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

12th World AIDS Conference

Abstracts 42254-42389 851

S42384 L-carnitine and magnesium (Carnesium ) as a supportive
supplement with antiviral drugs
Henry John Davis', L.J. Mienie2, N. van der Westhuizen3, S. Hicklin3. 1PO Box
35148 Menlopark, 0102 Pretoria; 2Dept. Biochemistry Pu For Che,
Potchefstroom; 3Private Practice, Cape Town, South Africa
Objectives: The effect of low dosages of L-carnitine on the metabolism of AIDS
patients treated with zidovudine and lamivudine.
Design: Pilot study.
Methods: Six patients with AIDS were treated with zidovudine and lamivudine
for at least a month before baseline blood and urine samples were taken for L-carnitine and acylcarnitine profiles. These tests were repeated monthly and were
analyzed with ES-MS-MS. One of these patients were treated with a protease
inhibitor as well. Patients were supplemented with *Carnesium: 5 ml twice daily,
after meals, commencing after taking of baseline bloods. Each 5 ml contained
1500 mg magnesiumchloride, 400 mg L-carnitine, 400 mg L-arginine-HCI and
120 mg glycine.
Results: The urinary L-carnitines showed that the total, free and acetyl carnitine
levels were extremely low (except for one patient) and increased with supplementation. The total bound fraction of the urinary carnitine was unproportionaly
high, due to the presence of an unknown carnitine conjugate, and both increased
after supplementation.
Conclusion: The depletion of L-carnitine could contribute to the clinical symptoms of myalgia and muscle weakness associated with the disease and antiviral
drugs. Low dosages of L-carnitine has a metabolic buffering effect and increases
urinary carnitine values. Follow up studies would determine if the unknown bound
fractions are due to the disease, or antiviral drugs or both.
42385 Effect of unique herbal formulation in Indian HIV patients:
A pilot study
Akala Deshpande', S. Vawdya2. 'Professor & Head, Medicine Dept., GMC &
SIR JJH, Mumbai; 2Research Associate, Medicine Dept, GMC & SIR JJH,
Mumbai, India
Background: There is a growing need to scientifically test alternative remedies
as immunoadjuvants in HIV disease. One such herbal formulation is evaluated in
this pilot study.
Methods: 21 consecutive HIV positive patients were included in an open, label
study. The herbal formulation passed through animal toxicity studies and is metal
and steroid free. The medication was free of side effects and was well tolerated
orally. All patients were evaluated clinically, weight, standard blood chemistry, liver
and renal chemistry. Occurrence of opportunistic infection was carefully noted.
CD4 counts were also done as surrogate marker. Evaluation was done on Day
0, 30, 60, 90 & 180 days. In 10 cases, evaluation also completed at 300 days.
All cases did not lose weight, remained clinically asymptomatic and were free of
liver or renal toxicities. CD4 counts in all cases showed a definate and consistent
improvement.
Conclusion: The preliminary results of this open-label study appears promising
and needs further prospective validation. The medicine is inexpensive, free from
side effects and a promising immunepotentiator and therefore useful in developing
countries.
42386 Comprehensive management of HIV disease - Ayurvedic
approach
Harish Singh, Prakash Bora, S.K. Hira, A.R. Shrinivas. 'ARCON JJ Hospital
Compound Byculla Mumbai 400008; 2MGM Medical College Mumbai; 3The
University of Texas & ARCON Mumbai; 4 Int. Inst. For Population Studies
Mumbai, India
Background: Ayurveda is an original holistic system of medicine whose principles of therapeutics are applicable universally. A model for comprehensive clinical
management was developed based on scientific Ayurvedic approach.
Methods: In view of Ayurvedic principles, guidelines for clinical management
in asymptomatic and symptomatic stage were formulated. Guidelines were designed based on 3 basic components-Nutrition, Change of lifestyle, and Rasayana
therapy. 140 (Asymtomatic-60, ARC-42 AIDS-38) patients willing for alternative
therapy were treated accordingly. Response was monitored on the basis of
different scales. Total no. of person year followed were 105.37.
Results: Therapy was beneficial in terms of subjective as well as objective
improvement. Feeling of well being, reduction in lethargy, increased performance
status was observed in 70% of the patients. Average weight gain of 1.68 k.g.
was observed (1.67kg in asymptomatics, 1.4 k.g. in ARC, 2.01kg. in stage of
AIDS.) Weight gain was observed in 70% of patients. There were 3 deaths out of
140. Disease progression from lower clinical stage to higher stage or death occurred in 20/106 p-y (1.87/100p-y). The annual incidence of death was 3/106 p-y
(2.8/100p-y) as compared with historical mortality rate of 7.3/100p-y in Mumbai.
Conclusion: Ayurvedic therapeutic principles should be evaluated in comprehensive clinical, management of HIV disease. There are indications of physical

well being and lower mortality rate in patients under Ayurvedic therapy. The
therapy has shown potential in terms of improvement in quality of life and weight
gain.

42387 Use and cost of alternative therapies in an HIV-infected
Medicaid population
Dan VoglI, M. Smith', B.D. Rapkin, I. Feldman2, H. Cruz, H. Plavin, D. Jemiolo.
'330 East 59th St. 8th Floor Psychiatry, MSKCC, New York, 2AIDS Institute,
NYS Health Department, Albany, NY US
Background: HIV/AIDS patients often turn to alternative therapies to supplement
physician-prescribed medical care. This study reports patient characteristics associated with use of alternative therapies and analyzes out-of-pocket expenses
for those therapies in a financially poor population.
Methods: 992 HIV-infected adult Medicaid recipients residing in New York
City completed a 50-minute interview as part of the AIDS Institute/HRSA-funded
"HIV/AIDS Client Cohort Study." Questions assessed health-care utilization, satisfaction with care, risk and health status, quality of life, and use of "alternative
therapies (like herbal remedies, homeopathy)".
Results: 289 patients (30%) reported using alternative therapies in the previous
3 months. In a multivariate model, patients with a grade school education were
0.38 times as likely to use alternative therapies as patients with a college education (p <.001); African-Americans were 0.57 times as likely to use alternative
therapies as Latinos, Whites, and others (p <.01); users of crack cocaine were
1.46 times as likely to use alternative therapies as other patients (p <.05); and
patients who perceived themselves as being in good to excellent health were 0.71
times as likely to use alternative therapies as patients with fair to poor perceived
health (p <.05). Most patients who used alternative therapies spent no money
(31%) or less than $100 (45%) on out-of-pocket expenses for those therapies in
the previous 3 months, but 19% spent between $101 and $300, and 5% spent
more than $300.
Conclusions: In this large urban sample of HIV-infected patients on Medicaid,
30% reported using alternative therapies. Patient characteristics associated with
use of alternative therapies included a higher level of education, Latino or White
race, a history of crack cocaine use, and poorer perceived health. Most patients
spent little or no money on alternative therapies.
S42388 Case reports of potential combinaton therapy using
botanical substances, selected on the basis of their
antiviral activity
GeorgeM. Carter', Michael Onstott2, F. Bingham3. 131 East 30th St. Suite 2A
New York, NY; 2National AIDS Nutrient Bank, Gverneville, CA; 3DAAIR, New
York, NY, USA
Issues: Globally, people with HIV use a variety of interventions to treat the disease aside from patentable pharmaceutical drugs. These include micronutrients
(vitamins, amino acids, minerals) and botanical substances (herbs). Small clinical
studies, scattered around the world, suggest that certain herbs have some effect
in slowing progression and/or reducing HIV load.
Project: As individual herbs (like AZT monotherapy) have only a limited antiviral effect, a combination herbal therapy ("CHT") may have a stronger impact. A
protocol, based on efficacy in other studies, was developed including curcumin
(2 capsules tid), bitter melon (5 capsules bid), the licorice root extract glycyrrhizin
(1 capsule tid) and a preparation of freeze-dried leaves of Box (Buxus sempervirens) known as SPV-30 (1 capsule tid). A preliminary review of the DAAIR
database identified several individuals using CHT. Each had obtained baseline
PCR viral load and stabilized antiviral therapy, if any. Data from eight individuals
was reviewed. All had used CHT for approximately eight weeks.
Results: Three of the 8 had viral load reductions from baseline of one log or
greater. Two remained stable or saw less than a one log reduction. Two saw no
benefit (viral load increases). An eighth individual initially saw a greater than one
log reduction over a one month period, however, after the onset of a serious flu,
the viral load climbed dramatically.
Interpretation and Future Plans: These preliminary observational cases suggest antiviral activity from CHT. DAAIR will continue and expand follow up. More
methodologically rigorous studies are needed. It is an indictment of the wellfunded US federal AIDS program that it focuses almost exclusively on patentable
drugs, while utterly ignoring low-tech, less costly interventions such as this and
others used by thousands of people living with HIV/AIDS. This must change.
42389 Preliminary evaluation of a local phytomedicine (NIPRD
94/006/1-2) for the management of HIV/AIDS
Charles Wambebel, Karynius Gamaniel', K. Ibrahim', A. Abimiku2, U. Sule3,
V. Eyo1. 'National Institute for Pharmaceutical Research & Development, PMB
21 Abuja; 3Police Headquarters Kaduna, Nigeria; 2lnst. of Human Virology, Univ.
of Maryland, Baltimore, USA
Issue: drugs currently in use against HIV/AIDS have cumbersome dosage regimen, unbearable and potentially fatal adverse effects, and are generally unaffordable hence the need for cheaper and less toxic alternatives.
Project: The potential value of a herbal product used locally for the treatment
of AIDS patients was investigated. The freeze-dried extract of the crude medicinal

sample was studied. Laboratory animals as well as clinical isolates of Mycobacterium tuberculosis, Candida albicans, Bacillus subtilis, Staphylococcus aureus,
Pseudomonas aeruginosa, Escherichia coli and Mycobacterium smegmatis were
used for the experiments. Acute toxicity (LD5o) was determined. The minimum inhibitory concentration and minimum bactericidal concentration were determined.
Immuno-active studies were carried out using the passive cutaneous anaphylaxis
(PCA) model in rats.