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“The only thing necessary for these diseases to the triumph is for good people and governments to do nothing.”

 

 

PCP PROPHYLAXIS
WITH DRUGS AND HERBS

by Subhuti Dharmananda, Ph.D.,
Institute for Traditional Medicine (ITM)
This version produced March 1996.

http://www.gpo.or.th/


Pneumocystis carinii is a cyst-forming fungus with characteristics of unrelated protozoal organisms that causes pneumonia in immune-compromised individuals. It is believed that virtually everyone is infected by this organism during early childhood and that it does not cause disease unless it can become active in the absence of adequate immune responses. The disease it causes, referred to simply as PCP, occurs mainly in persons treated with immune-suppressive drugs (e.g. cancer patients and transplant recipients) and in persons with advanced HIV disease. Until 1989, PCP was the main cause of death in persons with HIV infection.

At this time, PCP can usually be prevented and treated successfully with drugs, especially the combination of TMP/SMX (Bactrim, Septra). Nonetheless, PCP can be deadly if it is not treated early enough. In an attempt to avoid this infection, virtually all patients with CD4 count below about 250 are given the drugs preventatively--those who do not receive the PCP prophylaxis drugs are usually persons who have avoided HIV-related testing and persons who have avoided standard medical interventions.

Drug prophylaxis runs into some problems, mainly intolerance to the drugs by some patients and failure of the alternative drugs that might be better tolerated by these patients. The primary intolerance problem is allergy, usually involving a severe skin rash (continued use can lead to more serious complications). This has been countered, in some cases, by a desensitization procedure in which prednisone (which inhibits the allergy response) is given along with the drugs until the body acclimates to the continued presence of the drug. While the immune-inhibiting effects of prednisone have been a concern and it has been suggested that this approach may increase the incidence of other opportunistic infections, the most recent study indicates no such difficulties with this approach. A new study in Los Angeles (ACTG268) is evaluating whether or not slow introduction of TMP/SMX (with increasing dosage over a period of several weeks) might not avoid some of the reactions, thus eliminating the need for prednisone treatment. The primary failure problem, aside from inconsistency of drug use by some individuals, is that most of the substitutes for TMP/SMX, such as Dapsone, Mepron, and pentamidine, that are given to intolerant patients have a more limited effect and there can be cases of "break through" PCP, that is, occurrence of the infection despite regular use of the drugs. Persons who are allergic to TMP/SMX often develop an allergy to Dapsone over time. It should be pointed out that a benefit of TMP/SMX is that it is broad-spectrum and, for many individuals, is well tolerated over a period of years; it can thus effectively inhibit not only Pneumocystis infection, but other infections, such as Toxoplasmosis and Aspergillis.

    

PCP prophylaxis is the only therapy consistently cited that clearly extends life span of persons with HIV infection. When TMP/SMX is given in time to prevent a first bout of PCP and then used consistently by a group of patients, those individuals will live, on average, about two years longer than persons who do not use this method of treatment. Aside from the fact that PCP can be deadly if not treated promptly, when a person experiences this disorder, there is usually a substantial weight loss (which is only partly reversed during recovery) and the HIV activity becomes stimulated (probably as the result of immune activity against the Pneumocystis and the effects of disease stress on resistance to HIV effects), leading to some disease progression.

Due to the problems that some patients experience with the drug therapies, and the great value in avoiding PCP infection, there has been an effort to find herbs that can be used along with the less effective drugs or as an alternative to them. To qualify as a suitable substance, the herb must have been shown effective against Pneumocystis or related organisms and it must have been shown to be safe for extended use. There are currently three major candidates for this purpose.

Garlic is one such herb which is already recommended for regular ingestion by those with HIV efforts to find better ways to administer high-potency garlic extracts are being undertaken. At this time, use of raw garlic (perhaps in blender drinks as well as in foods) and Kyolic aged liquid garlic extract (not the dried version) are recommended.

A second example of a potentially suitable herb therapy for PCP prophylaxis is the three-herb combination of stemona (root of Stemona japonica), sophora (root of Sophora flavescens),and phellodendron (bark of Phellodendron amurense) developed by the current author. These herbs are used in the treatment of lung diseases, though they have several other anti-infection applications. In addition to having antiprotozoal, antibacterial, and antifungal activity, they are also used effectively in the treatment of human tuberculosis (a type of mycobacterium infection). These herbs are safe for long term use (according to Chinese experience in non-HIV patients) and have been utilized, without apparent adverse reaction, by numerous persons in the U.S. with AIDS who were in need of additional prophylaxis for PCP or mycobacterium infection (in the form of MAC). In China, stemona is used as a prophylaxis for bronchitis. The three-herb combination (combined with three other herbs to aid digestive functions) has been prepared in tablet form, called Stemona Tablets, and the suggested dosage is 6 tablets three times daily.

A third candidate for therapy is the herb ching-hao (tops of Artemisia annua). This herb has long been used in China for treatment of infections and for fevers of unexplained etiology in weakened patients; its main current use is in treatment of malaria. A laboratory animal study conducted in China showed that it could inhibit Pneumocystis. A practitioner of Chinese medicine in New York City (Susan Paul), has been administering this herb to AIDS patients for the past three years (dosage 6 grams of extract granules daily) and has claimed that it is safe and apparently of benefit. Ching-hao has the interesting immunological property of promoting cell-mediated immune responses and inhibiting antibody-driven responses (and, for that reason, is used successfully in treating some autoimmune diseases, such as SLE). It has been proposed that such an immunological adjustment might be of benefit to persons with HIV infection, since HIV tends to down-regulate cellular immunity in favor of humoral immune responses.

    

It is important to recognize that the possible herbal therapies for PCP remain unproven at this time and are not likely to be firmly established as being either effective or ineffective in the near future. Because of the importance of PCP prophylaxis to longevity, it is recommended that proven drug therapies be approached as the first choice, and that herbal therapies be considered as a back-up in case that the more effective drugs are not tolerated. It would be a reasonable approach to alternate between the possible herb therapies to minimize potential problems from extended use of a single regimen. At this time, it does not appear necessary to use such herbs along with TMP/SMX for PCP prophylaxis. There may be other herbs that can aid in tolerance to this drug combination (see the ITM report on Chinese Herbs that Inhibit Allergy Reactions published in the Protocol Journal of Botanical Medicine and the International Journal of Oriental Medicine).

 

 

 

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