Alternative medicine use in HIV-positive men and women: demographics, utilization patterns and health status.

Between 1995 and 1997, 1,675 HIV-positive men and women using complementary and alternative medicine (CAM) were enrolled into the Bastyr University AIDS Research Center's Alternative Medicine Care Outcomes in AIDS (AMCOA) study. Funded by the National Institutes of Health (NIH) Office of Alternative Medicine (OAM) and National Institute of Allergy and Infectious Diseases (NIAID), the AMCOA study collected information on participant demographics, health status and use of conventional and CAM therapies. Participants from 46 states completed a baseline questionnaire, while additional clinical information (such as CD4 count and HIV-RNA viral load) was obtained from laboratory records. AMCOA participants reported using more than 1,600 different types of CAM therapies (1,210 CAM substances, 282 CAM therapeutic activities and 119 CAM provider types) for treating HIV/AIDS. Approximately two-thirds (63% n = 1,054) of the AMCOA cohort reported using antiretroviral drug therapy (ART) during the six-months previous to completing the baseline questionnaire, while 37% (n = 621) indicated they were not using ART. Of those not using ART, 104 subjects reported never having used any conventional medications for their HIV and 12 subjects used only non-prescription diarrhoea medications. The most frequently reported CAM substances were vitamin C (63%), multiple vitamin and mineral supplements (54%), vitamin E (53%) and garlic (53%). CAM provider types most commonly consulted by the AMCOA cohort were massage therapists (49%), acupuncturists (45%), nutritionists (37%) and psychotherapists (35%). CAM activities most commonly used were aerobic exercise (63%), prayer (58%), massage (53%) and meditation (46%). The choice of CAM therapies among the AMCOA cohort does not appear to be solely based on scientific evidence of efficacy of individual therapies. The majority of AMCOA subjects could be characterized as using integrated medicine, since an overwhelming proportion of the cohort consult with both conventional and CAM providers and use both conventional and CAM medications, yet few subjects reported that their conventional and CAM providers work as a team. These data and this cohort set the stage for conducting studies of health status changes associated with specific CAM therapies.

A cross-over study of the effect of a single oral feeding of medium chain triglyceride oil vs. canola oil on post-ingestion plasma triglyceride levels in healthy men.

Due to its unique absorption and metabolism characteristics, medium chain triglyceride (MCT) oil, consisting of fatty acids with 8-12 carbons, has been used therapeutically since the 1950s in the treatment of fat malabsorption, cystic fibrosis, epilepsy, weight control, and to increase exercise performance. Medium chain triglycerides are easily hydrolyzed in the intestines and the fatty acids are transported directly to the liver via the portal venous system, in contrast to long-chain fatty acids (LCFAs), which are incorporated into chylomicrons for transport through the lymphatic system or peripheral circulation. Medium chain fatty acids (MCFAs) do not require carnitine to cross the double mitochondrial membrane of the hepatocyte, thus they quickly enter the mitochondria and undergo rapid beta-oxidation, whereas most LCFAs are packaged into triglycerides in the hepatocyte. In this single-blind, randomized, cross-over study, 20 healthy men ingested a single dose of either 71 g of MCT oil or canola oil. Blood samples were taken at baseline and at hours one through five post-ingestion to compare the effect of a single oral dosing of MCT oil versus canola oil on post-ingestion plasma triglyceride levels. Mean triglyceride values after canola oil increased 47 percent above baseline (p <0.001), while mean triglyceride values after MCT oil decreased 15 percent from baseline (p <0.001), which is consistent with several other studies involving short- and longer-term feeding with MCT oil. The effect of long-term usage of MCT oil on triglycerides is yet to be established.

Treatment of human immunodeficiency virus-positive patients with complementary and alternative medicine: a survey of practitioners.

OBJECTIVE: To investigate complementary and alternative medicine (CAM) practices provided to human immunodeficiency virus (HIV)-infected individuals, provider experience in HIV disease, patients' characteristics, provider perceptions of treatment effectiveness, and feasibility and interest in future studies. DESIGN: Mailed survey. PARTICIPANTS: 117 providers, recruited from professional associations and conferences, who offer CAM therapies to HIV-infected individuals. OUTCOME MEASURES: Provider credentials, patient descriptors, treatments prescribed and their perceived effectiveness, health service information, medical information charted, and research participation capability and interest. RESULTS: Providers are treating patients at all stages of HIV disease with a variety of CAM practices, claiming a mean of 6.5 years of HIV disease treatment experience and 105 HIV-positive patients in treatment per provider (solo practice or clinic). Eighty percent of respondents report holding state licenses to practice. A total of 115 different CAM therapies with an average of 12 treatments per provider were used. Ninety percent of providers claimed their therapies were "somewhat" to "very effective" on all disease stages, indicating effectiveness for symptom management (96%), quality of life (98%), raising or maintaining CD4+ lymphocyte levels (66%), slowing progression to acquired immunodeficiency syndrome (AIDS) (69%), and extending survival (73%). Research readiness and willingness was reported by a majority of respondents. CONCLUSIONS: Providers with substantial experience treating HIV disease with a range of CAM practices claim effectiveness for their methods. Providers are generally willing to participate in studies that would examine such claims and appear to have the capacity meaningfully to contribute. These claims should be investigated.