Popular Use of Traditional Chinese Medicine in HIV Patients in the HAART era

Kurtland Ma; Shui-Shan Lee; Elsie K. Y. Chu; Dennise K. P. Tam; Victoria S. C. Kwong; Choi-Fung Ho; Kathy Cheng; Ka-Hing Wong

Disclosures

AIDS and Behavior. 2008;12(4):637-642. 

In This Article

Results

The survey was conducted over a four-week period in July and August 2005. Eighty-two patients were recruited, accounting for 36.4% of all patients attending the clinic in the same period of time. The results of 76 successfully completed questionnaires were finally available for analysis. There was no significant difference between the age, viral load and CD4 counts between recruited patients and those who had not been recruited (results not shown).

The mean age of the enrolled patients was 45.36 (range: 25-72 years). They have been receiving medical care at the ITC for a mean of 80.7 months (range: 17-215 months). The main route of HIV transmission was heterosexual contact, 50 (66.7%), followed by sex between men, i.e. in men having sex with men (MSM) 23(30.3%). A fraction (36.8%) of the subjects had developed AIDS before the survey. The median duration of treatment with HAART was 58.6 months (range: 13-101 months). All had undetectable viral load (less than 400 copies/ul) during the recent blood taking at within 4 months prior to the survey. The one with high viral load (54,000 copies/ul) had in fact stopped HAART recently following treatment failure. Full adherence to all doses of HAART within the past month was reported by 54 (66.7%) of all study participants while 27 (33.3%) reported having missed one dose or more within the past month.

Prevalence and Patterns of TCM Use

Forty-five of the patients (59.2%) had used TCM before—26 (57.8%) of them purchased proprietary items over the counter (OTC), 28 (62.2%) consulted TCM practitioner, and 5 (11.1%) obtained from other sources. Thirteen of them (28.9%) have consulted a TCM practitioner in the preceding 6 months at the following frequencies: a total of ≤2 times (7, 53.8%), 3-4 times (3, 23.1%) and 5 or more (3, 23.1%). Table 1 shows the characteristics of the TCM users and non-users. The median age of TCM users was 47 (25-72 years old), and 42 (28-71 years old) for non-TCM users. TCM users tended to be older in age, but it did not reach statistical significance (Mann-Whitney U = 515.50, P > 0.05). No difference was found in duration of illness, duration on HAART and CD4 count between the two groups. However, use of TCM was associated with clinical stages. Patients in stage B were less likely to use TCM (OR = 0.23; 95% CI 0.09-0.63) while patients in stage C were more likely to use TCM (OR = 3.00; 95% CI 1.08-8.37).

Patients who had used TCM were classified as Infrequent or Common Users. Infrequent Users were those that reported using any 1 or more types of TCM only 1-2 times in the preceding 6 months, such as patients who had sampled one form of TCM but had not used it habitually. The more frequent users and those taking TCM regularly were classified as Common Users. Using this criteria, 11 (14.5%) were Infrequent TCM Users and 33 (43.4%) were Common Users (the two did not add up to 45 because of one missing entry). There's no difference in age, duration of illness and HAART between the two groups.

A total of 30 different types of TCM had been reportedly used by the patients. Some TCM-using patients reported usage of multiple types of TCM while others did not specify any. All reported recipes were oral preparation and were classified into three categories(prescription from TCM practitioner, over-the-counter preparations, and herbal tea). Two thirds (31) used only one type/recipe of TCM, while 32.7% (13) used more than one. Of the 24 OTC TCM preparations reported, only two forms had been used by more than one patient, namely, lingzhi (a mushroom, Ganoderma lucidum), in 10 (41.7%), and cordyceps (a genus of Ascomycete fungi) by 3 (12.5%) of the patients. Herbal tea was reported as TCM, and have been used quite commonly, in 9 (20.5%) of the patients.

Beliefs About TCM

For those who used TCM, the treatment of minor ailments (27/45, 60.0%) and general health maintenance (26/45, 57.8%) were the main indications. Common Users were more inclined to consume TCM for general health maintenance (OR = 5.33; 95% CI 1.18, 24.18), while Infrequent Users were more likely to consume TCM to treat minor ailments (OR = 9.41; 95% CI 1.08, 82.10). About half trusted that TCM was useful because of prior experience of effectiveness (23/44, 52.3%), or following recommendations of family members or friends(19/41, 43.2%). There was no difference between Common and Infrequent Users in this regard.

Comparing between TCM and western medicine, a majority (58/75, 77.3%) believed that the latter was more effective in treating major illnesses; whereas opinion on minor illness was split. Overall, many believed TCM to be useful for supporting the maintenance of health (56/75, 74.7%). In the event of a minor medical problem, many (33/76, 43.4%) preferred to see only western doctor,or not seeking any advice (27/76, 35.5%) instead of consulting a TCM practitioner in the first place (4/76, 5.3%).

HIV, HAART and TCM Use

All except one patients trusted that HAART was more potent than TCM for the treatment of HIV infection, though a majority (86.3%) acknowledged that side effect was plentiful with HAART. Western medicine was believed to be more effective in managing HAART associated side effects (51.3% vs. 27%). Many (58/41, 78.4%) believed that there could be interactions between TCM and HAART, which could be negative (43.1%), positive (6.9%), or both (50.0%) ( Table 2 ). For those who had taken TCM (n = 45, missing = 3), all except 2 (4.7%) took it one hour or more before or after antiretroviral medications. Seventeen (40.5%) actually took TCM at an interval of 4 h from HAART. Almost every respondent (19/21, 90.5%) did not inform the TCM practitioner about his HIV status.

Respondents were asked how their TCM usage had changed since their HIV diagnosis. No patient began using TCM after their HIV diagnosis. A majority of the Infrequent (69.2%) and Common (76.0%) TCM Users reported no change in the habit after HIV diagnosis. Increase in TCM usage since diagnosis was reported by none of the Infrequent Users and 7 (21.2%) of the Common Users. On the other hand, 1 (9.1%) Infrequent User and 2 (6.1%) Common Users decreased their TCM usage since diagnosis. Only 15.4% of Infrequent Users (n = 2) reported having stopped taking TCM altogether since HIV diagnosis while no Common TCM User reported doing so.

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