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
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.
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 .
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) .
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 .
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) Family 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 .
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.
An independent, inter-disciplinary partnership of TM healers, botanists, conventional doctors and scientists cooperated to form the company , PhytoNova (Pty) Ltd, to offer a reconstructive herbal treatment for those suffering from diseases affecting the immune system who have little or no access to conventional medicine. The Phyto Nova team have shared knowledge and experience of the medicinal benefits of Sutherlandia , particularly in the supportive treatment of people living with HIV/AIDS. Sutherlandia is used to boost the immune system of such patients which may delay progression of the disease and can also be considered by physicians for use with antiretroviral treatments where available or as an alternative treatment if side effects from conventional medicine are intolerable.
PhytoNova makes and supplies medicinal remedies derived from cultivated Sutherlandia, of a variety specially selected for its plant chemical profile, for the treatment of HIV/AIDS symptoms direct to doctors, nurses, NGO's and patients in the region. Key information was released into the public domain early on in the development of the product by Phyto Nova to prevent important novel activities of the plant from being patented. The plant has the ability to enhance the immune system, and more specifically encourage CD4 cell production in immune-compromised patients as well as profoundly stimulating appetite and anti-wasting activities in wasted patients. This does not prevent patents being taken out on isolated pure chemical constituents of the plant, but open dissemination of information has encouraged other companies to make Sutherlandia products available and has generated a great deal of academic research into the plants' many biological activities. It has also encouraged farmers to plant Sutherlandia as a crop.
It is estimated that many thousands of HIV/AIDS patients are being treated with Sutherlandia by nurses, doctors, NGO's and indigenous healers, although no accurate figures are available from the companies manufacturing and distributing Sutherlandia products. The price to Africans for a month's supply of pills made from the Sutherlandia bush is about £2.50, and the powder form of the dried leaves, which is thought by rural folk to be more effective because of its bitter taste, costs less than 60p for two month's supply .
Gericke describes immune modulation in HIV/AIDS patients and promoting of weight gain in wasted, full-blown AIDS patient as Sutherlandia's principal and most valuable medicinal properties in field of HIV/AIDS treatment. Frequent significant and often sustainable gains in weight have been recorded in HIV patients taking Sutherlandia tablets. Records, including weight changes, of HIV/AIDS patients receiving treatment with Sutherlandia have been kept by Anne Hutchings from November 1999 to the present day, who has treated almost 1 000 patients at a herbal clinic she has run under supervision at Ngwelezane Hospital. (see Box1) Weight increases of up to15 kg were reported in some wasted patients, and many with lesser weight gains were able to maintain their weight . 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, but they must continue to take the treatment, or the benefits are lost after a few months of non-compliance” 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 Credo Mutwa, a traditional healer (sanusi). This anecdotal evidence supports the theory that AIDS may have become a chronic illness rather than a fatal one.
PhytoNova informed the Office of the President and the Ministry of Health of the South African Government, and scientists from the Medical Research Council 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 is a broad-spectrum a tonic, the scientists tend to be dismissive. They would prefer, with classical reductionist thinking, to look for a single 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. We have enough compelling anecdotal evidence of efficacy, says Gericke, and a safety study conducted in vervet monkeys by the Medical Research Council. What is urgently needed is an independent, controlled clinical study to scientifically evaluate the efficacy of Sutherlandia.” To protect wildstocks of the plant from over-harvesting in the region, PhytoNova 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 almost 1000.
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 hemerocallidea .) Phyto Nova 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 .
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.
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 the1918 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 .
Sutherlandia has a “beautiful portfolio of chemicals” says Gericke (see Box 2). Prof Ben-Erik van Wyk and Dr Carl Albrecht of PhytoNova have analysed and identified a range of known plant chemicals, which have been previously been known to have potential application in the treatment of patients with cancer, TB diabetes, schizophrenia and depression and as anti-retrovirals. 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 . Gericke recognises the great potential of the plan t'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 HIV and 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 showed 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 .
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. This is the first South African medicinal plant to be evaluated for toxicity using primates in a controlled study .
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 .
Not all testimonies to the powers of Sutherlandia are glowing . The lone dissenting voice is Stuart Thomson, director of Gaia Research Institute in South Africa (not the better known organisation Gaia Research in the UK) who has attacked the plant, the MRC safety study and Phyto Nova. 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 . 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 desperate people living with HIV / AIDS .
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”.
Credo Mutwa, the 82 year-old African traditional healer, 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 . Since resistance to quinine has become more prevalent, the shrub Artemesia was discovered to contain artemisinin, an alkaloid with even great efficacy for the treatment of chloroquin- and mefloquin- resistant strains of Malaria.
The MRC also planned a pilot clinical trial involving 50 people on the medicinal effects of Sutherlandia . This was scheduled to begin in February 2002, pending a decision by the Governments Medicines Control 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 , “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.
|Primary symptoms reported byHIV+ and AIDS Patients in Ngwelezane Hospital.||Oral and topical Traditional Medicines Prescribed to combat the primary symptoms of HIV and AIDS at Ngwelezne Hospital.|
|Cough, cold, bronchitis||Lippia javanica (umsuzwane) fresh leaves to make tea infusion.|
|Chest pain||Warburgia salutaris (isibaha) two fresh leaves in tea infusion. Contraindicated in pregnancy.|
|Diarrhoea||Psidium guajava (guava) two crushed leaves with plenty of liquid. Discontinue when symptoms subside.|
|Itchy, painful rashes,||Centella asiatica (pennywort) fresh leaves blended with glycerine to make a cream.|
|Headaches, shortness of breath||Artemisia afra (umhylonyane) fresh aromatic leaves inhaled from a gauze bag to ease symptoms.|
|Loss of Energy, weakness,||Hypoxis hemerocallidea (inkomfe). Weak infusions made from the corms of the African potato make an excellent strengthening tonic, but must be used under medical supervision.|
|Loss of weight/appetite||Sutherlandia (unwele) tablets from dried leaves. One 300mg twice a day with meals (half dose for child)|
|Oral sores, body sores, swelling,||Bulibine frutescens (ibhucu) sap from leaves, applied directly or in a cream.|
|Throat infections||Siphononchilus aethiopicus (African ginger (indungulu) Tablets made from the Rhizomes derived from fresh roots.|
*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 .
L-Canavanine is a potent non-protein amino acid, l-arginine antagonist with documented anti-viral, anti-bacterial, anti-fungal and anti-cancer activities. L-canavanvine has patented anti-viral activity against influenza and retrovirus, including HIV. A US patent registered in 1988 claims selective destruction of 95% HIV infected lymphocytes in vitro.
Pinitol is a known anti-diabetic agent, described in its 1996 patent as having some benefits in the clinical application of treating wasting in cancer and HIV/AIDS.
GABA is an inhibitory neurotransmitter. This could account for Sutherlandia's success in treating anxiety, stress and depression and for observed improvements in mood and well being experienced by patients taking preparations from the plant
SU1 is a novel triterpenoid isolated by members of the Phyto Nova team, which is showing promising biological activity
Article first published 01/04/04
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