HIV This Week

Fritts M, Crawford CC, Quibell D, Gupta A, Jonas WB, Coulter ID, Andrade A. Traditional Indian medicine and homeopathy for HIV/AIDS: a review of the literature. AIDS Res Ther. 2008;5(1):25.

India ranks third in the world in absolute burden of HIV. While increasing numbers of Government-sponsored clinics are providing free antiretroviral therapy, its utility is limited by lack of affordability and acceptability and the requirement for lifelong administration. Allopathic practitioners in India are outnumbered by practitioners of traditional Indian medicine and homeopathy, which is used by two-thirds of its population in rural areas to help meet its primary health care needs. However, little is known about traditional Indian medicine and homeopathy use, safety or efficacy in HIV management. These data suggest that India’s community-based, culturally-relevant traditional Indian medicine and homeopathy system, which is one of the largest indigenous medical systems in the world, remains an untapped ally in the fight against its HIV epidemic. The purpose of this review was to assess the quality of peer-reviewed, published literature on traditional Indian medicine and homeopathy for HIV treatment and care. Of 160 original articles reviewed, 19 laboratory studies, 17 clinical studies and six previous reviews of the literature were identified that covered at least one system of traditional Indian medicine and homeopathy, which includes Ayurveda, yoga, naturopathy, Unani medicine, and Siddha medicine and homeopathy. Most studies examined either Ayurvedic or homeopathic treatments. Only four of these studies were randomized controlled trials, and only 10 were published in MEDLINE-indexed journals. Overall, the studies reported positive effects and even cure and reversal of HIV infection, but frequent design flaws call into question their internal and external validity. Common reasons for poor methodological quality included lack of details on products and their standardization, small sample sizes, selection of inappropriate or weak outcome measures, and incomplete reporting of study results. This review exposes a broad gap between the widespread use of traditional Indian medicine and homeopathy therapies for HIV, and the dearth of high-quality data supporting their effectiveness and safety. In light of the suboptimal effectiveness of vaccines, antiretroviral treatment, barrier methods, and behaviour change strategies for prevention and cure of HIV infection, it is both important and urgent to develop a rigorous research agenda that uses innovative methodologies to investigate, evaluate, and maximize the role of traditional Indian medicine and homeopathy in managing HIV and associated illnesses in India.

Editors' note: This review presents an interesting overview of the history and principles of each system of traditional Indian medicine and homeopathy and highlights the current antiretroviral treatment gap, before summarising the results of in vitro, in vivo, and clinical studies of the impact of traditional Indian medicine and homeopathy on HIV. While yoga and healthy diet are considered beneficial by most people, the use of herbal preparations and homeopathic treatments for tuberculosis and HIV in the absence of data on effectiveness is concerning. Both the paucity of evidence and the use of these therapies by significant numbers of people living with HIV call for systematic assessment of the potential benefits and potential harms of traditional Indian medicine and homeopathy. Increased cross-training between traditional medicine and allopathic (modern) practitioners and development of a collaborative research agenda for studies using rigorous methodologies hold the promise of improved patient outcomes.

Tonwe-Gold and colleagues describe a family-focused approach to HIV care and treatment and report on the first 2 years experience of implementing the mother-to-child transmission (MTCT)-plus program in Abidjan, Côte d’Ivoire. The MTCT-plus initiative aims to enrol HIV-infected pregnant and postpartum women in comprehensive HIV care and treatment for themselves and their families. Between August 2003 and August 2005, 605 HIV-infected pregnant or postpartum women and 582 HIV-exposed infants enrolled. Of their 568 male partners reported alive, 52% were aware of their wife’s HIV status and 30% were tested for HIV; 53% of these tested partners were found to be HIV-infected and 78% enrolled into the program. Overall only 10% of the women enrolled together with their infected partner. On the other hand, the program involved half of the seronegative men who came for voluntary counselling and testing in the care of their families. Of 1624 children <15 years reported alive by their mothers (excluding the last newborn infants of the most recent pregnancy systematically screened for HIV), only 10.8% were brought in for HIV testing, of whom 12.3% were found to be HIV-infected. With respect to lessons learned and challenges, the authors conclude that this family-focused model of HIV care pays attention to the needs of families and household members. The program was successful in enrolling HIV women, their partners and infants in continuous follow-up. However engaging partners and family members of newly enrolled women into care involves numerous challenges such as disclosure of HIV status by women to their partners and family members. Further efforts are required to understand barriers for families accessing HIV services as strategies to improve partner involvement and provide access to care for other children in the households are needed in this West African urban setting.

Editors' note: Nondisclosure was the major factor limiting this family-centred programme in two poor urban Abidjan slums experiencing multiple unfavourable social and political conditions. The cascade of effort deployed to engage partners resulted in 30% having HIV testing and counselling, however only 69 of the estimated 300 men likely to have HIV infection enrolled in the programme. Testing was also an entry point for seronegative men to participate in adherence support sessions for their family members and attend peer support groups. Recognizing that the immediate environment has a direct impact on an individual’s ability to promote his or her own health, the innovative MTCT-plus model of care starts with pregnant women as the entry point to HIV care and services for the whole family.