UCLA and RAND researchers found that half of HIV-infected Americans use alternative medicine to supplement or replace antiretroviral drugs. One-quarter of HIV-positive patients choose alternative medicine that could interact with conventional therapy, yet do not inform their physicians. Reported in the June 19 edition of the Journal of AIDS, the findings emphasize the need for doctors to openly discuss alternative medicine practices with their patients.
"Antiretroviral drugs can help people with AIDS enjoy longer and healthier lives, but these medicines are expensive, can be hard to take and some may cause serious side effects," said Dr. An-Fu Hsiao, an internist and health services researcher at the David Geffen School of Medicine at UCLA
"Alternative medicine can ease antiretroviral drugs' side effects, but also create its own set of problems," he said. "Our findings illustrate why it's essential for doctors to discuss alternative medicine use with their patients."
The UCLA/RAND team reviewed data collected in person and by phone from a follow-up survey of 2,466 HIV-positive adults who participated in the HIV Cost and Services Utilization Study (HCSUS). This study surveyed a nationally representative group of 2,864 patients who received care for HIV disease at a U.S. inpatient or outpatient facility in 1996.
The HCSUS study asked participants (1) whether they used alternative medicine, (2) if they used it instead of or in addition to antiretroviral drug therapy and (3) whether they had discussed their alternative medicine use with their doctor.
Hsiao's team concentrated on forms of alternative medicine with the potential for harmful results. These methods included megavitamin doses, homeopathy and the unlicensed use of prescription drugs not designed to treat AIDS.
The UCLA/RAND team also focused on herbal medicine, which can react harmfully with antiretroviral drugs.
"Many HIV patients don't realize that the herb St. John's wort reduces the level of the antiretroviral drug Indinivar," Hsiao said. "This could result in therapeutic failure and the development of drug resistance."
Antiretroviral drugs and some methods of alternative medicine can produce similar side effects, so patients taking both therapies often wrongly blame the side effects on the drugs. If patients do not tell their doctor that they are using a form of alternative medicine, the physician may unnecessarily alter the patients' drug regimen. This also increases the patients' risk of treatment failure and drug resistance.
The UCLA/RAND study discovered the following:
- Fifty-three percent of the study participants used some form of alternative medicine -- compared to an average usage rate of 40 percent in the general population found in other studies.
- Twenty-six percent did not discuss their alternative medicine use with their doctors.
- Twenty-six percent used potentially harmful alternative medicine methods. Fifteen percent used herbs and 13 percent took megavitamin doses. One-third of these patients did not inform their medical providers of their use.
- Three percent substituted alternative medicine for antiretroviral therapy, of whom more than half did not discuss this with their physicians.
- People who strongly desired to be involved in the medical decision-making for their HIV treatment were more likely to use alternative medicine and to substitute it for antiretroviral therapy.
- Persons who believed that the risks of antiretroviral therapy were "definitely not worth taking" were eight times more likely to substitute alternative medicine for antiretrovirals.
"This is a wake-up call for physicians to ask their patients about alternative medicine use," Hsiao said. "Twenty-six percent of these HIV patients used a form of alternative medicine that could adversely interact with conventional treatment. Yet one-third of their doctors had no idea."
"Physicians can't predict which patients will use alternative medicine," he said. "Doctors need to learn to bring up the subject and to listen to their patients in a nonjudgmental manner."
Hsiao's co-authors included Dr. Martin Shapiro, Dr. Neil Wenger, Dr. Mitchell Wong, Dr. Honghu Liu and Dr. Ronald Anderson from UCLA; Dr. David Kanouse and Dr. Rebecca Collins from RAND, Santa Monica; Dr. Allen McCutchan from UCSD; and Dr. Allen Gifford and Dr. Sam Bozzette from the San Diego Veterans Affairs Healthcare System and RAND.
Major funding for HCSUS was provided by the federal Agency for Healthcare Research and Quality. The study also was supported by the U.S. Department of Health and Human Services, and by other organizations. The study was conducted by RAND in conjunction with a consortium of private and public research institutions.