In exploring all the treatments for HIV disease, many individuals examine approaches outside of standard mainstream therapies. In fact, various studies indicate between a quarter and three-quarters of people living with HIV have employed some form of alternative treatments. Because HIV is a life-threatening illness where conventional medicine has not found a cure, alternative approaches—including ancient traditional healing modalities, spiritual approaches, foreign pharmaceuticals, homeopathy and East Indian spices—have been widely used to combat this disease and its symptoms. Stories of remarkable success and failure have been documented. At the same time, rip-offs abound.
This article describes the elements that an individual may consider in devising a comprehensive, holistic, aggressive approach to fight HIV. This approach focuses on body, mind, and spirit and incorporates general health maintenance, nutritional factors, and alternative therapies. A person living with HIV can learn about these approaches from a variety of practitioners, then integrate them with standard medical care in collaboration with an HIV-experienced physician. No endorsement of any particular or specific program or product is intended or should be inferred. Scientific studies are discussed when available. Use the same criteria to evaluate natural approaches as you would for standard therapy drugs. Just because a treatment is natural doesn't mean it has no potential toxicity or adverse effects. As always, potential toxicity, cost and availability need to be balanced with a treatment's potential effectiveness.

General Health Maintenance
A solid foundation for better health is achieved by making some well-known—indeed commonsense—lifestyle choices. These steps are the basics of any healing plan and should be taken before any specific alternative product or modality is contemplated.

Nutrition
People living with HIV need a higher-protein, lower-fat, nutrient-rich diet with frequent, regular meals including fresh fruits and vegetables, complete proteins, whole grains, less sweets and highly refined foods. A good diet for someone with HIV has multiple protein sources such as lean meat, cheese, fish, chicken, nuts and yogurt. While it is possible for someone with HIV to get adequate and complete proteins in a vegetarian diet, strict macrobiotic diets have usually not benefited people with HIV. Several servings daily of fruits, grains, and vegetables are also important for a balanced diet. Small, frequent meals make it easier for the body to digest food than does a single, large portion.

Studies show that even early, asymptomatic HIV-positive individuals can have decreased absorption of nutrients, so that the recommended dietary allowances (RDAs) are inadequate. People with HIV, from the beginning of their illness, need more basic nutrients to compensate for poor absorption. This is crucial since maintaining a stable weight, especially lean body mass (muscle and organ weight), directly correlates with survival. Fat weight doesn't help.

Exercise
Physical exercise has a demonstrated value for improving health and as a supportive HIV treatment. For people living with HIV who are symptom free, vigorous regular aerobic exercise, lasting 30-45 minutes, three to four times per week, provides a solid cardiovascular workout. Examples of this aerobic exercise include running, biking, dancing, aerobics classes, swimming, cross-country skiing, roller-blading, games like soccer, racquetball or basketball and use of cardiovascular machines such as Stairmasters, stationary bikes, Nordic Tracks or treadmills. Many people cross-train with a variety of activities to keep up their interest and motivation.

An aerobics program conditions the heart and lungs, combats depression by raising endorphin levels, and in several studies actually raised CD4+ cell counts (an indicator of the strength of the immune system). One study showed fewer opportunistic infections and better coping with stress in a group of regular exercisers. However, marathons and other extreme endurance workouts have sometimes weakened a person's immune system. Resistance exercises (using weights or machines) build muscle mass, help preserve lean body weight and promote better health.

For those who are symptomatic or recovering from illness, it's important to discuss a specific exercise program with your health care provider. Physical therapists are trained to help develop rehabilitation programs. Regardless of your health status, always begin exercise gently and build slowly. In almost all cases, any exercise is better than none at all.

Relaxation
Life is stressful. Having HIV disease is very stressful. Being a patient is stressful. Fear, loss, grief and financial trouble can all be stressful. Studies show that people with HIV benefit from some form of structured daily relaxation, whether it's yoga, music, deep breathing, muscle relaxation, meditation or tai chi. Multiple studies reported at recent international AIDS conferences have shown that regular relaxation decreases depression, improves attitude and improves specific laboratory measurements of immune function. Other studies have shown that high levels of stress can weaken the immune system, which may lead to increases in symptoms and infections.

Substance Abuse Treatment
An obvious lifestyle change for any person living with HIV is to consider ending any form of substance abuse. Overall health and the strength of the immune system are significantly improved when certain substances are avoided. Terminating these substances may be one of the most difficult challenges an individual can face. Addiction is its own life-threatening illness.

Cigarette smoking has been correlated with increased problems with Pneumocystis carinii pneumonia (PCP), as well as more frequent cases of cryptococcal meningitis (a fungal infection). Elimination of cigarette smoking restores the lungs' ability to cleanse themselves within just a few weeks, with lung function continuing to improve over time.

There is diversity of opinion regarding marijuana use. Marijuana smoke has had an impact on the lungs similar to tobacco smoke and some studies have shown marijuana to be slightly injurious to the immune system. Yet its appetite-stimulating effect (the "munchies") has helped people who don't eat enough gain weight. If you are considering marijuana use, talk to your physician about its risks and benefits.

Chronic use or overuse of alcohol and hard drugs poisons the same organs (brain, liver and immune cells) that HIV attacks. Studies show cocaine and narcotics may increase viral replication. In my practice when patients have quit alcohol or hard drugs, the improvement in their health has been obvious to them and to me and is reflected in their lab values, including their CD4+ cell counts.

Supportive Activities
While there are no hard data linking support groups or the role of a positive attitude with in creased survival, people living with HIV disease frequently attest that these activities are associated with a higher quality of life and greater optimism about the future.

The value of being in a support group has been researched in cancer patients, with one study reporting that being in a group for a year doubled the survival time for women with breast cancer. Similar studies of HIV support groups are in progress and may show significant value. People with HIV who attend support groups initially receive assistance in coping with their feelings of shock and denial as they deal with their diagnosis. They often encounter people who are surviving and thriving with this disease. Groups also serve as a forum for sharing new information on treatments and resources, as well as provide time for problem solving. Individuals often have the opportunity to build a support network that extends outside of the group meeting that may help meet emotional needs for friendship and intimacy. All this occurs in a context of talking through the difficult issues raised by HIV: who and when to tell about one's HIV status, family issues, career changes, dating, sex, love and one's personal search for the meaning of life. Support groups also provide time for healing activities, such as singing, meditation and the use of imagery.

disease progression in individuals with increased intake (from food or supplements) of various vitamins, including vitamin A, B6, C, E, thiamine, riboflavin, niacin and beta-carotene. Vitamins should always be taken with food, with the exception of carnitine and NAC (two amino acids that are better absorbed on an empty stomach). If you are serious about using nutritional supplements, work closely with a nutritionist experienced with HIV.

Positive Attitude

The overall attitude a person with HIV takes toward his or her illness also makes a difference. For instance, the notion of the patient as helpless victim can be replaced by a model of one who is actively involved in his or her health care and is educated and empowered to make treatment choices. Researchers in a relatively new field, psychoneuroimmunology, are studying the connections between thought, feeling, and the immune system. It seems that what we tell our bodies about our health or illness can impact the progression or outcome of a disease.

The placebo effect is the best known example of this process. Studies show that when someone believes a medicine will be effective, as many as 40% of those taking the placebo (a sugar pill with no active ingredients) will realize a positive effect. Likewise, if someone believes the illness to be a death sentence, this result may be more likely to come true. Studies of the characteristics of long-term AIDS survivors show that most have a positive outlook and believe that their actions will make a real difference.

Vitamins and Supplements
The use of vitamins and supplements is a highly individualized choice, with some people using none and others taking literally dozens of capsules and tablets a day. As of yet, no hard scientific data are available from controlled clinical trials reporting which vitamins and supplements, and what doses, are best for people with HIV disease. Several recent observational studies have been published showing delayed

Acupuncture and Chinese Herbs
Chinese medicine is an ancient method of healing used by over 20% of the world's population, with an emphasis on treating the whole person, not just a particular disease. For instance, two people with HIV disease might receive very different Chinese-medicine treatment plans geared to each individual's strengths, weaknesses, imbalances and lifelong patterns.

In spite of this highly individualized approach of Chinese medicine, protocols have been established to test standard herbal formulations and acupuncture treatments in HIV disease. In several studies, formulas with astragalus, lingustrum, ginseng, licorice and other Chinese herbs have shown effectiveness against various symptoms such as fatigue, sweats, weight loss, diarrhea and skin rashes. These herbs have not been documented to improve lab values.

Some people choose to add one of the standard combination herbal formulas based on astragalus to their treatment regimen. Others who want to go further should work with a practitioner of Chinese medicine experienced with HIV. There are many ways to combine these approaches with standard medical practices. In fact, Chinese medicine can often relieve the side effects from standard prescription drugs.

Herbs and "Natural" Pharmaceuticals
When no approved drugs existed, people living with HIV viewed herbal remedies as drugs from nature. Some of the products were immune enhancers or antivirals by reputation, others were more specifically focused against HIV. Initial recommendations were made based on folklore and anecdotal information. Now a few have been studied scientifically. People often mistakenly believe natural means safe. For all potential HIV treatments, potential risk and benefit must be balanced.

Compound Q
Compound Q is an intravenous medicine that comes from the root of the Chinese cucumber plant. It is used in China as a cancer therapy and to induce abortions. Imported and sold through buyers' clubs for HIV disease, compound Q is administered through intravenous (in the vein) infusion, given by physicians willing to work with unapproved products or by underground clinics staffed by knowledgeable laypeople.

Compound Q is different from other antivirals, which slow the spread of the virus to uninfected cells; instead, compound Q kills already infected cells. Practitioners hope that compound Q will greatly reduce the viral load, allowing the immune system to repair itself. Currently, there is wide variation in dosages being used (one or two vials up to twenty vials), the frequency of administration (weekly to monthly) and the duration of the infusion (2-24 hours). In various studies, CD4+ stabilization has been achieved in some patients, with dramatic increases for a few. While research has continued with compound Q, also known as GLQ223, no definitive data have yet emerged to confirm its value as an HIV treatment, although the existing data are considered interesting and promising.

Common side effects, such as muscle aches and fatigue, are reduced by beginning anti-inflammatory drugs like ibuprofen before the infusion. There is a rare life-threatening side effect—an emergency allergic reaction—called anaphylaxis. Benadryl pretreatment, either orally or intravenously, may lessen this risk. There have been reports of serious central nervous system side effects (disorientation, hallucinations and coma) that may be prevented, with pretreatment with Decadron and by screening out individuals with low CD4+ cell counts. Anyone with a CD4+ cell count under 100 should approach compound Q with great caution. If used, this compound must be administered by someone experienced with it and prepared for the emergency treatment of anaphylaxis.

Hypericin
Hypericin is an extract from the flower St. John's Wort, and produced synthetically, with reputed broad spectrum antiviral effects against HIV, herpes, cytomegalovirus and Epstein-Barr. It provides several good examples of our growing understanding about herbal medicines. Originally, people with HIV took St. John's Wort, the herb itself, since there was test tube evidence that hypericin stopped HIV replication. Later it was seen that hypericin levels from the orally administered herb were less than 1% of the test tube levels that showed antiviral effects. A study was begun with much higher intravenous doses of hypericin but was stopped quickly because of liver toxicity and light sensitive skin rashes. A natural concentrate, administered orally, has been developed, but data are sketchy. Hypericin clearly requires further study.

Echinacea and Other Immune System Stimulants
Several natural products stimulate the immune system, such as echinacea, Viscum album or mistletoe, goldenseal, shitake mushrooms, acemannen or aloe, and garlic. While each product has a theoretical basis for boosting CD4+ cell counts, these stimulants require further research in people with HIV. The complexities of the interactions between HIV and the immune system are so great that the idea of stimulating the immune system is clearly an oversimplification. A stimulus to CD4+ cells might help the body or might lead to increased viral replication. Boosting some of the immune system's chemical messengers (cytokines) may help the body, while boosting others may lead to disease progression. As a result, immune-stimulating herbs have become controversial in HIV therapy, and some experts advise against them.

Similarly, if substances like garlic and pau d'arco contain natural antibiotics and antifungals, there are still considerations about changing the balance of the body's normal flora (the natural balance of bacteria and fungi) as well as the possibility of developing resistance as with standard treatments for HIV. Clinical trials are in progress for some of these products, which should help answer some of these questions.

Curcumin
Curcumin is one of the elements in tumeric. Along with several other compounds, it slows HIV replication in test tubes. Results of trials in humans are pending, but the appeal is great because of curcumin's low price and easy availability.

Shark Cartilage
The soft bones of sharks contain natural antibiotics and other substances that may slow the growth of a tumor's new blood-vessel formation. Because shark cartilage is difficult to take orally, causes nausea, and is poorly absorbed in the stomach, it is usually administered as a retention enema. It has been studied in small numbers of people and was shown to be effective in a few cases.

Blue-Green Algae
Blue-green algae grows on the surface of an Oregon lake and is sold as an amino acid and mineral-rich nutrient. It is claimed that it can energize both the body and the mind. People report increased energy on this supplement, and in the early days of high AZT doses it seemed to help some people avoid AZT-induced anemia. Researchers at the National Cancer Institute found certain substances (sulfolipids) from other algae species that inhibit HIV in the test tube, but this result has not been found with blue-green algae.

Kombucha
Kombucha is a living, growing colony of fungal and bacterial elements also known as the Manchurian mushroom. Rapid growth in kombucha's popularity resulted from early positive press and because it is readily available. It is brewed and taken as a tea, with supposed immune-enhancing and antibiotic properties. There are a few dramatic stories of improvement in HIV illness, and frequent reports of increased energy and mental clarity. A concern of some specialists is that other potentially disease causing germs, such as the mold aspergillus, may also be growing in the brew. In addition, if it does contain antibiotic substances, the development of resistance is a concern. Individuals with low CD4+ cell counts should be wary and discuss taking this treatment with their physician.

Licorice
Licorice root has long been used as an anti-inflammatory treatment, and also as a tonic and treatment for low blood pressure. It is used in many Chinese herbal mixtures. In Japan, glycyrrhizin, the extract from the root, is used as an intravenous pharmaceutical with documented effectiveness against hepatitis B. Most of the research done with licorice has come from Japan. In a handful of small studies it has shown benefit in HIV infection with decreases in fatigue and light-headedness and small lab improvements. It showed value for people with liver problems. Side effects include high blood pressure, fluid retention and cardiac problems.

Physical Agents
A variety of therapies have been tried against HIV that are best described as physical agents. For instance, blood has been exposed outside the body to certain wavelengths of light and to heat. People have tried hyperbaric chambers (used to treat the bends in scuba divers) and heating the body or the blood. So far these and other methods have not shown any consistent scientific value, but several are popular in certain alternative therapy circles.

DNCB
DNCB, di-nitrochlorobenzene, is a chemical used in photography that has been an underground AIDS therapy since the beginning of the epidemic. It was first used as a treatment for Kaposi's sarcoma (KS), with individual lesions being painted at regular intervals. After five years its use began to wane because of the lack of consistent results, but recently DNCB has reemerged as an immune enhancing therapy that is not just for KS. On a weekly basis, people paint DNCB on themselves in a two-to-four-inch patch on their forearm, using a gradually weaker solution as the body's sensitivity increases. It creates a poison ivy-like reaction varying from an itchy red area to painful blisters like a serious burn. The theory behind DNCB is that it will activate the immune system to fight HIV. There have been some bad rashes from DNCB, and no hard data support its use.

Ozone
Ozone is an unstable form of oxygen that is commercially used to kill bacteria. In theory it works because high oxygen levels are toxic to many microbes. Thus a belief developed that ozone might kill HIV. Ozone is administered intravenously, rectally and through ex-vivo infusion (blood drawn from the body, mixed with ozone and then reinfused) in people with HIV. The obvious flaw in this theory is that 99% of HIV in the body is not in the blood but tucked away in the lymph nodes, inside cells and in other organs. While no good data support its use, ozone therapy has strong supporters, and people travel far and spend large sums of money to try it.

Hyperthermia
There is a belief in natural healing that fever is the body's way to fight infection. Before the discovery of antibiotics, syphilis was treated by giving a patient malaria to induce high fevers. In the late 1980s, several reports concluded that hyperthermia (heating of the blood) as a treatment for HIV had no value, and its use was not allowed in the US. As a result, clinics were set up outside the US where several people died from the treatment. Hyperthermia treatment centers exist, but no clear, documented data support its use in HIV. Scientifically, it faces the same objection as ozone therapy—only a tiny and insignificant amount of the overall HIV viral load exists as free virus in the blood. Most of the HIV is incorporated inside cells or body tissue, where such treatments are unlikely to have any effect.