Impact of African herbal medicines on antiretroviral metabolism

Mills, Edward; Foster, Brian; Heeswijk, Rolf van; Phillips, Elizabeth; Wilson, Kumanan; Leonard, Blair; Kosuge, Kazuhiro; Kanfer, Isadore

doi:10.1097/00002030-200501030-00013

Cited by 101 publications

(84 citation statements)

References 2 publications

(6 reference statements)

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“…This was in concordance with a 2013 study by Gwaza et al study on adult volunteers which showed that hypoxis is not associated with clinically significant changes in the pharmacokinetics of the ARV agent, LPV/r pharmacokinetics 18 . This study, however, differs from in-vitro studies by Mills et al in 2005 who demonstrated the potential of hypoxis to increase metabolism of some drugs including ARV due to its significant effects on cytochrome P450 3A4 in-vitro metabolism 16 . Furthermore, a 2014 laboratory study validated the findings of Mills and showed that H. hypoxis, E. purpurea, M. oleifera,T.…”

Section: Discussioncontrasting

confidence: 74%

“…It could be surmised that even greater access to ARV through universal access programs since 2008 and the reduced costs of these treatments would have resulted in a reduced demand for ATM 6 . Furthermore, there was growing evidence of invitro studies which indicated that commonly used South African ATM interacted with ARV 15,16,17 . Reduced ATM use in the current study may also be attributed to efforts by health care professionals in communication the potential for herb-drug interactions (HDI) to patients during pre-counselling sessions.…”

Section: Discussionmentioning

confidence: 99%

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Concurrent use of Antiretroviral and African traditional medicines amongst people living with HIV/AIDS (PLWA) in the eThekwini Metropolitan area of KwaZulu Natal

2017

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Background: People living with HIV/AIDS (PLWA) often use African Traditional Medicines (ATM) either alone or in combination with Western medicines including Antiretrovirals (ARV). Objective: To explore the prevalence of concurrent Antiretrovirals (ARV) and African Traditional medicines (ATM) use and determine the effects of any concurrent use on the CD4+ Lymphocyte count and Viral Load (VL) of PLWA in the eThekwini Metropolitan area. Methods: A descriptive and exploratory study was carried out on 360 patients. Information was gathered on patients socioeconomic characteristics, ATM usage, outcome measures of HIV disease progression (CD4+ Count, VL). The data was analysed using descriptive statistics, univariate and multivariate analyses. Results: 4.98% (14/281) of the patients used ATM and ARV concurrently during the study period. Over 65% (185/281) reported ATM use before diagnosis with HIV whilst 77.6% (218/281) reported previous ATM use after their HIV diagnosis but before initiation with ARV. Place of residence (p=0.004), age (p<0.001) and education level (P=0.041) were found to be significantly and positively correlated with ATM use. There were no statistically significant changes in mean plasma CD4+ Count and inconclusive effects on VL during the period of the study in the group taking ARV alone when compared with the group using ARV and ATM concomitantly. Conclusion: Concurrent ARV and ATM use is quite low (4.98%) when compared to ATM use before HIV diagnosis and after HIV diagnosis but before initiation with ARV. This may point to efficient pre-counselling efforts before ARV initiation by health care professionals. This study also demonstrated that there were no significant differences in the CD4+ and inconclusive effects on VL, between patients taking both ARV and ATM concomitantly and those using ARV alone.

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Section: Discussioncontrasting

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Concurrent use of Antiretroviral and African traditional medicines amongst people living with HIV/AIDS (PLWA) in the eThekwini Metropolitan area of KwaZulu Natal

2017

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“…Despite their popularity in Africa, scientific evidence regarding their therapeutic effectiveness as anti-HIV medications remains poorly documented. Moreover, recent in vitro experiments indicate that both herbs inhibit CYP3A4 activity and activate PXR [52]. This is strikingly similar to St. John's Wort and kava kava.…”

Section: Hypoxis and Sutherlandiamentioning

confidence: 56%

Pregnane X receptor and natural products: beyond drug–drug interactions

Staudinger

Ding

Lichti

2006

Expert Opinion on Drug Metabolism & Toxicology

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The pregnane X receptor (PXR, NR1I2) is a member of the nuclear receptor superfamily that is activated by a myriad of compounds and natural products in clinical use. Activation of PXR represents the basis for several clinically important drug-drug interactions. Although PXR activation has undesirable effects in patients on combination therapy, it also mediates the hepatoprotective effects exhibited by some herbal remedies. This review focuses on PXR activation by natural products and the potential therapeutic opportunities presented. In particular, the biological effects of St. John's Wort, gugulipid, kava kava, Coleus forskolii, Hypoxis, Sutherlandia, qing hao, wu wei zi, gan cao and other natural products are discussed. The impact of these natural products on drug metabolism and hepatoprotection is highlighted in the context of activation and antagonism of PXR.

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“…Interactions of TM with antiretroviral therapy are a major concern as they could lead to treatment failure or significant side effects as a result of drug interactions with antiretroviral treatment regimens. 9,10 Of the TM users, 46% were not sure if they had experienced adverse events and 4% reported a bad reaction with its use. Notably bleeding and jaundice as adverse reactions is of concern in patients undergoing operative procedures.…”

Section: Discussionmentioning

confidence: 99%

“…3 A number of studies have investigated the use of traditional medicine and concerns have been raised about the potential for drug interactions and adverse effects with this medication. 3,[7][8][9][10] Very few studies if any have looked at the use of African TM in a South African patient population booked for elective surgery. The concern in this patient population using TM is potential pharmacokinetic and pharmacodynamic interactions with drugs administered during their perioperative course in addition to physiologic changes affecting healing, for example bleeding.…”

Section: Introductionmentioning

confidence: 99%

Traditional medicine use in surgical patients in a South African tertiary hospital

Nethathe

Matamba

Malumalu

et al. 2016

Southern African Journal of Anaesthesia and Analgesia

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Background: The use of traditional medicine (TM) in South Africa is reportedly high. TM use in a South African surgical population presenting for elective surgery is unknown. Aim: The study aim was to survey the perioperative usage of TM in a South African population presenting for elective surgery at a tertiary hospital. Methods: A prospective, contextual and descriptive study was carried out on adults presenting for elective surgery at a tertiary South African hospital. Results: During a 2 month study period 495 patients were interviewed (97% response rate). The mean age was 46.6 years (SD 14.8) with 34% male and 66% female. Patients underwent orthopaedic (42%), general (32%) and gynaecological (26%) surgery. Fifty per cent of the participants were on chronic medication. Thirty-nine per cent of participants reported past TM use and 7% admitted to current TM use. The most common reason for TM was for cleansing purposes (41%) followed by pain (17%). Seven (4%) participants reported adverse events attributed to TM use with 46% unsure whether an adverse event occurred. Factors associated with current TM use were planned surgical procedure (p-value = 0.009), known positive HIV status (p-value = 0.04), and current arthritic medication use (p-value = 0.002). Conclusion: Perioperative TM use is clinically relevant and should be considered in elective surgical patients. However, TM use in the current survey was found to be lower than that quoted in the literature.

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Impact of African herbal medicines on antiretroviral metabolism

Cited by 101 publications

References 2 publications

Concurrent use of Antiretroviral and African traditional medicines amongst people living with HIV/AIDS (PLWA) in the eThekwini Metropolitan area of KwaZulu Natal

Concurrent use of Antiretroviral and African traditional medicines amongst people living with HIV/AIDS (PLWA) in the eThekwini Metropolitan area of KwaZulu Natal

Pregnane X receptor and natural products: beyond drug–drug interactions

Traditional medicine use in surgical patients in a South African tertiary hospital

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