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Original / Research

A Retrospective Study of an Ayurvedic Herbal Combination in the Management of HIV/AIDS
AA Mundewadi*

55 HIV positive patients were treated with an Ayurvedic Herbal Combination during 1999-2004. All Opportunistic
Infections were treated with appropriate modern drugs. Regular clinical assessment was conducted and laboratory
investigations were done as possible. The overall results proved the Ayurvedic medicine to be highly effective as anti-
viral and immuno-stimulant, and safe on long-term use. A nutritious diet, Ayurvedic baseline therapy, timely allopathic
treatment of Opportunistic Infections and regular counselling support appears to be an ideal combination in the
management of HIV / AIDS patients.

INTRODUCTION
At present, there is no scientifically proved cure for HIV /AIDS. Globally, the number of infected HIV /AIDS patients is increasing
at an alarming rate; with a current estimate of 39.4 million people who are living with HIV.1 At the end of 2003, India was
estimated to have around 5.1 million HIV positive people.2 Hence, there is a dire need to search for a safe, effective and
economical treatment for HIV/AIDS.
In a retrospective study in 55 patients, Ayurvedic treatment has proved to be very promising in the management of HIV/AIDS.
Methods
This is a retrospective study of 55 adult patients who desired, and were given Ayurvedic treatment for HIV/AIDS, during the
period from April 1999 to November 2004. Each patient had tested positive for HIV/AIDS on at least 2 different occasions. No
patient was taking anti-retroviral drugs at the time of commencing Ayurvedic treatment. All patients were started on treatment
after written, informed consent.
The Ayurvedic Herbal Combination (AHC) comprises eleven different herbs in different dosage strengths, based upon their
respective potencies, reported anti-viral and immunomodulatory properties, and their traditional usage according to Ayurvedic
principles of medicine.3-5
The constituents of AHC with their respective dosages are as follows:-
Terminalia arjuna: 250 mg.
Zinziber officinale: 250 mg.
Phyllanthus niruri :1 gm.
Glycyrrhiza glabra:1 gm.
Withania somnifera:1gm.
Eclipta alba: 250 mg.
Centella asiatica: 250 mg.
Boerhavia diffusa: 250 mg.
Emblica officinalis: 250 mg.
Tinospora cordifolia: 250 mg.
Rubia cordifolia: 250 mg.
This AHC was dispensed in a combined dose of 5 gms. t.i.d. , to be taken with water after meals. Aqueous herbal extracts of all
the medicines were used, in tablet form.
All patients were advised to eat a well-balanced, nutritious diet. Therapeutic counselling sessions were conducted regularly to
help the patients achieve mind relaxation, to modify their risk behaviour , and to increase adherence and compliance to
therapy.
All patients were followed up at monthly intervals. Detailed clinical examination was done at each visit and significant findings
were recorded. In addition, in affording and willing patients, investigations like CBC, Hb, Liver and Renal functions, X-ray chest,
Western Blot, CD4 count and Viral Load were done wherever possible. Other investigations were done, if required, for
Opportunistic Infections (O.I.). All O.I. were promptly and aggressively treated with modern medicines. A close watch was kept
for adverse reactions of the drugs.
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Therapeutic outcome was assessed by overall clinical examination, change in Karnofsky score, change in weight, occurrence
and response to O.I., and change in CD4 and Viral Load values.
Results
The overall age-wise distribution of patients was as follows:-
20-29 years, n = 23(42%)
30-39 years, n = 21 (38%)
40-49 years, n = 10 (18%)
50-59 years, n = 1 (2 %)
Thus, maximum number of patients were in the age ranging from 20 - 39 years (80%). Of the total number of 55 patients, 39
were male (71%) and 16 were female (29%), with the male : female ratio being 2.4: 1. There were 7 couples who took
treatment together.
Of the 55 patients, 5 patients died, 42 patients took treatment for varying periods and then stopped treatment, while 8 patients
are still continuing treatment. The 5 patients who died were critically ill at the time of presentation, and died mostly within the
first two months of starting Ayurvedic treatment. The cause of death varied; 1 patient died from cirrhosis of the liver, 3 died of
extensive Pulmonary Tuberculosis (multi-drug resistant) and 1 died of a combination of Pulmonary Tuberculosis and
demyelination disease of the brain.
In the 50 patients who were alive till the time of their last follow-up , there was an average weight-gain of 2.3 kgs. (range = - 4 to
+ 7.5 kgs), usually within the first 3 months. In those patients who took continuous treatment for more than 3 months, the
Karnofsky score increased from an average of 75.9 at the commencement of treatment to 87.4 at the last follow-up.
Almost all the patients had1-3 O.I. at the time of presentation. Other than Tuberculosis, all the O.I. cleared up rapidly within the
first 2 months of treatment.
Long-term administration of Ayurvedic medicines (upto 30 months) did not seem to have any major adverse effects. In fact, in a
few patients, the tests for liver and renal function appeared to normalize further, with treatment. Haemoglobin readings
gradually improved in those patients taking regular, prolonged treatment.
The most striking effect of the Ayurvedic medicines was on the Viral Load and CD4 counts. Because of financial constraints,
only 15 patients (27 % ) agreed to do either the Viral Load or the CD4 count, or both. In most patients, there was a definite and
steady decrease in the Viral Load, and an increase in the CD4 cell counts. The actual Viral Load and CD4 counts are given in
Table 1. The mean, time-related changes in the Viral Load and CD4 are given in Fig. 1 and Fig. 2 respectively.
Duration in weeks*
Fig 1: Chart showing change in viral load with ayurvedic
treatment.
**Figures represent the mean actual viral load/10.
4
Viral
load **
Fig. 2 : Chart showing the mean change in CD4 count.
Mean CD4 count
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Discussion
Antiretroviral medicines are the mainstay in the modern treatment of HIV/AIDS. However, a plethora of side-effects,
development of resistance to drugs and escalating treatment costs are serious concerns. In the absence of a definite cure for
HIV/AIDS, Ayurvedic medicines may provide a useful alternative for long-term management of patients, since these medicines
are economical and devoid of serious side-effects. However, scientific research is necessary to determine efficacy of these
medicines. This retrospective study is one such effort to assess long-term therapeutic effects of an Ayurvedic Herbal
combination in the management of HIV/AIDS.
In this study, 4 patients died within the first 2 months of commencing treatment. Onset of probably could not benefit from
Ayurvedic treatment. This emphasizes the need to start treatment as early as possible in immuno-compromised patients. The
causes of death indicate that Tuberculosis and CNS involvement are major killers in HIV patients. Multi-drug resistance to
Tuberculosis is also a major concern.
16 patients (29%) did not come back after just one (11%) or two (18%) visits. The reasons cited were, a complete inability to
pay for treatment, or a search for a better or a guaranteed cure. Fortunately, perceptions have changed in the last two years.
Even illiterate patients from the lower socio-economic strata are no longer asking for a guarantee or a cure. Long-term
management with minimum expenses is a mantra being readily accepted by the HIV positive patient of today.
All the patients who took medicines regularly, had a high-protein diet and kept themselves busy, improved very well and put on
weight. Even 2 to 3 years after stopping Ayurvedic treatment, most of the patients are doing very well, some inspite of very low
CD4 counts. This is probably one of the biggest long-term advantages of taking Ayurvedic medicines for HIV/AIDS. However,
patients with socio-economic difficulties and a lot of psychological pressure who could not have access to regular treatment,
started losing weight after initially improving with treatment. A comprehensive management of each patient thus needs to
address several issues relevant to each individual patient.
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This study also brought forth some interesting results. One patient who subsequently died, had severe demyelinating disease
of the brain (as diagnosed in a major hospital), and had lost most of his motor control and sensory senses, since several
months. After being given Ayurvedic treatment for about 11/2 months he became alert, and could speak clearly, albeit
temporarily, for 1 week. Another patient with Nephrotic syndrome resulting in long-standing generalized oedema (2 years) had
complete regression of the oedema after 2 months of Ayurvedic treatment without any other treatment. One HIV positive patient
with suspected malignancy of lung in the right upper lobe was steadily losing weight. After starting Ayurvedic treatment, he
started putting on weight. This patient later underwent a CT-guided FNAC, the results of which are awaited. Another patient
with history suggestive of HIV Encephalopathy was semi-conscious at presentation. He was passively fed on liquid diet and a
combination of both modern drugs and Ayurvedic treatment. This patient became ambulatory within 2 weeks, and after 2
months of treatment he is faring well, even with a CD4 count of just 6.The above 4 instances indicate that the Ayurvedic
medicines may have multi-faceted properties and need further evaluation.
Conclusion
The retrospective study of 55 HIV positive adult patients treated with an Ayurvedic Herbal combination from April 1999 to
November 2004 proved the Ayurvedic medicines to be considerably effective as anti-viral and immuno-stimulant,and safe on
long-term use. A nutritious diet, Ayurvedic baseline therapy, timely allopathic treatment of Opportunistic Infections and regular
counselling support appears to be an ideal combination in the management of HIV/ AIDS patients.
Acknowledgement
The medicines used in this study were purchased from Chaitanya Pharmaceuticals, Nasik and Nahar Pharmaceuticals,
Gujarat.
References
1. UNAIDS. Global Summary of the AIDS Epidemic. Update. December 2004.
2. UNAIDS. Epidemiological Fact Sheets on HIV/AIDS. India. Page 2. 1/9/2004.
3. Foundation for Integrative AIDS Research. Potential Anti-HIV Herbs. 15/9/2002.
4. Sharma PV. Vegetable Drugs. IV Edition. Chaukhamba Publications.1978:2.
5. Dahanukar S A, Kulkarni RA, Rege NN. Pharmacology of Medicinal Plants and Natural Products. Indian J
Pharmacology 2000; 32 : S81 - S118.

*Ayurvedic Physician, T.M.C. Office Bldg., 1st Floor, Mumbra, Thane 400612.
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