Herbs, supplements and HIV

January 2005     View PDF     En español

Conclusion

There are generally two schools of thought about using vitamins. One is that people should take vitamin supplements in pill form. The other is that people should simply improve their nutrition and increase their vitamin intake through better eating. Likely the best approach for people at risk for vitamin deficiencies is one that lies somewhere between these two approaches.

It’s unknown if the body can really use vitamins that are delivered from pills. Some contend that in order for the body to optimally absorb and use vitamins they need to be delivered through better nutrition, in foods where they exist in complex forms which may help the body to better use the nutrients.

Herbal remedies and other vitamins are sold as “food supplements” and do not undergo the rigorous testing that prescription meds do. They’re not regulated and may not reveal all of a product’s contents on its label. They also may not contain the ingredient(s) listed or the amount(s) claimed. Don’t assume that just because something is available over-the-counter or is “natural” that it doesn’t have side effects or won’t interact negatively with your other meds.

In the U.S. alone, it’s estimated that $20 billion was spent on complementary therapies in 2001. The use of these therapies has risen almost 400% in the past eight years, and it’s estimated that half the people in the U.S. use them. Currently, the industry has done very little to document the safe and effective use of its products. It’s unlikely that it ever will.

The U.S. Government, through the NIH, has established two botanical centers to evaluate these types of therapies. A third center will be funded shortly. Every few years, new discussions are held about whether and how to better regulate the marketing of nutritional supplements and herbs.

There is a great difficulty in evaluating herbs and herb-drug interactions because often the active ingredient in the products and its dose are not known. Although drug interaction studies for medications typically take a matter of a week to ten days, drug-herb interaction studies are expected to take much longer. This is a more expensive process since people will probably have to take herbs for a few weeks before an effect is seen.

Even when the interactions are known for one particular product, it’s unclear how they will relate to similar products because of the lack of control over dosing. Because no studies have determined the proper or best dose of many complementary therapies, researchers face another challenge in first selecting the dose of herbs to use in studies. Funding for these studies still remains a problem and a limitation to moving forward rapidly. Many companies that sell complementary therapies are reluctant to fund studies which may reveal their products are not useful, have side effects or have interactions with common meds. This information could hurt their profit margins. Pharmaceutical companies are also unwilling to fund these studies for many of the same reasons, and the FDA does not require them.

Whatever the possible benefits of herbs, vitamins and supplements, there’s simply no meaningful information to guide making decisions when using them. Be aware that using them entails some risk. For more information on studies of herbs and vitamins conducted in HIV disease, see below.