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More Than Half in Barcelona HIV Clinic Use Alternative Therapies
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11th International Workshop on Clinical Pharmacology and HIV Therapy, April 7-9, 2010, Sorrento
Mark Mascolini
More than half of 1000 HIV-infected people surveyed at a large HIV clinic in Barcelona use complementary or alternative therapies that they believe help them control their infection or its symptoms [1]. Better educated people were more than twice as likely to use an alternative therapy, and only half who used such remedies asked their HIV physicians about them. Many of the agents used have some impact on the CYP3A4 enzyme, which is involved in the metabolism of many key antiretrovirals.
Jose Molto and colleagues at the University Hospital Germans Trias i Pujol gave a self-administered questionnaire to 1000 HIV-infected adults attending the HIV clinic pharmacy department. The researchers matched results with medical records from the clinic.
The group's age averaged 43.2 years (+/- 8.5 standard deviation), 75.4% were men, 88% were Caucasian, and 73.7% had a high school or college education. But only 57.4% had a job, and 49.7% had an income below 1000 Euros per month. The study group averaged 12.6 years (+/- 7.5) since their HIV diagnosis, 43.1% were gay men, 88.7% were taking antiretrovirals, 79.9% had a viral load below 50 copies, and 60.7% had non-HIV symptoms. The group's CD4 count averaged 572 (+/- 314).
Of the 1000 survey respondents, 584 acknowledged using some alternative therapy, and most used more than one: the median number of unlicensed remedies was 3 (interquartile range 2 to 7). Of the 584 people using alternative remedies, only 324 (55.5%) had discussed their use with their HIV clinician, and only 124 (21.2%) had been monitored for potential interactions between such agents and antiretrovirals.
More than 400 people used dietary supplements, and more than 300 used herbal remedies. The most frequently used agents that may interfere with antiretroviral metabolism were garlic (71 people, CYP3A4 induction), ginseng (67 people, CYP3A4 inhibition), Echinacea species (60 people, CYP3A4 induction and/or inhibition), and milk thistle (36 people, CYP3A4 induction).
Five factors independently raised the chance of using alternative therapies:
· Consultation with primary care physician about possibility of using alternative therapies: odds ratio (OR) 3.12, 95% confidence interval (CI) 2.30 to 4.23, P < 0.001
· High school or university degree: OR 2.63, 95% CI 1.78 to 3.88, P < 0.001
· Non-HIV-related symptoms: OR 1.68, 95% CI 1.24 to 2.28, P = 0.001
· Perception that alternative therapies are totally or partially beneficial: OR 2.28, 95% CI 1.18 to 4.41, P = 0.015
· Non-Caucasian race: OR 1.65, 95% CI 1.07 to 2.56, P = 0.024
Molto and coworkers recommended that HIV patients and physicians "should be sensitized to the potential risks . . . of complementary or alternative medicine, and especially herbal remedies, and encouraged to discuss such therapies openly during clinical visits."
Reference
1. Molto J, Miranda C, Malo S, et al. Patterns and correlates of the use of complementary and alternative medicine among HIV-infected patients. 11th International Workshop on Clinical Pharmacology and HIV Therapy. April 7-9, 2010. Sorrento. Abstract 31.
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