Can I take ARVs and herbal medicine?

Dear Doctor, <br>I am HIV-positive and have been using herbal remedies for some time. Recently I went for a CD4 count and was told that I needed to start using ARVs because my CD4 is low.

Dear Doctor,
I am HIV-positive and have been using herbal remedies for some time. Recently I went for a CD4 count and was told that I needed to start using ARVs because my CD4 is low. Can I continue using my herbal medicine and take ARVs at the same time? I feel the herbal medicine was helping me too.
Nalongo.


Dear Nalongo,
Herbal medicines and nutritional supplements are widely used in HIV-infected patients but little is known about how these remedies work although they are widely used with some good reports or effects. The biggest obstacle is that often we do not know the active ingredients in herbal remedies plus how much one is supposed to take for good effect or to avoid over dosage.
There is also a possibility of interactions between ARVs and herbal drugs, which could render ARVs less potent or even more toxic to the body. There is for example, a herb called St John’s Wort, which affects the potency of a drug called Indinavir, which is often used when the common first line ARVs have failed. This herb should therefore be avoided when using ARVs.
Garlic supplements are sometimes used by HIV-infected people because they are thought to have good effects on the body. However, raw garlic and garlic supplements inhibit important enzymes used to break down drugs in the body and continued use might harm the body or render ARVs less effective. So in case of adverse effects or treatment failures which appear with no other cause, clinicians should include alternative herbal medicines in their drug histories. Lastly, it is important that your doctor or any other healthcare giver is told about any other drugs you are using including herbal remedies so that in case of any adverse reactions due to drug interactions or failure of ARVs to help you, they know how to assist you.