HIV/Aids

Updated 24 June 2014

AIDS-related Kaposi's sarcoma

Sarcoma is a type of cancer that develops in connective tissues like bone, cartilage, fat, blood vessels, muscle or fibrous tissues (related to tendons or ligaments).

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BACKGROUND

Sarcoma is a type of cancer that develops in connective tissues like bone, cartilage, fat, blood vessels, muscle or fibrous tissues (related to tendons or ligaments).

The disease usually causes tumors to form in the tissues below the skin or face or in the mucous membranes of the nose, mouth or anus. Patients typically suffer from lesions on the skin, which appear as raised blotches or lumps that may be purple, brown or red.

While the skin lesions may be disfiguring, they are not usually life threatening. In some cases, the lesions may be painful or cause swelling. If KS develops in the lungs, liver or gastrointestinal tract, however, the disease may be life threatening, causing internal bleeding or difficulty breathing.

Kaposi's sarcoma (KS) was named after Dr. Moritz Kaposi who first described the disease in 1872. For decades KS was considered a rare disease that primarily affected elderly men of Mediterranean or Jewish descent, organ transplant recipients or young adult African men. This type is called classic KS.

However, in the last 20 years, most KS cases have developed in association with the human immunodeficiency virus (HIV) and the acquired immune deficiency syndrome (AIDS). This type is called HIV-related KS, AIDS-related KS or epidemic KS.

Researchers believe a herpes virus called human herpes virus 8 (HHV-8) causes HIV-related Kaposi's sarcoma. In a recent study, men who had HHV-8 were nearly 12 times more likely to develop KS than men who did not have HHV-8. The herpes virus is usually dormant in healthy individuals. However, immunocompromised patients, including HIV/AIDS patients, may develop KS as a result of the infection.

According to the U.S. Centers for Disease Control and Prevention (CDC), KS is considered an AIDS-defining disease. This means that when HIV-infected patients develop KS, their condition has progressed to AIDS. In the United States, KS serves as an AIDS-defining illness in about 10-15% of HIV-infected homosexual men.

With new treatments for AIDS, including antiretroviral therapy (ART), as well as greater awareness of HIV, the number of KS cases due to HIV infection has decreased about 85% to 90%, according to researchers. Before ART was available, an estimated 90% of patients who had AIDS-related KS died from the disease. Today, researchers estimate that in areas where antiretroviral therapy (HIV/AIDS treatment) is available, 47% of patients who have AIDS-related KS die.

Local therapies, including radiation therapy, intralesional vinblastine, cryotherapy (use of cold temperatures to treat disease) and retinoids have been used to treat patients who experience localized lesions. However, local therapy does not stop the development of new lesions. Systemic therapies, including interferon-alpha and chemotherapy, are indicated for extensive or symptomatic visceral disease (when organs are involved).

CAUSES

A herpes virus called Human Herpes Virus 8 (HHV-8) has shown to cause AIDS-related KS. However, not everyone who has HIV and HHV-8 develops KS. One study found that the presence of HHV-8 in both blood cells and saliva was associated with KS, while patients who only had HHV-8 in their saliva were much less likely to develop KS.

In a recent study, men who had HHV-8 were nearly 12 times more likely to develop KS than men who did not have HHV-8. For unknown reasons, men who have sex with men are the most likely to develop the herpes infection. Therefore, men are more likely than women to develop KS.

Early in the AIDS epidemic, doctors saw a sudden appearance of KS. This is because HIV and AIDS patients have a weakened immune system, and their ability to fight against disease and infection is impaired. HHV-8 is usually dormant in healthy individuals. However, immunocompromised patients, including HIV/AIDS patients, may develop KS as a result of the infection.

It has also been suggested that KS may sometimes be caused by an overactive immune system. HIV infections activate T-cells, which secrete a growth factor called oncostatin M. Increased levels of oncostatin M. may stimulate the growth of early KS cells, which may eventually become cancerous. However, further research is needed to confirm this theory.

Once the KS cells have developed in one part of the body they can enter the bloodstream and lodge in other tissues, which causes additional lesions.

According to the CDC, KS is considered an AIDS-defining disease. This means that when HIV-infected patients develop KS, their condition has progressed to AIDS.

SYMPTOMS

Symptoms of AIDS-related KS vary from minimal skin involvement to widespread organ involvement.

Common symptoms include skin lesions that may erupt at many places on the body, including on the skin (raised lumps that may be purple, brown or red), in the mouth, on the lymph nodes and other organs (especially organs in the gastrointestinal tract, lungs, liver and spleen). Most patients experience enlarged lymph nodes and unexplained fever or weight loss. Sometimes patients experience painful swelling, especially in the legs, groin area or skin around the eyes.

While the skin lesions may be disfiguring, they are not usually life threatening. In some cases, the lesions may be painful or cause swelling. If KS develops in the lungs, liver or gastrointestinal tract, however, the disease may be life threatening, causing internal bleeding or difficulty breathing.

DIAGNOSIS

General: Several tests, including chest X-rays, thallium or gallium scans, as well as a bronchoscopy, esophagogastroduodenoscopy (EGD) or colonoscopy, may indicate KS. However, a tissue biopsy is the only definitive diagnostic test for KS.

Biopsy: A biopsy is the only definitive diagnostic test for KS. During the procedure a sample of tissue is analyzed under a microscope for cancerous cells. The tissue sample may be taken from the skin (punch biopsy), gastrointestinal tract (endoscopic biopsy), tissue that lines the lungs and the inside of the chest wall, (pleural biopsy) or lung tissue (transbronchial biopsy).

Chest X-ray: Chest X-rays provide variable and nonspecific results. They may detect abnormal tissue growth, enlarged lymph nodes or an isolated pulmonary nodule (oval-shaped sore (lesion) in the lungs.

Thallium or gallium scans: Thallium or gallium scans may help a healthcare provider distinguish KS from an infection. Thallium or gallium is injected into the patient before an X-ray is taken. KS lesions in the lungs usually demonstrate intense thallium uptake and no gallium intake. Infections, on the other hand, do not uptake either substance.

Bronchoscopy: A bronchoscopy may be used to determine if there is pulmonary involvement. During the test, a bronchoscope (thin, flexible tube with a camera) is inserted into the esophagus, through the mouth. The test allows the healthcare provider to look inside the lungs. If KS is in the lungs, a slightly raised, red lesion will be visible. However, a biopsy is generally avoided because there is a risk of bleeding.

Esophagogastroduodenoscopy (EGD) or colonoscopy: A qualified healthcare provider may observe the gastrointestinal tract during an esophagogastroduodenoscopy or colonoscopy test. During the procedure, an endoscope (thin, flexible tube with a camera) is either inserted through the mouth (esophagogastroduodenoscopy) or the anus (colonoscopy) to view the gastrointestinal tract. The physician looks for gastrointestinal lesions, which are frequently observed in KS patients. In addition, the physician may insert a biopsy needle into the endoscope to remove a small tissue sample. The sample is then analyzed under a microscope for cancerous cells.

TREATMENT

General: Highly active antiretroviral therapy (HAART) has shown to reduce the risk of fatality in patients who have AIDS-related KS. Local therapies, including radiation therapy, intralesional vinblastine, cryotherapy (use of cold temperatures to treat disease) and retinoids have been used to treat patients who experience localized lesions. However, local therapy does not stop the development of new lesions. Systemic therapies, including interferon-alpha and chemotherapy, are indicated for extensive or symptomatic visceral disease (when organs are involved).

Highly active antiretroviral therapy (HAART): When HIV reproduces, different strains of the virus emerge, and some are resistant to antiretroviral drugs. Therefore, it is common for healthcare providers to recommend a combination of antiretroviral drugs known as HAART. This strategy, developed by NIAID-support researchers, usually combines drugs from at least two different classes of antiretroviral drugs, and it has been shown to suppress the virus. While these drugs cannot cure HIV infection or AIDS, they can suppress the virus.

The U.S. Food and Drug Administration (FDA) has approved several antiretroviral drugs to treat HIV. These drugs fall into three major classes - reverse transcriptase (RT) inhibitors, fusion inhibitors and protease inhibitors. In July 2006, the FDA approved a multi-class combination called Atripla©.

Fusion inhibitors prevent the virus from fusing with the cellular membrane, thus blocking entry into the cell. The fusion inhibitor Fuzeon© is FDA-approved.

Protease inhibitors (PIs) interfere with the protease enzyme that HIV uses to produce infectious viral particles. They are a class of medication used to treat or prevent viral infections, including HIV and Hepatitis C. PIs prevent viral replication by inhibiting the activity of protease, an enzyme used by the virus to cleave nascent proteins for final assembly of new virons. FDA-approved protease inhibitors include Agenerase©, Aptivus©, Crixivan©, Invirase©, Kaletra©, Lexiva©, Norvir©, Prezista©, Reyataz© and Viracept©.

Reverse transcriptase (RT) inhibitors disrupt the reverse transcription stage in the HIV lifecycle. During this stage, an HIV enzyme, known as reverse transcriptase, converts HIV RNA to HIV DNA. There are two main types of RT inhibitors - non-nucleoside RT inhibitors and nucleoside/nucleotide RT inhibitors. Non-nucleoside RT inhibitors bind to reverse transcriptase, preventing HIV from converting the HIV RNA into HIV DNA. Approved non-nucleoside RT inhibitors include Rescriptor©, Sustiva© and Viramune©.

Nucleoside/nucleotide RT inhibitors serve as faulty DNA building blocks, and once they are incorporated into the HIV DNA, the DNA chain cannot be completed. Therefore, the drugs prevent HIV from replicating inside a cell. Approved drugs include Combivir©, Emtriva©, Epivir©, Epzicom©, Hivid©, Retrovir©, Trizivir©, Truvada©, Videx EC©, Videx©, Viread©, Zerit© and Ziagen©.

Radiation therapy: Radiation therapy (cancer treatment with high-energy rays) is the most widely used and effective local therapy. About 80-90% of patients have positive responses to treatment, according to researchers. A higher cumulative dose (40 grays) results in better local control than lower doses (8 grays or 20 grays). Electron beam therapy is only used to treat superficial lesions (on the skin surface). Radiation therapy should be used cautiously because HIV patients are more prone to develop radiation-induced mucositis (inflammation of the lining in the gastrointestinal tract) than individuals who do not have HIV.

Intralesional vinblastine: Intralesional vinblastine, an antineoplastic agent (anti-cancer drug) is commonly used, and it is generally well tolerated. The lesion is injected with 0.1mL/cm2 (at a concentration of 0.2mg/mL). Side effects include skin discoloration and superficial erythema (reddening of the skin).

Cryotherapy: During cryotherapy, liquid nitrogen is applied topically (to the skin surface). This procedure may be an effective treatment for small facial lesions. Cryotherapy may cause hypopigmentation (light spots on the skin) or hyperpigmentation (dark spots on the skin), which generally lasts a few months.

Topical retinoids: Topical retinoids (chemical compounds similar to vitamin A) may reduce the chance of malignant degeneration. A 0.1% alitretinoin gel (Panretin©) has been applied topically two to four times daily, until the lesions are gone. This agent is generally well tolerated, but it may cause local erythema (reddening of the skin) and irritation. Topical retinoids should not be used during pregnancy because they may cause birth defects.

Interferon-alfa: Interferon-alfa is most effective when the CD4 count (helper T-cells that HIV primarily infects and destroys) is greater than 150-200/mL or when administered along with antiretroviral therapy. The agent is injected under the skin daily or three times weekly. Response may occur with low (1 million U/m2), intermediate (30 million U/m2) or high doses (50 million U/m2). It generally takes about four months for the patient to respond to treatment. Toxicity is more common and severe with higher doses. Symptoms of toxicity include fatigue, flu-like symptoms, myalgia (muscle pain), arthralgia (joint pain), fever, myelosuppression (decreased bone marrow activity) and hepatotoxicity (liver toxicity).

Chemotherapy: Chemotherapy is not a curative treatment. However, it may help the patient achieve rapid tumor regression and may reduce tumor-related symptoms. Chemotherapy is used for symptomatic visceral (affecting internal organs) or rapidly progressive skin disease. Several cytotoxic agents are FDA-approved for AIDS-related KS, including liposomal doxorubicin (Doxil©), liposomal daunorubicin (DaunoXome©) and paclitaxel (Taxol©).

INTEGRATIVE THERAPIES

Good scientific evidence :

Greater celandine : Ukrain™, a semisynthetic drug derived from greater celandine (Chelidonium majus), has been studied in clinical trials of various types of cancer with consistently positive outcomes. However, the quality of the research performed to date is inadequate, and higher quality studies are needed.

Use cautiously in patients taking amphetamines, morphine, hexobarbital, MAOIs, or dopaminergic or serotonergic drugs, or in patients undergoing radiation therapy. Avoid in patients with liver disease or in pregnant and lactating women.

Guided imagery : Early research suggests that guided imagery may help reduce cancer pain. Further research is needed to confirm these results.

Guided imagery is usually intended to supplement medical care, not to replace it, and guided imagery should not be relied on as the sole therapy for a medical problem. Contact a qualified health care provider if mental or physical health is unstable or fragile. Never use guided imagery techniques while driving or doing any other activity that requires strict attention. Use cautiously with physical symptoms that can be brought about by stress, anxiety or emotional upset because imagery may trigger these symptoms. If feeling unusually anxious while practicing guided imagery, or with a history of trauma or abuse, speak with a qualified health care provider before practicing guided imagery.

Meditation : There is good evidence that various types of meditation may help improve quality of life in cancer patients. Studies have shown benefits for mood, sleep quality, and the stresses of treatment. The specific effects of meditation are not fully understood. Additional research is needed in this area.

Use cautiously with underlying mental illnesses. People with psychiatric disorders should consult with their primary mental healthcare professional(s) before starting a program of meditation, and should explore how meditation may or may not fit in with their current treatment plan. 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 should not be used as the sole approach to illnesses.

Psychotherapy : Psychotherapy is an interactive process between a person and a qualified mental health care professional (psychiatrist, psychologist, clinical social worker, licensed counselor, or other trained practitioner). There is good evidence that psychotherapy may enhance quality of life in cancer patients by reducing emotional distress and aiding in coping with the stresses and challenges of cancer. Therapy may be supportive-expressive therapy, cognitive therapy or group therapy. While some patients seek psychotherapy in hopes of extending survival, there conclusive evidence of effects on medical prognosis is currently lacking. Psychotherapy may help people come to terms with the fact that they may die of cancer, which is the 4th stage of dealing with a terminal illness, including denial, anger, bargaining, and acceptance.

Psychotherapy is not always sufficient to resolve mental or emotional conditions. Psychiatric medication is sometimes needed. The reluctance to seek and use appropriate medication may contribute to worsening of symptoms or increased risk for poor outcomes. In order to be successful, psychotherapy requires considerable personal motivation and investment in the process. This includes consistent attendance and attention to treatment recommendations provided by the practitioner. Not all therapists are sufficiently qualified to work with all problems. The client or patient should seek referrals from trusted sources and should also inquire of the practitioner's training and background before committing to work with a particular therapist. Some forms of psychotherapy evoke strong emotional feelings and expression. This can be disturbing for people with serious mental illness or some medical conditions. Psychotherapy may help with post-partum depression, but is not a substitute for medication, which may be needed in severe cases.

Yoga : Yoga is an ancient system of relaxation, exercise, and healing with origins in Indian philosophy. Several studies report enhanced quality of life in cancer, lower sleep disturbance, decreased stress symptoms and changes in cancer-related immune cells after patients received relaxation, meditation and gentle yoga therapy. Yoga is not recommended as a sole treatment for cancer but may be helpful as an adjunct therapy.

Yoga is generally considered to be safe in healthy individuals when practiced appropriately. Avoid some inverted poses with disc disease of the spine, fragile or atherosclerotic neck arteries, risk for blood clots, extremely high or low blood pressure, glaucoma, detachment of the retina, ear problems, severe osteoporosis, or cervical spondylitis. Certain yoga breathing techniques should be avoided in people with heart or lung disease. Use cautiously with a history of psychotic disorders. Yoga techniques are believed to be safe during pregnancy and breastfeeding when practiced under the guidance of expert instruction (the popular Lamaze techniques are based on yogic breathing). However, poses that put pressure on the uterus, such as abdominal twists, should be avoided in pregnancy.

Unclear or conflicting scientific evidence :

Acupuncture : Acupuncture, or the use of needles to manipulate the "chi" or body energy, originated in China over 5,000 years ago. There has been limited research on acupuncture for cancer pain, and the research that was done was shown to have mixed results. More studies are needed to determine potential benefits. Evidence from several small studies supports use of acupuncture at a specific point on the wrist (P6) to help chemotherapy patients reduce nausea and vomiting. Acupuncture may also reduce the pain associated with cancer.

Needles must be sterile in order to avoid disease transmission. Avoid with valvular heart disease, infections, bleeding disorders or with drugs that increase the risk of bleeding (anticoagulants), medical conditions of unknown origin, or neurological disorders. Avoid on areas that have received radiation therapy and during pregnancy. Use cautiously with pulmonary disease (like asthma or emphysema). Use cautiously in elderly or medically compromised patients, diabetics or with history of seizures. Avoid electroacupuncture with arrhythmia (irregular heartbeat) or in patients with pacemakers.

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.

Aloe : Transparent gel from the pulp of the meaty leaves of Aloe vera has been used on the skin for thousands of years to treat wounds, skin infections, burns, and numerous other skin conditions. Dried latex from the inner lining of the leaf has traditionally been used as an oral laxative. Preliminary research suggests that aloe may help in the area of cancer prevention or may aid in the regression of cancerous tumors. Additional research is needed in this area.

Although aloe has been suggested as a possible treatment for HIV infection, further research is needed before a firm conclusion can be made.

Caution is advised when taking aloe supplements as numerous adverse effects including a laxative effect, cramping, dehydration and drug interactions are possible. Aloe should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.

American pawpaw : Evidence supporting the use of the American pawpaw (Asimina triloba) tree for cancer treatment in humans is largely anecdotal and subjective. However, use in humans has reported minimal side effects, and evidence from animal and test tube studies suggest that American pawpaw extract does have some anticancer activity. Pawpaw standardized extract has been used for 18 months in patients with various forms of cancer.

Well-designed studies on the long-term effects of pawpaw extracts are currently lacking. Pawpaw should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.

Antineoplastons : Antineoplastons are a group of naturally occurring peptide fractions, which were observed by Stanislaw Burzynski, MD, PhD in the late 1970s to be absent in the urine of cancer patients. There is inconclusive scientific evidence regarding the effectiveness of antineoplastons in the treatment of cancer. Several preliminary human studies (case series, phase I/II trials) have examined antineoplaston types A2, A5, A10, AS2-1, and AS2-5 for a variety of cancer types. It remains unclear if antineoplastons are effective, or what doses may be safe. Until better research is available, no clear conclusion can be drawn.

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, an active infection due to a possible decrease in white blood cells, high blood pressure, heart conditions, chronic obstructive pulmonary disease, liver disease or damage, or kidney disease or damage. Avoid if pregnant or breastfeeding.

Arabinoxylan : Arabinoxylan is made by altering the outer shell of rice bran using enzymes from Hyphomycetes mycelia mushroom extract. Arabinoxylan has been found to improve immune reactions in patients with diabetes and cancer of various types.

Arabinoxylan products may contain high calcium and phosphorus levels, which may be harmful for patients with compromised renal (kidney) function. Caution is advised when taking arabinoxylan supplements, as numerous adverse effects including drug interactions are possible. Arabinoxylan should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.

Aromatherapy : Healing with fragrant oils has been used for thousands of years. Aromatherapy is often used in people with chronic illnesses (frequently in combination with massage), with the intention to improve quality of life or well-being. There is currently not enough scientific evidence to form a firm conclusion about the effectiveness of aromatherapy for quality of life in cancer.

Essential oils should only be used on the skin in areas without irritation. Essential oils should be administered in a carrier oil to avoid toxicity. Avoid with a history of allergic dermatitis. Use cautiously if driving or operating heavy machinery. Avoid consuming essential oils. Avoid direct contact of undiluted oils with mucous membranes. Use cautiously if pregnant.

Art therapy : Art therapy involves the application of a variety of art modalities including drawing, painting, clay and sculpture. Art therapy enables the expression of inner thoughts or feelings when verbalization is difficult or not possible. Limited evidence suggests that art therapy may be of benefit in cancer caregiving for families of cancer patients. Possible benefits include reduced stress, lowered anxiety, increased positive emotions and increased positive communication with cancer patients and health care professionals. Art therapy may also reduce pain and other symptoms in cancer patients. More studies are needed to determine how best to use this form of intervention with this population. Art therapy may also benefit children hospitalized with leukemia during and after painful procedures. Limited available study suggests that art therapy improves cooperation with treatment. Children requested art therapy again when procedures were repeated, and parents reported that children were more manageable after art therapy.

Art therapy may evoke distressing thoughts or feelings. Use under the guidance of a qualified art therapist or other mental health professional. Some forms of art therapy use potentially harmful materials. Only materials known to be safe should be used. Related clean-up materials (like turpentine or mineral spirits) that release potentially toxic fumes should only be used with good ventilation.

Astragalus : Astragalus (Astragalus membranaceus) has been used in Chinese medicine for centuries for its immune enhancing properties. Although early laboratory and animal studies report immune stimulation and reduced cancer cell growth associated with the use of astragalus, reliable human evidence in these areas is currently lacking. In Chinese medicine, astragalus-containing herbal mixtures are also sometimes used with the intention to reduce side effects of chemotherapy and other cancer treatments.

Some studies suggest that astragalus may inhibit herpes viruses. Antiviral effects have been also been reported in early studies for HIV. Additional research is needed in this area.

Caution is advised when taking astragalus supplements, as numerous adverse effects including drug interactions are possible. Astragalus should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.

Baikal skullcap : Although the outcomes of early studies using baikal skullcap for cancer are promising, high-quality clinical studies are needed in this area before a conclusion can be made.

Avoid if allergic or hypersensitive to Baikal skullcap (Scutellaria barbata), its constituents, or members of the Lamiaceae family. Use cautiously if taking sedatives and/or operating heavy machinery. Use cautiously if taking antineoplastic (anticancer) agents or agents metabolized by cytochrome P450 enzymes. Avoid if pregnant or breastfeeding. Baikal skullcap is an ingredient in PC-SPES, a product that has been recalled from the U.S. market and should not be used.

Bee pollen : Bee pollen is considered a highly nutritious food because it contains a balance of vitamins, minerals, proteins, carbohydrates, fats, enzymes, and essential amino acids. Research has found that bee pollen may reduce some adverse effects of cancer treatment side effects. Additional study is needed before a firm recommendation can be made.

Caution is advised when taking bee pollen supplements as allergic reactions may occur in sensitive individuals. Bee pollen should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.

Beta-glucan : Treatment with a beta-glucan, called lentinan, plus chemotherapy (S-1) may help prolong the lives of patients with cancer that has returned or cannot be operated on. More research is needed in this area.

Avoid if allergic or hypersensitive to beta-glucan. When taken by mouth, beta-glucan is generally considered safe. Use cautiously with AIDS or AIDS-related complex (ARC). Avoid using particulate beta-glucan. Avoid if pregnant or breastfeeding.

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.

Bitter melon : Bitter melon (Momordica charantia) is used in Avurvedic medicine from India to lower blood sugar levels. Research has also found that bitter melon extracts may be beneficial in cancer therapies. MAP30, a protein isolated from bitter melon extract, is reported to possess anti-cancer effects in laboratory studies. Potential anti-cancer effects have not been studied appropriately in humans.

Laboratory studies have also shown that 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.

Caution is advised when taking bitter melon supplements, as numerous adverse effects including blood sugar lowering and drug interactions are possible. Bitter melon should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.

Black tea : Black tea (Camellia sinensis) is from the same plant as green tea, but the leaves are processed differently. Black tea usually contains more caffeine than green tea. Several studies have explored a possible association between regular consumption of black tea and rates of cancer in several populations. This research has yielded conflicting results, with some studies suggesting benefits, and others reporting no effects. Laboratory and animal studies report that components of tea, such as polyphenols, have antioxidant properties and effects against tumors. However, effects in humans remain unclear, and these components may be more common in green tea rather than in black tea. Some animal and laboratory research suggests that components of black tea may actually be carcinogenic, or cancer causing, although effects in humans are not clear. Overall, the relationship of black tea consumption and human cancer prevention remains undetermined.

Avoid if allergic or hypersensitive to caffeine or tannins. Skin rash and hives have been reported with caffeine ingestion. Use caution with diabetes. Use cautiously if pregnant. Heavy caffeine intake during pregnancy may increase the risk of SIDS (sudden infant death syndrome). Very high doses of caffeine have been linked with birth defects. Caffeine is transferred into breast milk. Caffeine ingestion by infants can lead to sleep disturbances/insomnia. Infants nursing from mothers consuming greater than 500 milligrams of caffeine daily have been reported to experience tremors and heart rhythm abnormalities. Tea consumption by infants has been linked to anemia, decreased iron metabolism, and irritability.

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.

Bovine cartilage : In early study, bovine tracheal cartilage (preparations such as Catrix© and VitaCarte©) has been studied for the treatment of cancer with encouraging results. High quality clinical research is needed to better determine the effectiveness of bovine tracheal cartilage preparations for cancer treatment.

Avoid if allergic or hypersensitive to bovine cartilage or any of its constituents. Use cautiously with cancer, renal (kidney) failure, or hepatic (liver) failure. Avoid if pregnant or breastfeeding.

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.

Bromelain : Bromelain is a sulfur-containing digestive enzyme (proteins which help with digestion) that is extracted from the stem and the fruit of the pineapple plant (Ananas comosus). There is not enough information to recommend for or against the use of bromelain in the treatment of cancer, either alone or in addition to other therapies. One small study found that a bromelain supplement decreased tumor size in 12 breast cancer patients. Patients took the supplements for different periods of time, lasting from months to years.

Caution is advised when taking bromelain supplements, as numerous adverse effects including blood thinning and drug interactions are possible. Bromelain should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.

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.

Cat's claw : Originally found in Peru, the use of cat's claw (Uncaria tomentosa) has been said to date back to the Inca civilization, possibly as far back as 2,000 years. Cat's claw has anti-inflammatory properties, and several low-quality studies suggest that cat's claw may slow tumor growth. However, this research is early and has not identified specific types of cancer that may benefit; thus, the results are not clear.

Caution is advised when taking cat's claw supplements, as numerous adverse effects including blood thinning and drug interactions are possible. Cat's claw should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.

Chaparral : Chaparral was used by the Native Americans for various health conditions. The chaparral component nordihydroguaiaretic acid (NDGA) has been evaluated as a treatment for cancer but due to risk of toxicity is considered unsafe and not recommended for use. Chaparral and NDGA have been associated with cases of kidney and liver failure, liver cirrhosis, kidney cysts, and kidney cancer in humans. In response to these reports, the U.S. Food and Drug Administration (FDA) removed chaparral from its "generally recognized as safe" (GRAS) list in 1970. Chaparral and NDGA are generally considered unsafe and are not recommended for use.

Avoid if allergic to chaparral or any of its components, including nordihydroguaiaretic acid. Use cautiously if taking blood thinners (anticoagulants), blood sugar medication, or drugs that are broken down by the liver (like amiodarone, phenobarbital, valproic acid). Stop use two weeks before surgery/dental/diagnostic procedures with bleeding risk, and do not use immediately after these procedures. Use cautiously if driving or operating heavy machinery. Avoid if pregnant or breastfeeding.

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.

Chlorophyll : Preliminary evidence in suggest that chlorophyll may aid in the reduction of side effects associated with photodynamic therapies, such as those used in management of malignant tumors. Further research is required to support the use of chlorophyll as a laser therapy adjunct for cancer treatment.

Avoid if allergic or hypersensitive to chlorophyll or any of its metabolites. Use cautiously with photosensitivity, compromised liver function, diabetes or gastrointestinal conditions or obstructions. Use cautiously if taking immunosuppressant agents or antidiabetes agents. Avoid if pregnant or breastfeeding.

Chrysanthemum : Early study indicates that hua-sheng-ping (includes Chrysanthemum morifolium, Glycyrrhiza uralensis, and Panax notoginseng) may be beneficial for patients with precancerous lesions. However, more research is needed.

Avoid if allergic or hypersensitive to Chrysanthemum, its constituents, or members of the Asteraceae/Compositae family, such as dandelion, goldenrod, ragweed, sunflower, and daisies. Use cautiously if taking medication for gout, cancer, or HIV. Use cautiously with compromised immune systems or if taking immunomodulators. Avoid with photosensitivity or if taking photosensitizers. Avoid large acute or chronic doses of ingested pyrethrin. Avoid pyrethrin with compromised liver function, epilepsy, or asthma. Avoid ocular exposure to pyrethrin. Avoid if pregnant or breastfeeding.

PREVENTION

Patients who are taking antiretroviral therapy are less likely to develop the disease. In fact, antiretroviral therapy has decreased the rate of KS by more than 80%.

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

 

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Dr Sindisiwe van Zyl qualified at the University of Pretoria in 2005. She is a patients' rights activist and loves using social media to teach about HIV. She is in private practice in Johannesburg.

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