The following letter was published in Science, 2002 Aug 23;297(5585):1276 in response to Jon Cohen's summary of the 2002 International Conference on AIDS held in Barcelona, Spain.

Science
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Re: Cohen, J. Confronting the Limits of Success, Science, 2002, Jun 28;296(5577):2320-2324.

To Whom It May Concern:

Jon Cohen's article "Confronting the limits of success" (News Focus, 28 June, p. 2320), which discusses the limits of antiretroviral therapy (ARV) in managing HIV disease, overlooks an important area of research. People with access to ARV have been using a variety of interventions, notably dietary supplements as defined by the Food and Drug Administration, to prevent or manage the immediate and delayed side effects of ARV.

Unfortunately, the majority of HIV-infected individuals do not have any access to ARV. The World Health Organization has estimated that nearly 80% of the world's population relies on botanical and other indigenous medicines as their primary source of healthcare (1). Some of these traditional medicines may be helpful in slowing the progression of HIV and are beginning to be investigated.

There is modest research on the use of supplements to counteract drug side effects or modulate immunity and on the use of traditional medicine against HIV, but the scope of this research is limited. One study showed the benefit of glutamine in offsetting diarrhea resulting from protease inhibitor treatment (2). Acetylcarnitine is being assessed at the Royal Free Hospital in London for its effect in managing neuropathy related to nucleoside analog therapy.

However, a great deal more clinical data are needed to evaluate the benefits, risks, and limitations of such interventions. Certain botanicals, multivitamins, and B-complexes have shown some efficacy in slowing HIV progression (37). Could some combination of low-cost and locally available interventions help to delay progression and provide hope as ARV is slowly being introduced to resource-poor areas?

The long-term impact of ARV interventions may not be fully understood, but we certainly understand the outcome of failing to treat people with HIV. The need for methodologically rigorous and ethically sound clinical studies of botanical and dietary supplement interventions must be undertaken immediately and vigorously.

George M. Carter,1* Richard Elion,2 Mark Kuebel, 1 Janet Mindes,3 Devan Nambiar,4 Jane Shull,5 Vince Silenzio,6 Jackie Wootton7

1Foundation for Integrative AIDS Research (FIAR), 62 Sterling Place, Suite 2, Brooklyn, NY 11217, USA. 2George Washington University School of Medicine, Washington, DC, USA. 3CAM Career Development Richard and Hinda Rosenthal Center for Complementary and Alternative Medicine, Columbia University, College of Physicians and Surgeons, New York, NY, USA. 4Gayatra Intergrative Health Consulting, Toronto, Ontario, Canada. 5Philadelphia FIGHT (Field Initiating Group for HIV Trials), Philadelphia, PA, USA. 6Columbia University Center for Family Medicine, New York, NY, USA. 7Alternative Medicine Foundation, Potomac, MD, 20859 USA.
*To whom correspondence should be addressed.


References:
1. World Health Organization, Research Guidelines for Evaluating the Safety and Efficacy of Herbal Medicines (WHO Regional Office for the Western Pacific, Manila, Phillipines, 1993).
2. F. Huffman, M. Walgren, paper presented at the IAS conference on AIDS Pathogenesis, Buenos Aires, Argentina, 6 to 11 July 2001.
3. A. S. Kanter et al., J. AIDS 21, 252 (1999).
4. P. Kelly et al., AIDS 13, 495 (1999).
5. R. D. Semba, A. M. Tang, Br. J. Nutr. 81, 181 (1999).
6. A. M. Tang et al., AIDS 11, 613 (1997).
7. A. M. Tang et al., Am. J. Epidemiol. 138, 937 (1993).

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