, most of whom live here in Baltimore and receive care at the Moore Clinic.
The second study, funded by the AIDS Clinical Trials Group, aims to address the inflammatory response that seems to be worsened by replacement of “good bacteria” by “bad bacteria” in the gut microbiome, triggered by HIV infection. Since probiotics contain “good bacteria,” the study team is investigating whether supplementing the diet with probiotic products can restore the balance of bacteria, potentially reducing inflammation that can come with AIDS-associated chronic conditions.
Dr. Andrade stresses that patients should exercise caution and consult their health care providers before taking any dietary supplement. As she explains, “These agents do not receive the same type of FDA regulatory oversight as traditional drugs. Therefore, there is limited information about their potential for drug interactions, safety and efficacy.” Continued research, like the studies Dr. Andrade is working on, is needed to help fill this information gap.
Dr. Adriana Andrade is an associate professor of medicine at the Johns Hopkins University School of Medicine. Her areas of clinical expertise include HIV/AIDS and infectious disease.