About AIDS

The FDA last week issued a Public Health Advisory urging HIV patients to avoid using the popular herbal product St. John's wort in combination with their HIV "drug cocktail." The warning is based on a study published in the British medical journal The Lancet, indicating that St. John's wort (aka Hypericin or Hypericum) significantly reduces blood concentrations of the protease inhibitor Crixivan (indinavir).

Apparently the herb is processed by the body through the same pathway (cytochrome P450) as Crixivan; the herb speeds up the liver's elimination of the Crixivan from the body. If the Crixivan concentration in the blood drops, there won't be enough of the drug to control the HIV, and viral resistance may develop. The potential result: a failed "cocktail" combination and a therapy option lost.

Although this study deals only with Crixivan, many HIV drugs are also C-P450-processed compounds, including all the protease inhibitors (PIs) and NNRTI's (non-nukes). Therefore, the warning should be regarded as applying to them, too. Indeed, St. John's wort should be avoided with all C-P450 drugs "for transplants, heart disease, depression, anxiety, some cancers" until future data demonstrate otherwise.

Hypericin/St. John's wort is a popular herbal product used for depression and anxiety, conditions which bother many people with chronic illness, including HIV disease. Because herbal products are sold unregulated as "food supplements," they have not been tested, but are viewed by the public as being harmless and that may false. Consult with your doctor to see if this herb/drug interaction might be a problem for you. For details, see The Lancet, 2/12/00; or go to http://www.nih.gov/news/pr/feb2000/wgmcc-10.htm