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HIV and pregnancy

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Related Terms
  • Acquired immune deficiency syndrome, acquired immunodeficiency syndrome, AIDS, antiretroviral therapy, antiretrovirals, ART, breast milk, CD4 cells, CD8 cells, cesarean section, compromised immune system, C-section, HAART, highly active antiretroviral therapy, HIV, HIV test, human immunodeficiency syndrome, immune, immune defense system, immune system, immunocompromised, immunodeficiency, infection, OI, opportunistic infection, perinatal HIV testing, reverse transcriptase inhibitors, transmission, viral infection, vertical transmission, virus, weakened immune system.

Background
  • The human immunodeficiency virus, also known as HIV, is a virus that causes AIDS (acquired immune deficiency syndrome). The incurable virus attacks the body's immune system, making the body extremely vulnerable to opportunistic infections (infections that occur in patients who have weakened immune systems).
  • HIV is transmitted from person to person via bodily fluids, including blood, semen, vaginal discharge, and breast milk.
  • Mother-to-child transmission (MTCT), also known as vertical transmission, occurs when an HIV-positive woman passes the virus to her baby. This can occur during pregnancy, labor, delivery or breastfeeding. Without preventative antiretroviral treatment, about 15-30% of babies born to HIV-positive women will become infected with HIV during pregnancy or delivery. An additional 5-20% will become infected through breastfeeding.
  • According to the Joint United Nations Programme on HIV/AIDS (UNAIDS), about 700,000 children younger than 15 years old became infected with HIV, mainly through MTCT in 2005. About 90% of these MTCT infections occurred in Africa. This is because of the high prevalence of HIV infection, lack of HIV screening, and poor access to obstetricians/gynecologists and antiretroviral therapy.
  • In high-income countries, including the United States, MTCT has been practically eliminated with the use of voluntary HIV testing and counseling, access to antiretroviral therapy, safe delivery practices and the widespread availability, and safe use of baby formulas. In fact, perinatal (shortly before or after birth) HIV infection rates can drop to as low as one to two percent for babies if their mothers take combination antiretroviral therapy during pregnancy, as well as zidovudine (AZT) or nevirapine preventative therapy during labor and after birth. While a cesarean section (surgical delivery of a baby), also called a C-section, can reduce the risk of transmission during birth, it is not typically necessary in patients who undergo antiretroviral therapy.
  • According to several studies, HIV-positive women who become pregnant do not become sicker than HIV-positive women who do not become pregnant.
  • While pregnancy itself is not considered dangerous to an HIV-infected woman, short-term antiretroviral monotherapy (taking a single antiretroviral drug) to prevent transmission to the newborn can be. This is because the mother has a higher risk of becoming resistant to treatment. When this happens, the medication does not effectively suppress the virus. Once a patient is resistant to a drug, the patient can no longer take the drug in the future because it is ineffective.
  • Therefore, combination antiretroviral therapies are the standard treatment for HIV-infected pregnant women. When drugs are combined, different stages of HIV's replication are suppresses because each drug works differently. Combination antiretroviral therapy has proven to be a more effective practice than monotherapy. However, if the pregnant woman only takes medications during labor and delivery, she is also at risk of becoming resistant to the drug.
  • Patients typically do not begin antiretroviral therapy until after the first trimester. This is because the risk of birth defects caused by antiretroviral medication is greatest during the first three months of pregnancy. However, if the HIV-infected mother chooses to discontinue taking some medications during pregnancy or does not adhere to the specific drug regimen prescribed, the HIV infection could worsen. Patients should always discuss the potential health benefits and risks of treatment options with their healthcare providers.
  • According to one cohort study, HIV-infected pregnant women are more likely to adhere to antiretroviral therapy than non-pregnant HIV-infected women. Researchers measured adherence by pill counting and self-reporting. 43.1% of pregnant women adhered to treatment, according to pill counting requirements, compared with 17.7% of non-pregnant women.

Author information
  • This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography
  1. AIDS InfoNet. Pregnancy and HIV. Fact Sheet 611. April 5, 2006. . Accessed May 14, 2009.
  2. AVERTing HIV and AIDS. Preventing Mother-To-Child Transmission of HIV. . Accessed May 14, 2009.
  3. Centers for Disease Control and Prevention. . Accessed May 14, 2009.
  4. Lopez-Cortes LF, Ruiz-Valderas R, Rivero A, et al. Efficacy of Low-Dose Boosted Saquinavir Once Daily Plus Nucleoside Reverse Transcriptase Inhibitors in Pregnant HIV-1-Infected Women With a Therapeutic Drug Monitoring Strategy. Ther Drug Monit. 2007 Apr;29(2):171-176. .
  5. National Institute of Allergy and Infectious Diseases. . Accessed May 14, 2009.
  6. Natural Standard: The Authority on Integrative Medicine. . Copyright © 2009. Accessed May 14, 2009.
  7. Rigopoulos D, Gregoriou S, Paparizos V, et al. AIDS in pregnancy, part II: Treatment in the era of highly active antiretroviral therapy and management of obstetric, anesthetic, and pediatric issues. Skinmed. 2007 Mar-Apr;6(2):79-84. .
  8. Rupali P, Condon R, Roberts S, et al. Prevention of mother to child transmission of HIV infection in Pacific countries. Intern Med J. 2007 Apr;37(4):216-23. .
  9. U.S. Department of Health and Human Services. AIDSinfo. . Accessed May 14, 2009.
  10. Vaz MJ, Barros SM, Palacios R, et al. HIV-infected pregnant women have greater adherence with antiretroviral drugs than non-pregnant women. Int J STD AIDS. 2007 Jan;18(1):28-32. .

Causes
  • HIV is transmitted from person to person via bodily fluids, including blood, semen, vaginal discharge, and breast milk. An HIV-infected woman can pass the virus to her baby during pregnancy, labor, delivery, or breastfeeding.
  • The higher the viral loads (level of HIV in the blood), the more likely the mother will infect her baby. HIV patients who are otherwise healthy and receiving antiretroviral therapy (ART) usually have about 200-500 copies per milliliter of blood. A high viral load can be anywhere from 5,000 to one million or more copies. A high viral load indicates that HIV is replicating and the disease will most likely progress quicker than if the viral load is low. However, no viral load is low enough to completely eliminate the risk of transmission. Even if the viral load is undetectable, the virus may still be transmitted.
  • While transmission of infection from mother to baby may occur at any time, it usually happens just before or during delivery, when the baby is exposed to the mother's blood and vaginal secretions. If the vaginal delivery is prolonged, the baby is more likely to become infected because the newborn is exposed to these fluids for a longer period of time.

Symptoms
  • General: Symptoms of HIV are the same for pregnant women as the rest of the HIV-infected population.
  • Initial infection: Many patients experience no symptoms when they first become infected with HIV. After one or two months, it is common for individuals to experience flu-like symptoms including headache, fever, fatigue, and enlarged lymph nodes. Infants who become infected during birth may also experience delayed physical development, as well as intermittent diarrhea. These symptoms usually subside after one week to one month, and they are often mistaken for another viral infection. Despite having minimal or no symptoms during this stage, individuals are very infectious and the virus is present in large quantities in bodily fluids including blood, semen, vaginal discharge, and breast milk.
  • Clinical latency: During the next stage, known as clinical latency, more serious symptoms develop. Once infected with HIV, it may take 10 or more years for more severe symptoms to appear in adults or up to two years in children who are born with HIV infection.
  • As the immune system continues to weaken, many symptoms appear, including swollen lymph nodes that may be enlarged for long periods of time. Other symptoms often experienced months to years before the onset of AIDS (acquired immune deficiency syndrome) include fatigue, weight loss, frequent fevers and sweats, persistent or frequent yeast infections (of the mouth or vagina), skin rashes, flaky skin, pelvic inflammatory disease (PID) in women and short-term memory loss.
  • In addition, patients have an increased risk developing shingles (painful nerve disease) or frequent and severe herpes infections that cause sores on the mouth, genitalia, or anus. Infected children may grow slowly or be sick often.
  • AIDS: Patients progress to AIDS (acquired immune deficiency syndrome) when their CD4 cell (immune cells that HIV infects and destroys) counts drops below 200 cells per microliter of blood. Healthy individuals have a CD4 cell count between 600 and 1,200 cells per microliter of blood. Some individuals will develop AIDS when they become infected with an AIDS-defining illness like Pneumocystis jiroveci pneumonia (formerly called Pneumocystis carinii or PCP).
  • The first symptoms of AIDS often include moderate and unexplained weight loss, recurring lung infections, and ulcers in the mouth. During this stage, the patient is most vulnerable to developing opportunistic infections and tumors like Mycobacterium tuberculosis,thrush, herpes viruses, cytomegalovirus (CMV), shingles, Epstein-Barr virus, Kaposi's sarcoma (type of cancer), and pneumonia.

Diagnosis
  • Mothers: Since HIV-infected mothers can pass the virus to their baby during pregnancy, labor, delivery, or breastfeeding, the U.S. Centers for Disease Control and Prevention (CDC) recommends that all pregnant women get tested for HIV. The most common HIV tests use blood to detect HIV infection. In most cases the enzyme immunoassay (EIA), used on blood drawn from a vein, is used to look for antibodies to HIV. These antibodies, which are present in the blood, are created to help the body detect and fight off the virus. If HIV antibodies are present in the blood, the patient has HIV, and will receive a positive test result. This initial test must be followed-up with a confirmatory test like the Western blot to make a positive diagnosis. During a western blot test, a small sample of blood is taken, and it is used to detect HIV antibodies, not the HIV virus itself.
  • Alternatively, a rapid test may be conducted. A rapid test produces results in about 20 minutes. Rapid tests use a sample of blood or oral fluid (fluid taken from the patient's gums) to detect HIV antibodies. The patient's sample is placed on a test strip that contains HIV antigens. If the patient has developed HIV antibodies, the strip changes colors, indicating a seropositive result. A positive HIV test should be confirmed with a follow-up confirmatory test before a final diagnosis of infection can be made. These tests have similar accuracy rates as traditional ELISA screening tests.
  • Babies: In the United States, it is recommended that all babies born to HIV-positive mothers be tested for the virus. However, different states have different testing guidelines. Some states, like New York and Connecticut, require that babies receive a mandatory HIV test if the HIV status of their mother is unknown. Some states require that all babies be tested for HIV unless the mother refuses. Other states only require healthcare facilities to offer an HIV test to pregnant women (not their babies), which they can either accept or refuse.
  • Prenatal tests before birth, including amniocentesis and chorionic villus sampling, should not be conducted because there is a slight risk of bleeding, which may increase the risk of transmitting the infection.
  • HIV infection is generally difficult to diagnose in newborns and infants. Babies born to infected mothers have HIV antibodies that they received from their mothers before birth. These antibodies may be present in the blood for up to 18 months. Therefore, a standard HIV antibody test is not useful in these babies until they reach this age.
  • Instead, tests that detect the HIV itself are performed in newborns. One laboratory procedure, known as polymerase chain reaction (PCR), can detect minute quantities of the virus in an infant's blood. Alternatively, an HIV virus culture can be performed. During the procedure, a sample of an infant's blood is placed on a Petri dish in a controlled environment that allows the virus to grow.
  • Currently, PCR assays and HIV cultures can effectively diagnose about one-third of infants at birth who ultimately prove to be HIV-infected. This is because the infant is newly infected, and there may not be enough viral particles to detect HIV. These techniques are more effective (about 90% effective) when they are performed in infants two months of age, and about 95% effective in patients three months of age.

Integrative therapies
  • Note: Currently, there is insufficient available evidence on the safety and effectiveness of integrative therapies for the treatment or prevention of HIV infection in pregnant women specifically. Integrative therapies should not replace conventional medicine when an individual is diagnosed with HIV.
  • Unclear or conflicting scientific evidence:
  • Aloe vera: Clear gel from the pulp of Aloe vera leaves has been used on the skin for thousands of years to treat wounds, skin infections, minor burns, and other skin conditions. Although aloe has been suggested as a possible treatment for HIV infection, further research is needed before a firm conclusion can be made.
  • Avoid if allergic to aloe or other plants of the Liliaceae family (garlic, onions, and tulips). Avoid injecting aloe. Do not apply to open skin, surgical wounds, or pressure ulcers. Avoid taking by mouth with diarrhea, bowel blockage, intestinal diseases, bloody stools, or hepatitis. Avoid with a history of irregular heartbeat (arrhythmia), electrolyte imbalances, diabetes, heart disease, or kidney disease. Avoid taking by mouth if pregnant or breastfeeding unless otherwise recommended by the patient's licensed healthcare provider.
  • Alizarin: Limited available evidence suggests that alizarin may be of benefit in the treatment of viral infections. Additional research is needed in this area.
  • Avoid if allergic or hypersensitive to alizarin or any plants in the Rubiaceae family. Alizarin may be toxic and should not be handled for long periods of time, rubbed in the eyes, or eaten. Avoid if pregnant or breastfeeding unless otherwise recommended by the patient's licensed healthcare provider.
  • Antineoplastons: Antineoplastons are substances found in human blood and urine. Preliminary study reported increased energy and weight in patients with HIV who were treated with antineoplaston AS2-1, as well as a decreased number of opportunistic infections and increased CD4 cell counts. However, this evidence cannot be considered conclusive. Currently, there are drug therapy regimens available for HIV with clearly demonstrated effects (highly active anti-retroviral therapy), and patients with HIV are recommended to consult with their physicians about treatment options.
  • Avoid if allergic or hypersensitive to antineoplastons. Use cautiously with high medical or psychiatric risk. Use cautiously with an active infection due to a possible decrease in white blood cells. Use cautiously with high blood pressure, heart conditions, chronic obstructive pulmonary disease, liver disease/damage, or kidney disease/damage. Avoid if pregnant or breastfeeding unless otherwise recommended by the patient's licensed healthcare provider.
  • Astragalus: Antiviral effects have been reported in early studies for HIV. Additional research is warranted.
  • Avoid if allergic to astragalus, peas, or any related plants or with a history of Quillaja bark-induced asthma. Avoid with aspirin or aspirin products or herbs or supplements with similar effects. Avoid with inflammation (swelling) or fever, stroke, transplant or autoimmune diseases (like HIV/AIDS). Stop use two weeks before surgery/dental/diagnostic procedures with a risk of bleeding and avoid use immediately after these procedures. Use cautiously with bleeding disorders, diabetes, high blood pressure, lipid disorders or kidney disorders. Use cautiously with blood-thinners, blood sugar drugs, or diuretics or herbs and supplements with similar effects. Avoid if pregnant or breastfeeding unless otherwise recommended by the patient's licensed healthcare provider.
  • Beta sitosterol: Beta-sitosterol is found in plant-based foods, such as fruits, vegetables, soybeans, breads, peanuts, and peanut products. It is also found in bourbon and oils (such as olive oil, flaxseed, and tuna). Due to data that suggest immune modulating effects of beta-sitosterol and beta-sitosterol glucoside, these sterols have been studied in combination in the treatment of HIV. Larger populations of patients with HIV should be evaluated in randomized controlled trials to draw any conclusions.
  • Avoid if allergic or hypersensitive to beta-sitosterol, beta-sitosterol glucoside, or pine. Use cautiously with asthma or breathing disorders, diabetes, primary biliary cirrhosis (destruction of the small bile duct in the liver), ileostomy, neurodegenerative disorders (like Parkinson's disease or Alzheimer's disease), diverticular disease (bulging of the colon), short bowel syndrome, celiac disease, and sitosterolemia. Use cautiously with a history of gallstones. Avoid if pregnant or breastfeeding unless otherwise recommended by the patient's licensed healthcare provider.
  • Bitter melon: Laboratory studies have shown that a protein in bitter melon called MAP30 may have antiviral activity against HIV. However, this has not been studied in humans. Further research is needed before a firm conclusion can be made.
  • Avoid if allergic to bitter melon or members of the Curcurbitaceae (gourd or melon) family. Avoid ingesting bitter melon seeds. Avoid with glucose-6-phosphate dehydrogenase deficiency. Use cautiously with diabetes, glucose intolerance, or with hypoglycemic agents due to the risk of hypoglycemia (low blood sugar). Avoid if pregnant or breastfeeding unless otherwise recommended by the patient's licensed healthcare provider.
  • Blessed thistle: Laboratory studies report no activity of blessed thistle against herpes viruses, influenza, or poliovirus. Effects of blessed thistle (or chemicals in blessed thistle called lignans) against HIV are not clear. Human research of blessed thistle as a treatment for viral infections is lacking.
  • Blessed thistle is generally considered to be safe when taken by mouth in recommended doses for short periods of time, with few reported side effects such as birth defects, bleeding, breathing problems, bruising, cancer of the nose or throat, increased production of stomach acid, itching, kidney disease, liver toxicity, skin rash, stomach discomfort, stomach ulcers, and vomiting. Allergic reactions to blessed thistle including rash may occur, as well as cross-sensitivity to mugwort and Echinacea. Cross-reactivity may also occur with bitter weed, blanket flower, Chrysanthemum, coltsfoot, daisy, dandelion, dwarf sunflower, goldenrod, marigold, prairie sage, ragweed or other plants in the Asteraceae/Compositae family. Avoid if pregnant or breastfeeding unless otherwise recommended by the patient's licensed healthcare provider.
  • Boxwood: Trials have been conducted for SPV30 (extract of boxwood, Arkopharma, France) to evaluate its potential effectiveness for HIV/AIDS. Rigorous clinical study is needed to confirm these early study results.
  • Avoid if allergic or hypersensitive to boxwood, its constituents, or any plants in the Buxaceae family. Use cautiously with HIV or AIDS. Avoid if pregnant or breastfeeding unless otherwise recommended by the patient's licensed healthcare provider.
  • Carrageenan: Carrageenan-based gels may reduce HIV transmission during sexual intercourse and have been investigated for safety and acceptability in published studies involving healthy females. Overall, studies suggest that carrageenan is not associated with abnormal genital clinical findings or severe side effects, and is considered acceptable for use by females and their male partners. Additional research is needed to better determine the role of carrageenan for HIV infection prevention.
  • Use oral carrageenan cautiously in infants. Use cautiously in patients with, or at risk for, cancer. Use cautiously in patients treated with azoxymethane or nitrosomethylurea. Use cautiously in patients with gastrointestinal, immune, inflammatory, or bleeding disorders, or in patients with low blood pressure or diabetes. Use cautiously intravaginally. Use cautiously in patients using antilipemic agents. Use cautiously in combination with any oral medication, as the fiber in carrageenan may impair the absorption of oral medications.
  • Chiropractic: Chiropractic care focuses on how the relationship between musculoskeletal structure (mainly the spine) and bodily function (mainly nervous system) affects health. There is currently not enough reliable scientific evidence to conclude the effects of chiropractic techniques on CD4 cell count or quality of life in patients with HIV/AIDS.
  • Use extra caution during cervical adjustments. Use cautiously with acute arthritis, conditions that cause decreased bone mineralization, brittle bone disease, bone softening conditions, bleeding disorders or migraines. Use cautiously with the risk of tumors or cancers. Avoid with symptoms of vertebrobasilar vascular insufficiency, aneurysms, unstable spondylolisthesis, or arthritis. Avoid with agents that increase the risk of bleeding. Avoid in areas of para-spinal tissue after surgery. Avoid if pregnant or breastfeeding due to a lack of scientific data unless otherwise recommended by the patient's licensed healthcare provider.
  • Coenzyme Q10: Coenzyme Q10 (CoQ10) is produced by the body and it is necessary for basic functioning of cells. CoQ10 levels decrease with age. There is limited evidence that natural levels of CoQ10 in the body may be reduced in people with HIV/AIDS. Reliable scientific research showing that CoQ10 supplements have any effect on this disease is currently lacking.
  • There are currently no documented cases of allergy associated with Coenzyme Q10 supplements, although rash and itching have rarely been reported. Stop use two weeks before surgery/dental/diagnostic procedures with bleeding risk and do not use immediately after these procedures. Use cautiously with history of blood clots, diabetes, high blood pressure, heart attack, or stroke. Use cautiously with anticoagulants (blood thinners), antiplatelet drugs, blood pressure drugs, blood sugar drugs, cholesterol drugs, or thyroid drugs. Avoid if pregnant or breastfeeding unless otherwise recommended by the patient's licensed healthcare provider.
  • Cranberry: Limited laboratory research has examined the antiviral activity of cranberry. Further research is warranted in this area.
  • Avoid if allergic to cranberries, blueberries, or other plants of the Vaccinium species. Sweetened cranberry juice may affect blood sugar levels. Use cautiously with a history of kidney stones. Pregnant and breastfeeding women should avoid cranberry in higher amounts than what is typically found in foods.
  • DHEA: DHEA (dehydroepiandrosterone) is a hormone that is secreted by the adrenal glands. Although some studies suggest that DHEA supplementation may be beneficial in patents with HIV, results from different studies do not agree with each other. There is currently not enough scientific evidence to recommend DHEA for AIDS, and other therapies are more proven in this area.
  • Avoid if allergic to DHEA. Avoid with a history of seizures. Use cautiously with adrenal or thyroid disorders. Use cautiously if taking anticoagulants, or drugs, herbs, or supplements for diabetes, heart disease, seizures, or stroke. Stop use two weeks before surgery/dental/diagnostic procedures with bleeding risk, and do not use immediately after these procedures. Avoid if pregnant or breastfeeding unless otherwise recommended by the patient's licensed healthcare provider.
  • Flaxseed and flaxseed oil: Flaxseed and flaxseed oil/linseed oil are rich sources of the essential fatty acid, alpha-linolenic acid (omega-6). While flaxseed has been used to treat HIV/AIDS, no strong evidence supports its use and no recommendation can be made without further research.
  • Flaxseed has been well tolerated in studies for up to four months. Avoid if allergic to flaxseed, flaxseed oil, or other plants of the Linaceae family. Avoid with prostrate cancer, breast cancer, uterine cancer, or endometriosis. Avoid ingestion of immature flaxseed pods. Avoid large amounts of flaxseed by mouth and mix plenty of water or liquid. Avoid flaxseed (not flaxseed oil) with history of esophageal stricture, ileus, gastrointestinal stricture, or bowel obstruction. Avoid with history of acute or chronic diarrhea, irritable bowel syndrome (IBS), diverticulitis (inflammation of the diverticula, small sacs in the intestine's inner lining), or inflammatory bowel disease (IBD). Avoid topical flaxseed in open wounds or abraded skin surfaces. Use cautiously with history of a bleeding disorder or with drugs that increase the risk of bleeding (such as anticoagulants and non-steroidal anti-inflammatories). Use cautiously with high triglyceride levels, diabetes, mania, seizures, or asthma. Avoid if pregnant or breastfeeding unless otherwise recommended by the patient's licensed healthcare provider.
  • Green tea: Green tea is made from the dried leaves of Camellia sinensis, a perennial evergreen shrub. Green tea has a long history of use, dating back to China approximately 5,000 years ago. Green tea, black tea, and oolong tea are all derived from the same plant. Preliminary research suggests that green tea may decrease viral load in carriers of the human T-cell lymphocytic virus. Additional well-designed controlled research is needed before a conclusion can be made.
  • Avoid if allergic or hypersensitive to caffeine or tannins. Use cautiously with diabetes or liver disease.
  • Healing Touch: Healing touch (HT) is a combination of hands-on and off-body techniques that influence the flow of energy through a person's biofield. Data from small preliminary studies are insufficient to support any recommendations for or against use of HT in HIV/AIDS patients. Studies of better design are needed before any conclusions can be reached.
  • HT should not be regarded as a substitute for established medical treatments. Use cautiously if pregnant or breastfeeding.
  • L-carnitine: L-carnitine may be beneficial in AIDS treatment by increasing proliferation of mononuclear cells and increasing CD4 counts. Additional study is needed to make a firm recommendation.
  • Avoid if allergic or hypersensitive to carnitine. Use cautiously with peripheral vascular disease, high blood pressure, alcohol-induced liver cirrhosis, and diabetes. Use cautiously in low birth weight infants and individuals on hemodialysis. Use cautiously if taking anticoagulants (blood thinners), beta-blockers, or calcium channel blockers. Avoid if pregnant or breastfeeding unless otherwise recommended by the patient's licensed healthcare provider.
  • Licorice: Early studies suggest that glycyrrhizin may inhibit HIV replication in patients with AIDS. However, human reports are lacking. Additional study is needed to make a conclusion.
  • Avoid with a known allergy to licorice, any component of licorice, or any member of the Fabaceae (Leguminosae) plant family. Avoid with congestive heart failure, coronary heart disease, kidney or liver disease, fluid retention, high blood pressure, hormonal abnormalities or with use of diuretics. Licorice can cause abnormally low testosterone levels in men or high prolactin or estrogen levels in women. This may make it difficult to become pregnant and may cause menstrual abnormalities.
  • Massage: Evidence is limited and mixed as to whether massage may be of benefit for immune functioning or health services utilization in people with HIV/AIDS.
  • Avoid with bleeding disorders, low platelet counts, or if on blood-thinning medications (such as heparin or warfarin/Coumadin®). Areas should not be massaged where there are fractures, weakened bones from osteoporosis or cancer, open/healing skin wounds, skin infections, recent surgery, or blood clots. Use cautiously with history of physical abuse or if pregnant or breastfeeding. Massage should not be used as a substitute for more proven therapies for medical conditions. Massage should not cause pain to the client.
  • Meditation: Various forms of meditation have been practiced for thousands of years throughout the world, with many techniques originating in Eastern religious practices. A common goal is to attain a state of "thoughtless awareness" of sensations and mental activities occurring at the present moment. More studies are needed to establish how meditation may be useful as an adjunctive therapy in HIV/AIDS patients.
  • Use cautiously with underlying mental illnesses. People with psychiatric disorders should consult with their primary mental healthcare professionals before starting a program of meditation and they should explore how meditation may or may not fit in with their current treatment plans. Avoid with risk of seizures. The practice of meditation should not delay the time to diagnosis or treatment with more proven techniques or therapies, and it should not be used as the sole approach to illnesses.
  • Melatonin: Melatonin is a neurohormone produced in the brain. There is a lack of well-designed scientific evidence to recommend for or against the use of melatonin as a treatment for AIDS. Melatonin should not be used in place of more proven therapies, and patients with HIV/AIDS should be treated under the supervision of their healthcare professionals.
  • Based on available studies and clinical use, melatonin is generally regarded as safe in recommended doses for short-term use. There are rare reports of allergic skin reactions after taking melatonin by mouth. Use cautiously with bleeding disorders, seizure disorders, or if taking drugs that increase the risk of bleeding.
  • Mistletoe: Treatment of HIV patients with mistletoe has been conducted in Europe since the beginning of the AIDS epidemic. Treatment seems to be tolerable with minimal side effects reported. Mistletoe may assist in inhibiting disease progression. However, not all mistletoe preparations have shown equal effects. Further study is needed before a firm conclusion can be made.
  • Avoid if allergic or hypersensitive to mistletoe or to any of its constituents. Anaphylactic reactions (life threatening, shock) have been described after injections of mistletoe. Avoid with acute, highly febrile, inflammatory disease, thyroid disorders, seizure disorders, or heart disease. Use cautiously with diabetes, glaucoma, or with cholinergics.
  • Prayer/distant healing: Prayer can be defined as a "reverent petition," the act of asking for something while aiming to connect with God or another object of worship. Limited study of prayer in patients with HIV/AIDS reports fewer new AIDS-related illnesses and hospitalizations. However, due to methodological problems, these results cannot be considered conclusive.
  • Prayer is not recommended as the sole treatment approach for potentially serious medical conditions, and it should not delay the time it takes to consult with a healthcare professional or receive established therapies. Sometimes religious beliefs come into conflict with standard medical approaches and require an open dialog between patients and caregivers.
  • Psychotherapy: Psychotherapy is an interactive process between a person and a qualified mental health professional. The patient will explore thoughts, feelings, and behaviors to help with problem solving. Psychotherapy, especially supportive psychotherapy, may reduce depression in HIV-positive patients. It may also help with treating substance abuse when used in combination with prescription medicine. Supportive-expressive group therapy may also have concomitant improvements in CD4 cell count and viral load. More research is needed in this area, especially to determine the best type of psychotherapy.
  • Psychotherapy cannot always fix mental or emotional conditions. Psychiatric drugs are sometimes needed. In some cases, symptoms may get worse if the proper medication is not taken. Not all therapists are qualified to work with all problems. Use cautiously with serious mental illness or some medical conditions because some forms of psychotherapy may stir up strong emotional feelings and expression.
  • Reiki: Reiki instruction may help reduce pain or anxiety in HIV/AIDS patients, but results are unclear.
  • Reiki is not recommended as the sole treatment approach for potentially serious medical conditions, and should not delay the time it takes to consult with a healthcare professional or receive established therapies. Use cautiously with psychiatric illnesses.
  • Relaxation therapy: Relaxation techniques include behavioral therapeutic approaches that differ widely in philosophy, methodology, and practice. Mental health and quality-of-life improvements have been seen in preliminary studies of HIV/AIDS patients. These findings suggest the need for further, well-controlled research.
  • Avoid with psychiatric disorders like schizophrenia/psychosis. Jacobson relaxation (flexing specific muscles, holding that position, then relaxing the muscles) should be used cautiously with illnesses like heart disease, high blood pressure, or musculoskeletal injury. Relaxation therapy is not recommended as the sole treatment approach for potentially serious medical conditions, and it should not delay the time to diagnosis or treatment with more proven techniques.
  • Selenium: Selenium is a mineral found in soil, water, and some foods. Selenium supplementation has been studied in HIV/AIDS patients, and some reports associate low selenium levels with complications such as cardiomyopathy. It remains unclear if selenium supplementation is beneficial in patients with HIV, particularly during antiretroviral therapy.
  • Avoid if allergic or sensitive to products containing selenium. Avoid with history of non-melanoma skin cancer. Selenium is generally regarded as safe for pregnant or breastfeeding women. However, animal research reports that large doses of selenium may lead to birth defects.
  • Shiitake: Based on preliminary studies, lentinan from shiitake mushroom may increase CD4 counts and may be effective as an adjunct therapy in HIV. Further well-designed studies are needed to confirm these results. Side effects have been reported and more proven therapies are recommended at this time.
  • Avoid if allergic or hypersensitive to shiitake mushrooms. Avoid if pregnant or breastfeeding unless otherwise recommended by the patient's licensed healthcare provider.
  • Sorrel: There is currently not enough evidence on the proposed antiviral effects of sorrel. More research is needed.
  • Avoid large doses of sorrel because there have been reports of toxicity and death. This may be because of the oxalate found in sorrel. Many sorrel tinctures contain high levels of alcohol and should be avoided when driving or operating heavy machinery. These sorrel formulations may cause nausea or vomiting when taken with the prescription drugs metronidazole (Flagyl®) or disulfiram (Antabuse®). Avoid if pregnant or breastfeeding unless otherwise recommended by the patient's licensed healthcare provider.
  • Spiritual healing: Distant healing and prayer have been used in patients with HIV/AIDS. There is conflicting evidence in this area and more study is needed.
  • Spiritual healing should not be used as the only treatment approach for medical or psychiatric conditions, and should not delay the time it takes to consider more proven therapies.
  • Therapeutic touch: There is currently not enough evidence that therapeutic touch may benefit immunity or emotional well-being in HIV/AIDS patients. More research is needed.
  • Avoid with fever or inflammation, and on areas of the body with cancer.
  • Thymus extract: Thymus extracts for nutritional supplements are usually derived from young calves. Preliminary evidence found no improvement in HIV progression to AIDS or immunostimulation, although some immunological activity was noted in a non-randomized controlled trial. Additional study is needed to better understand the effects of thymus extract for HIV/AIDS.
  • Avoid if allergic or hypersensitive to thymus extracts. Use bovine thymus extract supplements cautiously due to potential for exposure to the virus that causes "mad cow disease." Avoid use with an organ transplant or other forms of allografts or xenografts. Avoid if receiving immunosuppressive therapy or hormone therapy. Avoid with thymic tumors, myasthenia gravis (neuromuscular disorder), or untreated hypothyroidism. Avoid if pregnant or breastfeeding unless otherwise recommended by the patient's licensed healthcare provider. Thymic extract increases human sperm motility and progression.
  • Traditional Chinese medicine (TCM): Traditional Chinese medicine (TCM) is a broad term that refers to many different treatments and traditions of healing. They share a common heritage of technique or theory rooted in ancient Chinese philosophy (Taoism) that dates back over 5,000 years. TCM herbs are a popular complementary therapy in HIV/AIDS. However, study results conflict. More studies are needed before the potential benefits of TCM herbs in HIV/AIDS can be established.
  • Chinese herbs can be potent and may interact with other herbs, foods, or drugs. Consult a qualified healthcare professional before taking. There have been reports of manufactured or processed Chinese herbal products being tainted with toxins or heavy metal or not containing the listed ingredients. Herbal products should be purchased from reliable sources. Avoid ma huang, which is the active ingredient in ephedra. Avoid ginseng if pregnant or breastfeeding unless otherwise recommended by the patient's licensed healthcare provider.
  • Turmeric: Turmeric is a perennial plant native to India and Indonesia, and it is often used as a spice in cooking. Based on early research, turmeric may help treat various viral infections. Several laboratory studies suggest that curcumin, a component of turmeric, may have activity against HIV/AIDS. However, reliable human studies are lacking in this area. Well-designed trials are needed.
  • Avoid if allergic or hypersensitive to turmeric (curcumin), yellow food colorings, or plants belonging to the Curcuma or Zingiberaceae (ginger) families. Use cautiously with a history of bleeding disorders, immune system deficiencies, liver disease, or gallstones. Use cautiously with blood thinners (e.g. warfarin). Use cautiously if pregnant or breastfeeding.
  • Vitamin A: Vitamin A is a fat-soluble vitamin that is derived from two sources: retinoids and carotenoids. Retinoids are found in animal sources (such as the liver, kidney, eggs, and dairy products). Carotenoids are found in plants like dark or yellow vegetables and carrots. The role of vitamin A in the prevention, transmission, or treatment of HIV infection is controversial and not well established. A clear conclusion cannot be formed based on the available scientific research.
  • Avoid if allergic or hypersensitive to vitamin A. Vitamin A toxicity can occur if taken at high dosages. Use cautiously with liver disease or alcoholism. Smokers who consume alcohol and beta-carotene may have an increased risk for lung cancer or heart disease. Vitamin A appears safe in pregnant women if taken at recommended doses. Use cautiously if breastfeeding because the benefits or dangers to nursing infants are not clearly established.
  • Zinc: Patients with HIV/AIDS, especially those with low zinc levels, may benefit from zinc supplementation. Some low quality studies cite reduction in infections, enhanced weight gain, and immune system function, including increased CD4 and CD8 cells, with use of zinc. However, other low quality studies conflict with these findings. Further research is needed before a conclusion can be made.
  • Zinc is generally considered safe when taken at the recommended dosages. Avoid zinc chloride since studies have not been done on its safety or effectiveness. While zinc appears safe during pregnancy in amounts lower than the established upper intake level, caution should be used since studies cannot rule out the possibility of harm to the fetus.
  • Fair negative scientific evidence:
  • Ozone therapy: Ozone molecules are composed of three oxygen atoms. Ozone exists high in the earth's atmosphere and absorbs radiation from the sun. Reports of using ozone for medicinal purposes date to the late 19th Century. Laboratory studies have shown the HIV virus to be sensitive to ozone, but high-quality human studies are lacking. A preliminary study measured the safety and effectiveness of ozone-treated blood in the treatment of HIV infection and immune disease. Ozone therapy was not shown to enhance immune activation or diminish the HIV virus.
  • Autohemotherapy (a therapy in which blood is withdrawn from the body) infused with ozone, and then replaced into the body), has been associated with transmission of viral hepatitis and with a possible case of dangerously lowered blood cell counts. Insufflation of the ear carries a risk of tympanic membrane ("ear drum") damage, and colon insufflation may increase the risk of bowel rupture. Consult a qualified health professional before undergoing any ozone-related treatment.
  • St John's wort: Anti-viral effects of St. John's wort have been observed in laboratory studies, but were not found in available human study. Multiple reports of significant adverse effects and interactions with drugs used for HIV/AIDS, including protease inhibitors (PIs) and non-nucleoside reverse transcriptase inhibitors (NNRTIs), suggest that patients being treated for HIV/AIDS should avoid this herb. Therefore, there is evidence to recommend against using St. John's wort in the treatment of patients with HIV/AIDS.
  • Avoid if allergic or hypersensitive to plants in the Hypericaceaefamily. Rare allergic skin reactions like itchy rash have been reported. Avoid with immunosuppressant drugs (such as cyclosporine, tacrolimus, or myophenic acid). Avoid with non-nucleoside reverse transcriptase inhibitors or protease inhibitors. Avoid with organ transplants, suicidal symptoms, or before surgery. Use cautiously with history of thyroid disorders. Use cautiously with drugs that are broken down by the liver, with monoamine oxidase inhibitors (MAOI) or selective serotonin reuptake inhibitors (SSRIS), digoxin, or birth control pills. Use cautiously with diabetes or with history of mania, hypomania, or seasonal affective disorder (SAD). Avoid if pregnant or breastfeeding unless otherwise recommended by the patient's licensed healthcare provider.

Preventing transmission
  • Testing: Since HIV-infected mothers can pass the virus to their baby during pregnancy, labor, delivery or breastfeeding, the U.S. Centers for Disease Control and Prevention (CDC) recommends that all pregnant women get tested for HIV. Without knowledge of their positive HIV status, infected mothers are not presented with options that may prevent their babies from acquiring HIV.
  • Antiretroviral therapy: Antiretroviral drugs are used to suppress HIV. These drugs slow down the time it takes the virus to replicate and inhibit its ability to infect new cells. Antiretroviral therapy can significantly reduce the likelihood of an HIV-infected pregnant mother passing the virus to her baby. Patients who were taking antiretroviral medication before becoming pregnant should talk to their healthcare providers to determine the safest and most effective treatment option. In general, efavirenz (Sustiva®), stavudine (Zerit®), hydroxyurea (Droxia® or Hydrea®), and the oral liquid formulation of amprenavir (Agenerase®) should not be taken during pregnancy because they may cause harm to the fetus.
  • Combination antiretroviral therapy with zidovudine (Retrovir®) and other antiretrovirals is the standard preventative treatment prescribed to HIV-infected pregnant women. Zidovudine is considered the most effective antiretroviral at preventing HIV transmission from mother to child. Treatment begins after the first trimester (14-34 weeks into pregnancy), when the baby is less susceptible to harmful side effects of the drug. The exact combination and dosage varies among patients, depending on their overall health and severity of their HIV infections. The newborn typically receives oral zidovudine every six hours for six weeks after birth.
  • Perinatal (shortly before or after birth) HIV infection rates have shown to drop to as low as one to two percent for babies if their mothers take combination antiretroviral therapy during pregnancy, as well as zidovudine or nevirapine (Viramune®) preventative therapy during labor and after birth.
  • Zidovudine may also be prescribed alone to prevent transmission from an HIV-infected pregnant woman to her baby. However, taking the drug alone is typically less effective at reducing the viral load than combination therapy with other antiretrovirals. Taking only one antiretroviral also increases the risk of developing drug resistance. Once drug resistance occurs, the particular drug can no longer suppress the virus, even if it is taken in the future. This treatment is usually administered after 28 weeks of pregnancy in women who have low levels of HIV in the blood and who are concerned about the side effects antiretrovirals may have on the baby. A single dose of nevirapine and zidovudine is then taken during labor.
  • Baby formulas: HIV-infected mothers should not breastfeed their babies because the virus may be transmitted via the breast milk. Instead, baby formulas should be used.
  • Cesarean sections: The baby is more likely to become infected if the vaginal delivery takes a long time because the newborn is exposed to the mother's blood and vaginal secretions. Mothers with a high viral load (high levels of the virus in their blood) might reduce their risk if they deliver their baby by cesarean section (surgical delivery of an infant), also called C-section. While a C-section can reduce the risk of transmission during birth, it is not typically necessary in patients who undergo antiretroviral therapy.
  • Counseling: Prevention counseling is not mandatory, but it should be offered to all women when they receive their HIV test results. Counseling should focus on reducing the risk of HIV infection or transmission, including vertical transmission. In addition, the counselor should also suggest achievable behavior changes that will help reduce the patient's risk of developing or transmitting HIV. The counseling session is a chance to clear up any misconceptions or questions the patient has about the disease.

Copyright © 2011 Natural Standard (www.naturalstandard.com)


The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.

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