Unravelling AIDS

What is the real extent of the AIDS epidemic? Why does AIDS attract so much controversy? Do conventional anti HIV drugs do more harm than good? Are there safe and effective treatments that can be made widely available at affordable costs?

This special mini-series is part of an in-depth report, Unravelling AIDS, to be published by ISIS later this year.

If you are interested in reserving a copy of the full report at a special prepublication price of £7.50, please e-mail sam@i-sis.org.uk

• AIDS the Global Pandemic?
• AIDS & HIV?
• African AIDS Epidemic?
• Can Traditional Medicine Help AIDS?
• Alternative Combination AIDS Therapy?
• "Pink Panacea", an AIDS Vaccine?
• Can Exercise Help AIDS?

ISIS Report 01/04/04

Can Traditional Medicine Help AIDS?

While billions of dollars have been pledged to help the worst affected, many of the poorest countries are still left without the medical support available in the west, and up to 80% of the population must rely on traditional medicine for primary healthcare. Sam Burcher reports on some successes with a native herb.

A fully referenced version of this report is posted on ISIS member's website. Full details here

Medicinal plants have been part of the great healing traditions around the world going back thousands of years; the best known being the Indian Ayurvedic medical system, Traditional Chinese Medicine and Western Herbal Medicine. These traditional medicines are the basis of a quarter of all drugs in today’s modern pharmacy [1].

The World Health Organisation (WHO) defines Traditional Medicine as health practices, approaches, knowledge and beliefs incorporating plant, animal and mineral based medicines, spiritual therapies, manual techniques (e.g. reflexology) applied singularly or in combination to treat, diagnose and prevent illness or maintain well-being. In 2002 WHO launched its first comprehensive traditional medicine strategy to assist efforts to promote affordable, effective and safe use of Traditional Medicine (TM) and Complimentary Alternative Medicine (CAM) [2].

In Africa, TM is used by up to 80% of the population to meet primary healthcare needs and is crucial in the fight against infectious diseases. The ratio of a conventional, or western-trained general practitioner (GP) to patients is 1: 20 000, whereas the availability of TM practitioners is 1: 200 to 1: 400. This highlights the need for reliable and affordable herbal medicines that are locally available [3].

In South Africa, it is estimated that over 6 million people are living with HIV/AIDS and 150 babies are born with HIV every day. Conventional drugs exist for the treatment of HIV/AIDS, but they are only affordable by an estimated 1% of sufferers. Three out of four AIDS patients in Africa rely on some form of TM for treating the symptoms of HIV/AIDS (see Box 1).

Sutherlandia Frutescens (subspecies Microphylla) genus Fabaceae (pea and bean/leguminosae) is a perennial shrub that grows wild in the arid regions of Botswana, Namibia, Zululand, Western and Eastern Cape regions of Africa. Sutherlandia can grow up to 1.5 metres in height in optimum conditions of stony grasslands exposed to constant sunshine in daylight hours. A display of blood red flowers bloom from June to December and its seeds are carried in greenish- red papery pods, which are almost transparent. The pinnate and compound shaped leaves have a green-grey colour giving the bush a silvery appearance [4].

The leaves and branches of the Sutherlandia bush are bitter to the taste, but are known traditionally to have health-giving properties. The dried leaves, containing four active compounds, are ground by traditional healers to make into tonics, teas, pills or creams (see Box 1). In the absence of easily available and affordable anti-retrovirals, these herbal treatments are used as the first line of defence in combating the symptoms of AIDS and other wasting diseases. Traditional Medicine practitioners who prescribe Sutherlandia are keen to preserve the use of the plant as a traditional medicine to maintain its patent-free status.

Conventional and traditional healers join up
An independent, inter-disciplinary partnership of TM healers, botanists, conventional doctors and scientists have joined up to form the group, PhytoNova, to prescribe and record the medicinal benefits of Sutherlandia in the treatment of HIV/AIDS symptoms. Dr Nigel Gericke, a GP and a botanist and his colleague Mr Credo Mutwa, 82-year-old traditional healer (sanusi), lead PytoNova's clinical practice and laboratory in Cape Town, South Africa.

PhytoNova makes and supplies medicinal remedies derived from Sutherlandia for the treatment of HIV/AIDS symptoms direct to their own patients and to AIDS clinics in the region before a big pharmaceutical company can get their hands on it. Hundreds of AIDS patients have been treated by Gericke and Mutwa, who share the view that as long as they can prove that something is in the public domain, and is widely used to treat HIV/AIDS, then no one can come along and patent it for profit.

The price to Africans for a month's supply of pills made from the Sutherlandia bush is £2.50, and the powder form of the dried leaves, which is thought to be more effective because of its bitter taste, costs less than 60p for two month's supply [5].

Gericke describes the promoting of weight gain in wasted, full-blown AIDS patient as Sutherlandia's principal and most valuable medicinal property. Frequent significant and often sustainable gains in weight have been recorded in HIV patients taking Sutherlandia tablets. Weight records of 244 patients receiving treatment of Sutherlandia between November 1999 and September 2002 are available from The HIV and AIDS clinic in the Ngwelezane Hospital. Weight increases of up to15 kg were reported in the majority and in some cases gains of 3-5kgs were sustained over the entire record keeping period [6]. This physiological boost has an immediate effect of enhancing energy levels and improving the patient's mood. Gericke said: "We have seen several examples of bed-ridden patients able to get up after a month's treatment and even to return to subsistence farming." Other AIDS patients who were told to "go away and die" are delighted to find themselves still alive three years on after being treated by Mutwa. This anecdotal evidence supports the theory that AIDS may have become a chronic illness rather than a fatal one.

Gericke informed South African government scientists of the benefits of Sutherlandia. These include improvements in appetite, weight gain, sleep, exercise tolerance, anxiety and an overall sense of well-being. But "because it was a tonic, the scientists dismissed it. They always rush, with classical reductionist thinking, to look for the magic ingredient," said Gericke, summing up the reality that HIV/AIDS itself is so complex, that it is increasingly apparent that there is no "one-stop" solution for its treatment. Gericke has also appealed to his government to grow the bush on a massive scale, to mobilise a public health drive, but this too was ignored. To protect wildstocks of the plant from over-harvesting in the region, he has contracted local farmers to grow acres of Sutherlandia shrubs. This precautionary approach has created local employment and maintained the "not at risk" status of Sutherlandia as a medicinal plant.

PhytoNova is convinced that progression to AIDS from HIV can be delayed once the patient has agreed to receive the appropriate treatment and doses of Sutherlandia, which are taken on an ongoing basis, in addition to careful attention to diet. It is recommended that alcohol; recreational drugs and other drugs that damage the immune system should be avoided. Anne Hutchings, an ethno-botanist and researcher of traditional Zulu medicine at the University of Zululand, who works in the weekly HIV and AIDS clinic at Ngwelezane Hospital, supports these prescriptions. She uses Sutherlandia derived products from PhytoNova in addition to her own remedies made up from local plants (see box1). She started with just 11 patients in 1999 and now has more than 400 [5].

In 2001, a community-based AIDS hospice in Emoyeni, South Africa, admitted 71 AIDS patients for terminal care. Sister Pricilla Dlamini treated the patients with Sutherlandia pills and infusions of another local plant often referred to as African potato (Hypoxis Hermerocallidea) PhytoNova tracked the progress of her patients one year later. Of the 71 patients, 30 had been discharged as healthy back into the community. Some have since returned for follow-up treatments with Sutherlandia while others have been lost to follow-up treatments. No adverse events were reported [7].

Virginia Rathele is a nurse and Zulu traditional healer (sangoma) in the Northern Cape town of Kuruman. She is using Sutherlandia pills to treat 300 AIDS patients in her clinic. She says "Sutherlandia does not work properly just on a diet of porridge. You have to have vegetables." One of her patients was close to death and weighed only 26kg, but after receiving treatment and an improved diet now weighs 45kg and is helping to run the clinic. Rathele is also keen to keep the plant patent free and believes the treatment should be accessible to everyone.

Traditional medicine dispels the darkness
Historically, Sutherlandia has been called many names and used for many purposes. The indigenous Koi San tribes-people name it "Insiswa" meaning "the one that dispels darkness." Insiswa has been used for centuries as an energy booster and anti-depressant. Sangomas know the plant as "unwele", a "great medicine" which so uplifts your spirit that you will not want to tear your hair out and was prescribed for the widows of Zulu warriors. The name "cancer bush" or "kankerbos" is another name ascribed to Sutherlandia by Afrikaners and attests to a traditional use as a cancer remedy. Sutherlandia came to the attention of British botanists when Zulu sangomas used it against the 1918 influenza pandemic that killed 20 million worldwide. The English version of Sutherlandia was named after James Sutherland, the first superintendent of the Edinburgh Botantical Gardens [8].

Sutherlandia has a "beautiful portfolio of chemicals" says Gericke (see Box 2). He has analysed and identified a range of chemicals, which have been previously used for the treatment of patients with cancer, TB diabetes, schizophrenia and depression and as an anti-retroviral agent. Some of these molecules, already identified from sources other than Sutherlandia have US patents attached to them for their use in treatment of these diseases [9]. Gericke recognises the great potential of the plant's chemistry and says: "The claim we are making on the basis of this, is that we can dramatically improve the quality of life of many AIDS patients. We are certainly not making the absurd claim that Sutherlandia is a cure-all or a cure for AIDS.

The medical records of a patient who had ceased taking conventional anti-retrovirals to combat symptoms of HIV /AIDS for two years before turning to PhytoNova for treatments using Sutherlandia pills were documented. These show a marked decrease in the patient's viral load and a significant increase of his CD4 lymphocyte cell count over a six-week period. His starting CD4 count in May 2001 was 340, which increased to 647 in June 2001. During the same period his viral load decreased from 25 000 to 9 200 [10].

A study on toxicity
To date, no severe adverse reactions to Sutherlandia in any form has ever been reported. Nevertheless an independent safety study was conducted by South Africa's Medical Research Council because of the significant ethno-botanical background and availability of the plant as well as the severity of the HIV/AIDS problem in the region. The study tested the effect of Sutherlandia on sixteen vervet monkeys in four groups including one control. The monkeys were fed with dried Sutherlandia leaf powder for three months and exhibited no single indication of toxicity even in the group fed nine times the dose prescribed for the treatment of AIDS in humans. A massive dose of 1x 500mg/kg by mouth was administered without any adverse effect. This is the first South African medicinal plant to be evaluated for toxicity using primates in a controlled study [11].

The Indigenous Knowledge Systems Division (IKS) of The MRC in South Africa is committed to the scientific and clinical validation of promising indigenous medicinal plants. Sutherlandia is considered by IKS to have a long history of medicinal use going back at least 105 years. It acknowledges that a tonic made from the plants may be of value to people living with HIV/AIDS in terms of enhanced well being, increased appetite and body mass as well as increased tolerance for exercise. Use of Sutherlandia is contraindicated in pregnancy [12].

The IKS was formed in 2001, and has created successful collaborations with traditional healers across the regions of Africa. So far they have identified 20 traditional healers across the region from the 300 000 that are estimated to exist on the continent. The select healers are encouraged to keep records of their consultations and it is hoped they will train other healers to do so. A medicinal garden project has also been started where plants can be cultivated and identified. A library and computers systems are also being developed alongside a TM database called TRAMED III, which incorporates medicinal plant monographs.

Not all testimonies to the powers of Sutherlandia are glowing. Stuart Thomson, director of Gaia Research has attacked the plant, the MRC trials and PhytoNova. He says Sutherlandia is a "poison panacea" and PhytoNova is unlawfully distributing a substance, which he believes is potentially toxic as well as using people as human guinea pigs. Thomson considers the MRC study to be invalid because the monkeys were not infected with HIV/AIDS and were studied for less than six months [13]. He also raises some questions on the safety of L-Canavanine (see box 2). But Sutherlandia taken under allopathic or traditional medical guidance would certainly seem to offer an alternative to sludgy liquids made of industrial solvents which sell on the streets of Johannesburg like hot cakes by those looking to exploit the numbers of desperate people living with HIV /AIDS [14].

Of course, there are plants among Africa's flora and fauna that are toxic and efforts are being made to study and document these to avoid incorrect TM treatment of HIV/AIDS or indeed any illness. One such plant recorded to have toxic properties is Callilepis Laurealo or "Impila".

One Sutherlandia plant can treat ten people
Mutwa of PhytoNova says cultivating Sutherlandia is a question of sanding each little seed with fine sandpaper; planting, watering and letting them grow. He refuses to see his country destroyed by HIV and AIDS when nobody really knows the origins of the disease. His reminds critics that the bark of the Cinchona tree forms the natural chemical basis of quinine which, when used correctly is a successful treatment of Malaria for many [15]. Since resistance to quinine has become more prevalent, the shrub Artemesia was discovered to contain Artemisian, an alkaloid with even great efficacy for the treatment of mefloquinine resistant strains of Malaria.

The MRC also plans a pilot clinical trial involving 50 people on the medicinal effects of Sutherlandia [16]. This was scheduled to begin in February 2002, pending a decision by the Governments Medical Approval Council. The Director of the IKS Dr Matlalepula Matsabisa told the New Scientist "A trial like this could act as a valuable template for other trials." He said [17], "The fact is people are already using it and will continue to whether or not the government approves trials." It appears that Africa's first line treatment of HIV /AIDS is Sutherlandia, local to the regions where it is needed the most, whose history as a beneficial, though bitter, Traditional Medicine puts it firmly in the hands of the people.

Box 1

*Secondary symptoms reported by patients at Ngwelezane Clinic: abdominal pain, night sweats/fevers, urinary problems, nausea/vomiting and swollen glands. All the above recommended TM treatments were made by healthcare professionals at an HIV/AIDS clinic in South Africa .

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