NATIONAL INSTITUTES OF HEALTH; Office of Alternative Medicine - Fact Sheet #7 - June 1994

The terms "alternative," "complementary," or "unconventional" therapy cover a broad range of healing philosophies and approaches. Some approaches are consistent with physiological principles of Western medicine, while others constitute independent healing systems. Some therapies are so far outside the realm of accepted medical theory and practice that they are difficult to subject to standard evaluative techniques.

How Does Alternative Medicine Fit Into the Treatment of HIV Disease?

At the beginning of the epidemic, little or no treatment was available for people with HIV/AIDS. Although as yet there is no cure, over the last decade researchers have identified a number of drugs that slow progression of the virus as well as therapies to treat the many opportunistic infections that attack people with HIV disease. The key to effective treatment is early detection and intervention. Some early treatments aim to strengthen the immune system, help patients reduce stress, and maintain good nutritional practices and appropriate exercise regimens. Many of the alternative therapies described below place significant emphasis on these lifestyle issues. Taking an active role in any disease is an important adjunct to treatment. Consideration of alternative therapies in conjunction with conventional medicine may offer additional opportunities for persons living with HIV/AIDS to be proactively involved in their treatment.

How to Approach Alternative Therapies

Here are a few suggestions to follow before getting involved in any alternative therapy.

* Obtain objective information about the therapy. Besides talking with the person promoting the approach, speak with people who have gone through the treatment--preferably both those who were treated recently and those treated in the past. Ask about the advantages and disadvantages, risks, side effects, costs, results they experienced, and over what time span results can be expected.

* Inquire about the training and expertise of the person administering the treatment (i.e., certification). If any uncertainty remains, verify the information.

* Consider the costs. Alternative treatments may not currently be reimbursable by health insurance.

* Discuss all treatments with your primary care provider, who needs this information in order to have a complete picture of your treatment plan.

People with HIV/AIDS in the United States use many kinds of alternative approaches to treatment. Some of the most common are briefly described below.

Herbal Medicine

The use of plants as medicine is common to many cultures, and a number of advanced pharmaceutical drugs were derived from plants. Not just herbalists but naturopaths, homeopathic, Ayurvedic, Chinese, and Native American medical practitioners all use herbs as one component in an overall system of medicine. For example, Chinese medicine practitioners may use herbal formulas, acupuncture, meditation, and massage techniques simultaneously. Chinese herbs are frequently used in combination to provide a tonic for general health or to try to fight a specific pathogen or condition. Herbs have been used extensively in hopes of improving immune response and reducing symptoms. Aloe vera, St. Johnswort, echinacea, licorice, and ginseng are just a few of the herbs used to treat HIV/AIDS.

Homeopathy

Homeopathic medicines, which include minerals, vitamins, and animal products, are natural substances given in very low doses. Homeopathy is based on the principle that "like cures like," that is, substances that in large doses would cause adverse symptoms will, in small doses, treat those same symptoms. Homeopathy is highly individualized to a patient's symptoms.

Acupuncture

Acupuncture involves the relatively painless insertion of extremely thin needles into the skin at specific points to help balance the body's flow of energy, referred to as qi ("chee"). When needles are inserted into the appropriate points, it is thought that energy is unblocked, and symptoms can be relieved. Variations of acupuncture include acupressure and shiatsu (pressure and massage of acupuncture points). Acupuncture is sometimes used to relieve some HIV-related symptoms such as neuropathy, fatigue, and pain. It is also used in an attempt to strengthen the immune system.

Diet and Nutrition

Persons with inadequate nutrition who are HIV infected have an increased susceptibility to opportunistic infections and a more rapid disease progression. Even when nutritional intake is adequate, an HIV-positive person may lose weight long before he or she develops AIDS. This happens because, throughout the progression of HIV infection, the patient's nutritional status is challenged by the manifestations of symptoms such as nausea, vomiting, malabsorption, diarrhea, oral/esophageal problems, and infections that impede fat storage. People with HIV may also develop lactose intolerance. After HIV infection has progressed to AIDS, malabsorption of nutrients may become severe. Weight loss can cause a vicious cycle of fatigue, muscle-wasting, and loss of appetite. Nutritionists and dieticians work with people with HIV infection to design diets that provide those nutrients that may be lacking. Some practitioners work within mainstream medicine, while others have unique approaches.

Dietary Supplements

Dietary supplements are commonly used in an effort to boost the immune system. Foods or substances derived from foods (garlic, Chinese bitter melon, turmeric) are also used, as well as nonfood dietary supplements such as shark cartilage or blue-green algae (spirulina). Vitamins, minerals, and amino acids are also used in an attempt to boost the immune system. An excellent overview of dietary supplements is contained in the Winter 1994 issue of Treatment Issues (address on last page of fact sheet).

Body Work and Massage

Massage is the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument-for remedial or hygienic purposes. Therapeutic massage is not only beneficial in relieving a variety of physical symptoms including chronic pain, but it may also be effective for relaxation and stress reduction. Massage can help people with HIV/AIDS relieve chronic muscle tension and ease the mental and emotional stress that accompany the illness. Body manipulation/massage techniques that are being used to treat HIV/AIDS include acupressure, the Alexander technique, deep muscle therapy, polarity therapy, Reiki, Rolfing, Shiatsu, Rubenfeld Synergy, Swedish massage, and therapeutic massage.

Chiropractic medicine is a system of therapeutics that attempts to restore normal function by manipulation and treatment of the body structures, especially those of the vertebral column. Through manipulation, chiropractors may be able to relieve joint stiffness and pain, which are common complaints of HIV/AIDS patients.

Yoga is the practice of an ancient system of breathing exercises, postures, stretching exercises, and meditations based on Ayurvedic medicine and Indian philosophy and religion. The aim of Yoga is to help the individual balance the body's chakras or energy centers. Its practitioners believe that yoga can aid in detoxification, strengthen particular organs, improve stamina, and alleviate chronic fatigue.

Mind-body Therapies

Sometimes called psychoneuroimmunology (PNI), these approaches are based on the concept that the mind or brain can influence the body's ability to fight disease.

Meditation uses deep breathing or other focusing techniques to enable a person to center his or her thoughts. Meditation may be used to reduce tension, fatigue, or anxiety and increase resistance to stress.

Visualization is the process by which a person is directed to see himself or herself in some other physical, emotional, or spiritual state. Patients might be guided to imagine themselves in a state of vibrant health and the disease organisms as weak and destructible. Through these mental images, patients might try to direct their immune systems to fight the virus. Other mind-body techniques for people with HIV/AIDS include hypnosis, humor therapy, biofeedback training, and listening to inspirational or relaxational audiotapes.

Additional Resources

Organizations

Office of Alternative Medicine, National Institutes of Health- For more information about the Office and its activities, write to the Information Center, Office of Alternative Medicine/NIH, 6120 Executive Boulevard, EPS Suite 450, Rockville, MD 20852, or call 301-402-2466, or fax 301-402-4741.

CDC National Prevention Information Network- The CDC National Prevention Information Network is a reference, referral, and publications distribution service for people working in the field of HIV and AIDS. In addition, the Clearinghouse provides information on clinical trials for persons with HIV and AIDS; bibliographic information on over 13,000 educational materials; and online access to up-to-date scientific information and news. To contact the Clearinghouse, call 800-458-5231 (toll free); 800-243-7012 (Deaf Access/TDD); or write to CDC National Prevention Information Network, P.O. Box 6003, Rockville, MD 20849-6003.

Buyers Clubs- According to U.S. regulations, individuals in this country may import drugs approved in other countries. People with HIV/AIDS have joined together in buyers clubs to facilitate these purchases. Many clubs also provide vitamins, food supplements, and herbal treatments. Some provide written information or have a nutritionist on staff to help with questions. Call the CDC National Prevention Information Network (see above) to locate buyers clubs.

Direct AIDS Alternative Information Resources (DAAIR)- DAAIR is a nonprofit organization that provides information on access to low-cost nutritional and botanical therapies for HIV/AIDS. They distribute a free information packet and run a buyers club. Call 212-689-8140, or write to them at 31 E. 30th St., #2A, New York, NY 10016.

Project Inform- Project Inform is a community-based organization established to provide information about treatment options to people with HIV/AIDS. Project Inform runs a national telephone hotline, staffed by volunteers, to answer questions about HIV/AIDS treatment and publishes a quarterly treatment newsletter called P.I. Perspective. To contact Project Inform, call 800-822-7422; local or international, 415-558-9051.

ACT UP (AIDS Coalition To Unleash Power)- ACT UP is a national organization of AIDS activists. Several local chapters have subcommittees focusing on education and advocacy on alternative medicine issues. Check with your local chapter. Call the CDC National Prevention Information Network for local phone numbers.

ACT UP/New York 212-564-2437 (Treatment and Data Committee).

Printed Materials

Newsletters often contain the most up-to-date information on alternative HIV/AIDS treatments.

Treatment Issues: Gay Men's Health Crisis, Department of Medical Information, 129 W. 20th Street, New York, NY 10011. 212-337-1950.

AIDS Treatment News: ATN, P.O. Box 411256, San Francisco, CA 94141. 800-873-2812.

AIDS Patient Care, a Journal for Health Care Professionals frequently has articles on alternative therapies. AIDS Patient Care, Liebert Enterprises, Inc., 1651 3rd Avenue, New York, NY 10128-3649. 212-289-2300.

For a complete list of HIV/AIDS-related newsletters, call the CDC National Prevention Information Network.

The following fact sheets are available from the Office of Alternative Medicine:

FACT SHEET #1: Frequently Asked Questions FACT SHEET #2: Research Supported by OAM FACT SHEET #3: Classification of Alternative Medicine Categories FACT SHEET #4: Upcoming OAM Events FACT SHEET #5: Shark Cartilage FACT SHEET #6: Biofeedback

Also available:

Functional Description of Office of Alternative Medicine Directory of Alternative Healthcare Associations

This fact sheet has been prepared by the Office of Alternative Medicine of the National Institutes of Health as an introduction to alternative therapies used in the treatment of HIV/AIDS. It is intended to help patients, their families, and health care providers begin to learn about the use of alternative therapies as one aspect of a comprehensive treatment plan. A brief list of additional resources on alternative therapies can be found at the end of this fact sheet. Inclusion of a treatment or resource in this fact sheet does not imply endorsement by any Federal agency.

DISTRIBUTED BY GENA/aegis (714.248.2836). SOURCE: National AIDS Clearinghouse.
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