Bridging the Gap: Conference Record [Abstract book, International Conference on AIDS (12th: 1998: Geneva, Switzerland)]

850 Abstracts 42254-42383

12th World AIDS Conference

lack of effectiveness (22%) and/or feeling that it was no longer necessary (18%).
Current CT users are more likely to have third-party prescription drug coverage
(95%) compared to non-users (83%). Of the users, 60% spend <$100/month on
CT, while 15% spend >$100/month. Pts HIV+ for >4 years are more likely to use
CT compared to those HIV+ for <4 years (96% vs. 73%). Use of CT is not related
to current viral load, CD4 count, number of current ARV's and current or past use
of protease inhibitors.
Conclusions: The frequency and pattern of CT use has changed since the
advent of new antiretroviral regimens. More patients are taking a greater number
of products now and the primary reason for current CT use is to promote general
health rather than to increase immunity.
42380 Use of alternative therapies to improve quality of life for
people with HIV/AIDS
Anil Purohit17, Deborah Levine3, R. Aranow4, S. Kalla86, M. Morewitz5,
J. Chakraborty2. c/o Judy Suleski, 1Dept. of Physiology & Molecular Medicine,
2Medical College of Ohio, 3035 Arlington Avenue, Toledo, OH; 3Director of
Lifestyles Programming, Thrive, San Francisco; 4Medical Advisory Board,
Immune Enhancement Center, San Francisco; 5San Francisco Department of
Health, Forensic AIDS Project, San Francisco, CA; 6State University of New
York, Syracuse, NY; 7BIDMC, Harvard Medical School, Boston, MA, USA; 8Dept.
of OB/GYN, John Radcliff Hospital, Oxford, UK
Issue: The purpose of this pilot study was to determine patients' perception of
the value of alternative and complementary therapies for treatment of HIV/AIDS.
Project: A 15-item survey was given to patients of a San Francisco clinic
who are HIV positive and engaged in some form of alternative treatment. The
survey included questions about standard antiviral therapies, as well as the type
and nature of alternative therapies available to the patients (including acupuncture, massage, herbs, vegetarian diet). Questions covered patients' qualitative
assessments of improvement in their quality of life after beginning alternative
treatments as well as information about change in T-cell count and side effects of
the alternative treatments.
Results: From this small pilot study, we discovered that people with HIV/AIDS
who are using alternative therapies (such as acupuncture, herbs, massage, vegetarian diet) believe that it does indeed improve the quality of their lives with
minimal side effects. Most patients are working in consort with their physician to
design the most effective individualized programs of treatment. A total of 10 men
and women were surveyed.
Lessons Learned: Patient perception of alternative treatment (including physician support and intensity of side effects) has an influence on the effectiveness of
such therapies. More research is needed with a larger study group to determine
exact effectiveness of various alternative therapies on the quality of life for people
with HIV/AIDS.
S42381 Treatment of HIV infected persons with Chinese herbs:
A randomized, placebo-controlled trial
Rainer Weber1, M. Loy1, L. Christen2, S. Schaller3, S. Christen2, C.R.B. Joyce4,
M.R. Cohen5. Division of Infectious Diseases University Hospital, CH-8091
Zurich; 2Arbeitsgemeinschaft Sozial/Gesundheitsforschung; 3Praxis
Wilfriedstrasse 8, Switzerland; 4Royal College of Surgeons in Ireland, Dublin,
Ireland; 5Quan Yin Healing Arts Center, San Francisco, USA
Objective: To study the effect of a treatment with Chinese herbs on quality of life
and course of HIV infection.
Design: Six month randomized, placebo-controlled, double-blind trial.
Participants: 68 HIV infected adults with CD4 cell counts below or equal
500/mm3, on stable antiretroviral therapy or no antiretroviral treatment, under
medical care of a physician, without intravenous drug use.
Intervention: 4 x 7 pills/day containing either a placebo or a standardized
preparation of 35 Chinese herbs.
Measurements: Symptoms, progression of HIV infection, HIV-1-RNA load,
CD4 lymphocyte counts, quality of life (MOS-questionnaire, SEIQoL examination), coping (SOC), depression (ADS), anxiety (STAI).
Results: The investigators are still blinded. Results of group A and B were
compared. Baseline data of the two groups were equal. A total of 54 men and
14 women were enrolled. Median age was 36 years (range: 26-54). Median
CD4 cell counts were 198 (3-700) and 245 (0-900) per mm3, HIV-1-RNA was
35,612 (171-501,838) and 52'027 (146-2,017,770) copies/ml in group A and
B, respectively. Six and 9 patients had a history of AIDS. 25 and 27 patients,
respectively, had no antiretroviral therapy at study entry. 24 and 29 participants
remained on study drugs until study end, and no toxicities were found. Adherence
to therapy was high. Until study end, HIV-RNA levels remained stable, and CD4
cell counts declined. The number and severity of reported symptoms and quality
of life remained stable over time, and there were no significant differences between groups A and B, as well as between participants and dropouts. During the
study period, 2 patients died. Psychometric testing revealed an overall increase
in depression in both groups. Group A had significantly better coping scores at

all measurements. Dropouts could mainly be attributed to patients who started
antiretroviral treatment.
Conclusions: A placebo-controlled trial of complementary medicine was feasible. The number of participants was lower than expected. Expectations as to
favourable effects of this Chinese herb treatment were not fulfilled. The participants remained fairly stable regarding all variables tested including clinical,
virologic, immunologic, psychometric and quality of life data. The study has to

be interpreted in consideration of historical perspectives because it was planned,
approved and initiated before antiretroviral triple-drug combination was available.
42382 1 Unorthodox treatments for HIV infection: determinants
and impact on recommended therapies and disease
evolution
Roberto Manfredi1 2, F. Chiodo2. 1Dept. of Clinical & Experimental Medicine
University of Bologna; Div. of Infectious Diseases-Sorsola Hospital Via
Massarenti, 11; 2Infectious Diseases-University of Bologna, Italy
Objective: To evaluate the determinants of recourse to unorthodox treatments
(UT) among HIV-infected patients (p), and the consequences of this attitude on
the compliance with recommended drug therapies, and HIV disease progression.
Methods: Data regarding UT (collected by a questionnaire) were related to
clinical charts and prescription of anti-HIV and anti-P. carinii compounds over
a 1-year period. P adopting UT were compared with p complying with usual
regimens.
Results: 184 of 468 evaluable p (39.3%) used at least one (mean 1.6 ~ 0.7)
UT during the last 3 months of follow-up (mean duration of use 6.1 ~ 4.2 months):
high-dose vitamins in 152 p, minerals in 129, special diets in 101, homeopathy in
55, oriental medicine in 51, unapproved medications in 43, and other approaches
(i.e. relaxation or meditation techniques), in 41 p. The use of UT increased significantly according to HIV disease progression: from CDC stage A to B (P <.01; X2 test) and from stage B to C (p <.05), as well as from a CD4+ cell count
>200//L to a cell count < 200/p1L (p <.007), while no relationship was found
with age, gender, type of exposure to HIV infection, and duration of HIV disease.
Antiretroviral therapy and anti-P. carinii prophylaxis (recommended according to
current guidelines), were more frequently refused or taken irregularly by the 184
p using UT, compared with the 284 p who followed conventional treatments: 23
of 165 p requiring anti-HIV therapy, and 14 of 87 p needing P. carinii prophylaxis
refused (or were not compliant with) these measures (p <.005 and p <.04,
compared with all p not using UT). P making an "alternative choice" justified
their attitude since they perceived usual therapies as poorly effective, toxic, and
inadequate for their organism and illness. However, the majority of p using UT
followed them concurrently with antiretrovirals (142 p of 165: 86.1%) and with
anti-P. carinii prophylaxis (73 p of 87: 83.9%). In most p (148 of 184: 80.4%),
UT were suggested by non-physician practitioners specialized in alternative care
(99 p), or were self-provided (49 p), with an estimated mean monthly cost of
35 US$. Even though 148 p of 184 (80.4%) perceived favorable effects on their
cenesthesia and quality of life, during a 1-year follow-up a relevant laboratory
and/or clinical worsening (as expressed by a >15% drop in CD4+ cell count,
and/or a >0.3 Log increase of HIV viral load, and/or the appearance of major or
minor HIV-related clinical disorders) occurred in 86.9% and 92.8% of p failing to
take properly antiretrovirals and P. carinii prophylaxis, respectively.
Conclusions: The use of UT is common in Italy, with a broad spectrum of
different alternative strategies and frequent overlapping with official treatments.
The recourse to UT proves ineffective when compared with the real p's needs,
and seems to parallel the progression of HIV disease, so that a significant relation
is found with a low compliance with approved therapies just in p with advanced
disease (requiring antiretrovirals and anti-P. carinii drugs). Health care providers
should carefully consider the uncontrolled use of unproven therapies for HIV
disease, and their potential consequences.
42383 The recent advanced treatment of AIDS terminal cases by
using Thai-Chinese alternative medicines in Thailand -
the first year study (1997)
Phra Alongkot Tikkapanyo1, S.F. Phousavan1, D. Lail, A. Biggs1,
S. Kaensuwan1, U. Khumnualthong1, S.F. Phounsavan2. 1AIDS Research
Group, Wat Phabathnum Phou T Kao Sam Yot, E. Emphermoung, Roburi,
Thailand; 2Natl. Res. Inst. of Chinese Medicine Taipei, Taiwan, ROC
Objectives: To evaluate the efficacy of Thai-Chinese alternative medicines and
other modern medicines in AIDS terminal patients.
Design: The clinical study of survive rate and other clinical prognosis markers
of AIDS patients with Thai-Chinese alternative medicines in comparison with
other medicines methods (e.g. AZT, DDI,...etc.).
Methods: Two hundred of AIDS terminal patients (CD4 less than 200 with
liver,kidney and lung complex) were chosen to this study. These patients took
part in voluntarily for the therapeutic methods either Thai-Chinese alternative
medicines or other medicines. Both therapeutic methods were applied to treat
these patients for one-year study period, from Jan. 1997 to Dec. 1997. AIDS
terminal patients volunteers (100 patients each group) were observed the survive
rate, weight lost and other clinical prognosis markers during this period.
Results: The survive rate of other modern medicines treatment is 0% that total
100 out of 100 AIDS patients died after the first 3 months study. The survive rate
of Thai-Chinese medicines treatment is 90% that only 10 out of 100 AIDS patients
died during this period and they continue to live after one-year study period.
Seventy out of 90 survive patients showed the improvement of clinical diagnosis

markers (body weight gained, appetite, immunity, and CD4 cells increased) and
live better life at home now.
Conclusion: The treatment of Thai-Chinese alternative medicines has better
survive rate (90%) than other modern medicines treatment (0%) on AIDS terminal
patients after one year period. It also helps the AIDS terminal patients to gain the
chance to live the quality life.