Alternative St John’s Wort

Note
Integrative therapies should not replace antiretroviral therapy (ART) in HIV patients. Patients should consult their healthcare providers before taking any herbs or supplements because they may interact with treatment.

Fair negative scientific evidence

St John’s Wort

Anti-viral effects of St. John’s Wort have been observed in laboratory studies, but were not found in available human study.
Multiple reports of significant adverse effects and interactions with drugs used for HIV/AIDS, including protease inhibitors (PIs) and non-nucleoside reverse transcriptase inhibitors (NNRTIs), suggest that patients being treated for HIV/AIDS should avoid this herb.

Therefore, there is evidence to recommend against using St John’s Wort in the treatment of patients with HIV/AIDS.

  1. Avoid if allergic or hypersensitive to plants in the Hypericaceae family. Rare allergic skin reactions like itchy rash have been reported.
  2. Avoid with immunosuppressant drugs (such as cyclosporine, tacrolimus, or myophenic acid).
  3. Avoid with non-nucleoside reverse transcriptase inhibitors or protease inhibitors.
  4. Avoid with organ transplants, suicidal symptoms, or before surgery.
  5. Use cautiously with history of thyroid disorders.
  6. Use cautiously with drugs that are broken down by the liver, with monoamine oxidase inhibitors (MAOI) or selective serotonin re-uptake inhibitors (SSRIS), digoxin, or birth control pills.
  7. Use cautiously with diabetes or with history of mania, hypomania, or seasonal affective disorder (SAD).
  8. Avoid if pregnant or breastfeeding.

Selected References
AIDS.org. www.aids.org. Accessed March 29, 2009.
American Foundation for AIDS Research (amfAR). www.amfar.org. Accessed March 29, 2009.
Centers for Disease Control and Prevention (CDC). www.cdc.gov. Accessed March 29, 2009.
Elizabeth Glaser Pediatric AIDS Foundation. www.pedaids.org. Accessed March 29, 2009.
Halperin DT, Steiner MJ, Cassell MM, et al. The time has come for common ground on preventing sexual transmission of HIV.Lancet. 2004 Nov 27-Dec 3;364(9449):1913-5.
Loutfy MR, Antoniou T, Shen S, et al. Virologic and immunologic impact and durability of enfuvirtide-based antiretroviraltherapy in HIV-infected treatment-experienced patients in a clinical setting. HIV Clin Trials. 2007 Jan-Feb;8(1):36-44.
National Institute of Allergy and Infectious Diseases (NIAD). www.niaid.nih.gov. Accessed March 29, 2009.
Natural Standard: The Authority on Integrative Medicine. www.naturalstandard.com. Copyright © 2009. Accessed March 29, 2009.
Rigopoulos D, Gregoriou S, Paparizos V, et al. AIDS in pregnancy, part II: Treatment in the era of highly active antiretroviral therapy and management of obstetric, anesthetic, and pediatric issues. Skinmed. 2007 Mar-Apr;6(2):79-84.
The Body: The Complete HIV/AIDS Resource. www.thebody.com. Accessed March 29, 2009.
U.S. Food and Drug Administration (FDA). www.fda.gov. Accessed March 29, 2009.
Vrouenraets SM, Wit FW, van Tongeren J, et al. Efavirenz: a review. Expert Opin Pharmacother. 2007 Apr;8(6):851-71.