Many herbal medicines contaminated with HIV medicine —Experts

EXPERTS have warned that there is widespread use of herbal medicines by people living with human immunodeficiency virus (PLWH) and contamination of herbal medicines with antiretrovirals in Nigeria.

In a study, experts have found that of the 138 herbal medicines sampled, three (2 per cent) contained detectable levels of three antiretrovirals — tenofovir, emtricitabine and/or lamivudine. Additionally, of the 742 PLWH surveyed, 310 (41.8 per cent) reported herbal medicine use.

Among the users, 191 (61.6 per cent) started taking herbals after commencing HIV therapy while herbal medicine use preceded ARVs treatment in 119 (38.4 per cent) PLWH.

The researchers had collected from all over the country herbal samples sold by street vendors in Nigeria for human immunodeficiency virus (HIV), acquired immune deficiency syndrome, fever and other non-specific symptoms associated with HIV across eight states in Nigeria between December 2014 and June 2015.

The semi-quantitative screen performed at the University of Liverpool had tried to estimate the amounts of nine different ARVs in these herbal samples. It was published in the International Journal of STD & AIDS.

In addition, a survey evaluated the prevalence of herbal medicine use among 742 PLWH aged between two and 91 years attending one rural and three urban HIV clinics in Nigeria, and related this to the time of ARV initiation.

The three urban HIV facilities were Specialist Hospital, Gombe; Faith Alive Foundation Clinic, Jos, and Dalhatu Araf Specialist Hospital, Lafia.  The others were Specialist Hospital Gombe and Rural Hospital, Idong.

These surveyed clinics attend to over 6000 PLWH and the Faith Alive Foundation Clinic in Jos attends to over 5000 PLWH per month, while Rural Hospital, Idong, a primary healthcare setting attends to less than 50 PLWH.

According to the study, PLWH who use herbals did so for a variety of reasons: to cure HIV (46.8 per cent) or following the advice of family (67.4 per cent) or friends (31.6 per cent) but altogether, 40.3 per cent said they felt herbals were ineffective for HIV while 4.5 per cent believed themselves cured.

In addition, the survey reported that ingestion of herbal medications while on ARVs was more likely in the elderly and the employed compared to the unemployed.

While the concentrations of ARVs detected were very low, they declared that there was the possibility that the actual concentrations of ARVs taken along with these herbal medicines was higher given the way many herbal remedies are prepared and degradation observed in these products over time.

Although the amount of drug detected is small, repeated exposure, or exposure to higher doses with different batches or preparations, they said could promote drug resistance.

Furthermore, potential drug-drug interaction of herbals and ARVs as well as safety, they said was difficult to ascertain since constituents of the herbal medicines were unknown.

They declared, “Our finding of contamination of herbals with ARVs is a concern, though concentration was very small and may not be sufficient to drive resistance, finding contamination in herbals is detrimental to treatment and HIV programme success.

“Enforcing the regulation of herbal medicine practices and re-evaluating policies guiding herbal practitioners in Nigeria is urgently required to avoid harmful practices that put the general public at risk.

“Erroneous perception of herbals to relieve HIV symptoms or cure disease is a problem and herbals need to be further evaluated for their medicinal benefits.”

Given that the surveys were only conducted in a small population from northern Nigeria, which may vary from other regions of the country, they stated that a larger study that will ensure fair representation of all the regions of Nigeria is required.

Previously, a Nigerian study reported 27.5 per cent herbal use among PLWH prior to starting ARVs and 4.25 per cent concomitant use with ARVs.

Globally, several studies have reported the use of herbal medicines among PLWH either as part of complimentary medicines or as a component for treating.

But widespread use of herbals among PLWH sabotages the intensified efforts to end the human immunodeficiency virus (HIV) epidemic by 2030. Use of herbal medicines could be associated with toxicities, reduced ARV adherence and poor health outcomes.

Nigeria National HIV/AIDS Indicator and Impact Survey (NAIIS) indicate that over 1.9 million people in Nigeria live with HIV.

Poor access to healthcare, lack of qualified healthcare personnel, healthcare cost, economic status, education and cultural beliefs promote dissatisfaction with health services and use of herbal medicines even while taking ARVs.