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

Discussion

This is the first study addressing the use of TCM in a Chinese population on HAART, showing that the practice was common. The main indication was general health maintenance, and/or treatment for minor illness, rather than specifically for HIV/AIDS. A good variety of TCM products were used, many of which might not actually be considered medicinal in nature in Chinese communities. The difference in the definition of TCM and the perception of patients about what constituted TCM could have affected the reported frequency in this and other study. Lingzhi, for example, is commonly used to improve health status, prolong life or sometimes as a tonic (Jong & Birmingham, 1992). Herbal tea was widely used for treating common cold or other minor ailments, and was the most common TCM product consumed in our study. The ready access to these products and the customary use in families probably explain their popularity. More than half of our TCM users did not consult any TCM practitioners upon their consumption. Over-the-counter TCM was actually preferred by patients. Although the use of TCM was common among those who have developed AIDS, further study is needed to explore the relationship between TCM use and severity of the illness.

HAART was the standard treatment received by patients in the study. While TCM was used, adherence to HAART was not adversely affected, as has been reported in earlier studies (Fong et al., 2003). This confirms the findings of other studies, that the choice of treatment was largely based on the type of illness which they are suffering from (Hon et al., 2004; Lau & Yu, 2000; Lewith & Chan, 2002). We postulate that our patients, while using another form of medication (TCM), exhibited an augmented initiative to care for themselves or a greater desire to be in control of their own healthcare decision-making (Hsiao et al., 2003). It's noted however that missing a few doses was quite common, and was associated with the use of TCM, though this did not reach statistical significance. The clinical relevance is not known as all patients had undetectable viral load, an indication of effective viral suppression.

Apparently, TCM and western medicines belong to two distinctly different framework of approaches to health and diseases. Effective integration is potentially beneficial but remains a distant goal to be achieved. An open, effective patient-health service provider communication is important, which could avoid serious adverse effects and negative interactions between the use of HARRT and TCM (Hsiao et al., 2003). More than 75% of our TCM users did not consult any clinic staff on their use of TCM, though they did not anticipate disapproval. Despite the low rate of disclosure, our patients did view positively their physicians' or nurses' responses to TCM (results not shown). There are two possible explanations for the low disclosure rate. First, the tremendous effort has been put forward by the clinic staff on adherence to antiretroviral drug, leaving little room for other issues like TCM (Wynia, Eisenberg, & Wilson, 1999). Second, as TCM consumption is generally thought to be unrelated to HIV treatment, patients may think that it is unnecessary to raise for discussion This may also reflect the lack of knowledge over the risk and benefits on TCM use, and the possible interaction, either positive or negative, with HAART. Future studies on barriers to effective discussion on TCM use between the physicians and the patients, and their clinical impacts, would be useful.

Understandably, our study was limited by its design in focusing on a selected group of HIV patients in a specialist clinic. The responses could be setting specific, and may not be extrapolated to patients with the same ethnicity in the same or other countries. Since HAART was the standard treatment in the clinic, it could be argued that only those accepting this form of treatment would be recruited. All our subjects have started their HAART treatment and may not encompass the views and opinions of patients who have chosen to utilize TCM as the core HIV treatment. Our results may therefore underestimate TCM usage in HIV patients in general. On the other hand, the term TCM was loosely defined in this study. We included a wide variety of OTC preparations or herbs/herbal preparations prescribed by TCM practitioners. We could not distinguish the perceived benefits between OTC preparations and TCM prescribed by TCM practitioners. Despite these drawbacks, our study did highlight the popularity of TCM use in the HAART era, a phenomenon which should be taken into consideration when studying the impacts of HIV treatment in the society.

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