Consumption of Sutherlandia frutescens by HIV-Seropositive South African Adults: An Adaptive Double-Blind Randomized Placebo Controlled Trial

Abstract

Background Sutherlandia frutescens (L.) R. Br. is widely used as an over the counter complementary medicine and in traditional medications by HIV seropositive adults living in South Africa; however the plant’s safety has not been objectively studied. An adaptive two-stage randomized double-blind placebo controlled study was used to evaluate the safety of consuming dried S. frutescens by HIV seropositive adults with CD4 T-lymphocyte count of >350 cells/μL.MethodsIn Stage 1 56 participants were randomized to S. frutescens 400, 800 or 1,200 mg twice daily or matching placebo for 24 weeks. In Stage 2 77 additional participants were randomized to either 1,200 mg S. frutescens or placebo. In the final analysis data from Stage 1 and Stage 2 were combined such that 107 participants were analysed (54 in the S. frutescens 1,200 mg arm and 53 in the placebo arm).Results S. frutescens did not change HIV viral load, and CD4 T-lymphocyte count was similar in the two arms at 24 weeks; however, mean and total burden of infection (BOI; defined as days of infection-related events in each participant) was greater in the S. frutescens arm: mean (SD) 5.0 (5.5) vs. 9.0 (12.7) days (p = 0.045), attributed to two tuberculosis cases in subjects taking isoniazid preventive therapy (IPT).ConclusionA possible interaction between S. frutescens and IPT needs further evaluation, and may presage antagonistic interactions with other herbs having similar biochemical (antioxidant) properties. No other safety issues relating to consumption of S. frutescens in this cohort were identified.Trial RegistrationClinicalTrials.gov NCT00549523

Antiviral potential of medicinal plants against HIV, HSV, influenza, hepatitis, and coxsackievirus: A systematic review

“…Due to the high prevalence of AIDS and drug‐resistant strains, the demand for new antiviral drugs against AIDS is rising. Various medicinal plants are used in the treatment of AIDS such as Withania somnifera (Williams‐Orlando, ), Tinospora cordifolia (Husain et al, ), Moringa oleifera (Monera‐Penduka et al, ), Hypericum perforatum (Béjaoui et al, ), Silybum marianum (Lovelace et al, ), Allium sativum (Maroyi, ), Panax ginseng (Cho & Kim, ), Lobostemon trigonus (Koffuor et al, ), Emblica officinalis (Bhagat, ), Curcuma longa (Kim et al, ), Hypoxis hemerocallidea (Jegede, Offor, Onanuga, Naidu, & Azu, ), and Sutherlandia frutescens (Wilson et al, ). Herbal medicines are used for the treatment of viral infections since ancient times.…”

“…Its pharmacological activity is adaptogenic (Cicero et al, 2004). Glatthaar, Sacher, and Esperester (2001) Silybum marianum (Lovelace et al, 2017), Allium sativum (Maroyi, 2014), Panax ginseng (Cho & Kim, 2017), Lobostemon trigonus (Koffuor et al, 2014), Emblica officinalis (Bhagat, 2014), Curcuma longa (Kim et al, 2014), Hypoxis hemerocallidea (Jegede, Offor, Onanuga, Naidu, & Azu, 2017), and Sutherlandia frutescens (Wilson et al, 2015). Herbal medicines are used for the treatment of viral infections since ancient times.…”

The Potential for Climate Impacts from Widespread Deployment of Utility-Scale Solar Energy Installations: An Environmental Remote Sensing Perspective

“…Randomized placebo-controlled clinical trials have been conducted to assess its safety and efficacy in HIV patients [2,3] with preparations underway for another upcoming clinical study. While a variety of formulations from this plant are commercially available and thus can be used for the clinical trial, very little is known regarding their quality and stability profiles, as well as the content of actives in such formulations.…”

Does Concurrent Use of Some Botanicals Interfere with Treatment of Tuberculosis?

“…While there are claims that some botanicals may interfere with TB infection/activation or accentuate proven treatments, a recent placebo-controlled randomized clinical trial (RCT)(Wilson, Goggin et al 2015) of Sutherlandia, a botanical widely used in southern Africa for treatment of symptoms of HIV and TB (van Wyk and Albrecht 2008; Davids, Blouws et al 2014; Sutherlandia.org 2016) has provided unsettling evidence for interference with isoniazid preventive therapy (IPT), a first line regimen used worldwide for prevention and treatment of TB. (WHO 2015) In this RCT, the mean and total burden of infection (BoI; defined as infection-related events in each participant) increased in the Sutherlandia (active) arm, where two cases of active pulmonary TB occurred in subjects, despite their receiving IPT(Wilson, Goggin et al 2015).…”

“…(WHO 2015) In this RCT, the mean and total burden of infection (BoI; defined as infection-related events in each participant) increased in the Sutherlandia (active) arm, where two cases of active pulmonary TB occurred in subjects, despite their receiving IPT(Wilson, Goggin et al 2015). Additional research is critically needed to determine whether Sutherlandia and other botanicals interfere with isoniazid activation in treatment of pulmonary TB and of central nervous system (CNS) TB.…”