Research Article: The Impact of Herbal Drug Use on Adverse Drug Reaction Profiles of Patients on Antiretroviral Therapy in Zimbabwe

Date Published: March 19, 2012

Publisher: Hindawi Publishing Corporation

Author(s): Tinashe Mudzviti, Charles C. Maponga, Star Khoza, Qing Ma, Gene D. Morse.


Background. The main objective was to determine the impact of herbal drug use on adverse drug reactions in patients on antiretroviral therapy (ART). Methodology. Patients receiving first-line ART from the national roll-out program participated in this cross-sectional study. Participants were interviewed and a data collection sheet was used to collect information from the corresponding medical record. Results. The majority (98.2%) of participants were using at least one herbal drug together with ART. The most common herbal remedies used were Allium Sativum (72.7%), Bidens pilosa (66.0%), Eucalyptus globulus (52.3%), Moringa oleifera (44.1%), Lippia javanica (36.3%), and Peltoforum africanum (34.3%). Two indigenous herbs, Musakavakadzi (OR = 0.25; 95% CI 0.076–0.828) and Peltoforum africanum (OR = 0.495; 95% CI 0.292–0.839) reduced the occurrence of adverse drug events. Conclusions. The use of herbal drugs is high in the HIV-infected population and there is need for pharmacovigilance programs to recognize the role they play in altering ADR profiles.

Partial Text

Several challenges exist in resource-limited settings between balancing the cost and toxicity that occurs during antiretroviral therapy (ART). Most HIV-infected patients in resource-limited settings receive a first-line triple combination of lamivudine, nevirapine, and stavudine or zidovudine [1]. Typical examples of ART in these settings include the World Health Organization prequalified fixed-dose combinations of stavudine/lamivudine/nevirapine (D4T/3TC/NVP) and zidovudine/lamivudine/nevirapine (AZT/3TC/NVP), which are being widely promoted in highly active antiretroviral therapy (HAART) “scale-up” programs.

The impact of herbal medicine use on the ADR profiles of the first-line regimens used in Zimbabwe was examined. One of the reasons that patients use herbals is to try and alleviate the discomforts caused by antiretroviral ADRs. A relationship was observed between the type of antiretroviral regimen received and the total number of herbs used. Those patients who were on the regimen containing AZT/3TC/EFV used fewer herbal therapies when compared to the other regimens. One possible reason for this could be the decreased rates of ADRs that are associated with this regimen which decreases the need for herbal use for managing toxicity. Another important finding was the relationship that Musakavakadzi and Peltoforum africanum had with the rates of ADRs. These herbal remedies were associated with decreased prevalence of ADRs, indicating that these herbals might offer some protection to the patients. It is important to note that 98.2 percent of patients were taking at least one herbal remedy and with such a high rate of herbal use there is a need to increase research in herbal remedies that have the potential to influence treatment outcomes.

The study observed a high prevalence of concomitant use of herbal medicines with ART. There was a correlation between 2 herbal preparations (Musakavakadzi and Peltoforum africanum) and a low incidence of ADRs. There is a need to develop pharmacovigilance programs that accommodate herbal medicines as factors that influence ADR prevalence.