- Email: [email protected]
The use of CAM by HIV-positive patients in Thailand
Short report
The use of CAM by HIV-positive patients in Thailand V. Wiwanitkit 1 1
Department of Laboratory Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
SUMMARY. Background: Complementary and alternative medicine (CAM) use is common in the general population, including patients with human immunodeficiency virus (HIV) infection. Our objective was to determine the frequency of use of CAM by HIV-positive patients in Thailand. Methods: During year 2000, we performed an interview survey on 160 HIV-seropositive patients attending Out-Patient Division, King Chulalongkorn Memorial Hospital. Data were collected on prevalence and patterns of CAM use. Results: A total of 160 HIV-infected patients (107 males and 53 females) were included of whom 152 (95%) used CAM and 124 (78%) visited a CAM provider. The most common use CAM detected in our study was a ritual remedy from Buddhist temples (128 cases, 84%), followed by a novel regime, a biophysical approach (102 cases, 64%). Most patients used more than one CAM. The most common source of information on CAM was friends. Patients who saw CAM providers made a median of four visits to them per year, compared with 12 visits per year to their primary care physician and nurse practitioner. Conclusion: CAM is frequently used by HIV-positive patients in Thailand and their physicians need to be aware of this possibility. © 2003 Elsevier Science Ltd. All rights reserved.
Viroj Wiwanitkit, Department of Laboratory Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. E-mail: [email protected]
INTRODUCTION
METHODS
At the beginning of the human immunodeficiency virus (HIV) epidemic, little or no treatment was available for people with the condition. Although over the last decade researchers have identified a number of drugs that slow progression of the virus as well as therapies to treat the many opportunistic infections that attack people with HIV disease, yet there is no cure. Since use of complementary and alternative medicine (CAM) is common in the general population, it would be expected that HIV-infected patients will seek alternative therapies. Among such patients, few data are available on the prevalence and patterns of alternative therapy use. Moreover, previously published research found that up to 70% of these patients who use such therapies did not tell their doctors.1 In a search of the published literature, we can find no previous report into the use of alternative therapies by HIV-positive patients in Thailand. Because of the special features of the oriental lifestyle, we hypothesized that prevalence and expenditure for CAM would be high in this population.
We performed a survey interviewing 160 HIVseropositive patients attending Out-Patient Division, King Chulalongkorn Memorial Hospital, Thailand during year 2000. We obtained informed consent verbally at the beginning of the interview. Data were collected on prevalence and patterns of CAM use in conjunction with conventional drugs. At no point during the interview did we use the term “alternative therapy” or any such term to avoid value judgments about what therapies might be “alternative”. On interview, the patients were asked about the use of vitamins, herbal therapies, dietary supplements, off-label prescription medications, and any other supplements in the past year, using open-ended questions. Off-label prescription medications were described as medications that were generally available only by prescription but that the patient was able to obtain in another manner. We asked patients specifically if they had visited an acupuncturist, herbalist, massage therapist, or other provider in the past year. We then asked open-ended questions about use of other therapies not already discussed or visits
Complementary Therapies in Medicine (2003), 11, 39–41 doi: 10.1016/S0965-2299(02)00108-5
© 2003 Elsevier Science Ltd. All rights reserved.
39
40 Complementary Therapies in Medicine Table 1
Reported use of CAM by 160 HIV positive patients also taking conventional drugs
Pattern Ritual remedy from Buddhist templeb (MOR PRA)c New regime, biophysical approachb (CHEE WA JIT)d Thai traditional herb remedyb (YAR MOR) Chinese traditional herb remedyb (YAR TIAB) Vitamin supplement Dietary supplement Folk remedyb (Yar Klang Ban)e Off-label prescription medications Massage Superstitious remedyb (YAR PEE BOK, MOR POA and others)f
Numbera
Percenta
128 102 84 80 78 54 28 22 15 11
84.2 67.1 55.3 52.6 51.3 35.5 18.4 14.5 9.9 7.2
a
Most patients reported usage of more than one CAM. Since in Thailand these remedies are already prepared from the suppliers and the patients actually cannot get the information on the particular herbal preparations, details are not available. c Provided by the abbot of the Buddhist temple, called MOR PRA. Patients are usually given holy water with which to prepare the remedy. d Regime comprising mainly vegetarian diet, ingestion of several herbs, meditation and coffee enema. e Provided by the village elder, differs according to villages, called MOR KLANG BAN. f Herbal preparations individually selected for each patient by a lay-person, called MOR POA, by divination. The remedy is considered to be directly dictated by the spirit (PEE BOK). b
to other practitioners not specifically queried earlier. Descriptive statistics were used for the responses.
RESULTS There were 160 HIV-infected patients (107 males and 53 females) included in this study. Of these, 152 (95%) used CAM, and 124 (78%) visited a CAM provider. Patterns of use of different CAMs are shown in Table 1. Most cases (134, 83.75%), used more than one CAM (a mean ± S.D. of 2.4 ± 1.5 treatments/person using CAM). Of the 152 who used CAM, the most common source of information on therapies was friends (85 cases, 56%), followed by family (37 cases, 24%) and the media (26 cases, 17%). Of interest, there were also four cases (2.5%) in which patients gained information from health care workers. The 124 patients who saw CAM providers made a median of four visits per year to these providers compared with 12 visits per year to their primary care physician and nurse practitioner.
DISCUSSION The rate of CAM use among HIV-infected patients in our population was very high, being consistent with those of earlier studies.2–4 Unlike a previous study in St. Louis,5 all patients who used CAM providers made more visits to conventional physicians than to the CAM provider. Furthermore, we observed a higher rate in our population, confirming our hypothesis. Due to the oriental culture, CAM is part of folklore among the general population. Concerning the pattern of treatment, also unlike the previous studies,6 the most common treatment was ritual remedy (MOR PRA) from the Buddhist temples, followed by a treatment regime that is new to
Thailand, a Biophysical approach (CHEE WA JIT). The use of dietary supplements and vitamins was found in a relatively small percentage. The difference in pattern observed in our study can be explained by the difference in culture, since traditional treatments are part of the folklore in Thailand. Such CAM use might have benefits for patients, for example offering additional opportunities for persons living with HIV to be proactively involved in their treatment. However, doctors should be careful not to misconstrue side effects or drug interactions that may be caused by therapies they have not prescribed. In conclusion, physicians working with AIDS patients in Thailand should be aware that their HIV-infected patients commonly seek alternative therapies, which may interact with conventional medication, without informing their doctors.
ACKNOWLEDGEMENTS The author would like to thank Professor Pairnt Deesudjit, STD Clinic, Chulalongkorn Memorial Hospital and the other medical personnel of the hospital who helped this study.
REFERENCES 1. Dwyer JT, Salvato-Schille AM, Coulston A, Casey VA, Cooper WC, Selles WD. The use of unconventional remedies among HIV-positive men living in California. J Assoc Nurses AIDS Care 1995; 6: 17–28. 2. Greenblatt RM, Hollander H, McMaster JR, Henk CJ. Polypharmacy among patients attending an AIDS clinic: the utilization of prescribed, unorthodox, and investigational treatments. J Acquir Immune Defic Syndr 1991; 4: 136–143. 3. Anderson W, O’Connor BB, MacGregor RR, Schwartz JS. Patient use and assessment of conventional and alternative therapies for HIV infection and AIDS. AIDS 1993; 7: 561–566.
The use of CAM by HIV-positive patients in Thailand 4. Cassileth BR, Lusk EJ, Strouse TB, Bodenheimer BJ. Contemporary unorthodox treatments in cancer medicine. Ann Intern Med 1984; 101: 105–112. 5. Rowlands C, Powderly WG. The use of alternative therapies by HIV-positive patients attending the St. Louis AIDS Clinical Trials Unit. Mo Med 1991; 88: 807–810.
41 6. Fogelman I, Lim L, Bassett R et al. Prevalence and patterns of use of concomitant medications among participants in three multicenter human immunodeficiency virus type I clinical trials. J Acquir Immune Defic Syndr 1994; 7: 1057–1063.
The use of CAM by HIV-positive patients in Thailand V. Wiwanitkit 1 1
Department of Laboratory Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
SUMMARY. Background: Complementary and alternative medicine (CAM) use is common in the general population, including patients with human immunodeficiency virus (HIV) infection. Our objective was to determine the frequency of use of CAM by HIV-positive patients in Thailand. Methods: During year 2000, we performed an interview survey on 160 HIV-seropositive patients attending Out-Patient Division, King Chulalongkorn Memorial Hospital. Data were collected on prevalence and patterns of CAM use. Results: A total of 160 HIV-infected patients (107 males and 53 females) were included of whom 152 (95%) used CAM and 124 (78%) visited a CAM provider. The most common use CAM detected in our study was a ritual remedy from Buddhist temples (128 cases, 84%), followed by a novel regime, a biophysical approach (102 cases, 64%). Most patients used more than one CAM. The most common source of information on CAM was friends. Patients who saw CAM providers made a median of four visits to them per year, compared with 12 visits per year to their primary care physician and nurse practitioner. Conclusion: CAM is frequently used by HIV-positive patients in Thailand and their physicians need to be aware of this possibility. © 2003 Elsevier Science Ltd. All rights reserved.
Viroj Wiwanitkit, Department of Laboratory Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. E-mail: [email protected]
INTRODUCTION
METHODS
At the beginning of the human immunodeficiency virus (HIV) epidemic, little or no treatment was available for people with the condition. Although over the last decade researchers have identified a number of drugs that slow progression of the virus as well as therapies to treat the many opportunistic infections that attack people with HIV disease, yet there is no cure. Since use of complementary and alternative medicine (CAM) is common in the general population, it would be expected that HIV-infected patients will seek alternative therapies. Among such patients, few data are available on the prevalence and patterns of alternative therapy use. Moreover, previously published research found that up to 70% of these patients who use such therapies did not tell their doctors.1 In a search of the published literature, we can find no previous report into the use of alternative therapies by HIV-positive patients in Thailand. Because of the special features of the oriental lifestyle, we hypothesized that prevalence and expenditure for CAM would be high in this population.
We performed a survey interviewing 160 HIVseropositive patients attending Out-Patient Division, King Chulalongkorn Memorial Hospital, Thailand during year 2000. We obtained informed consent verbally at the beginning of the interview. Data were collected on prevalence and patterns of CAM use in conjunction with conventional drugs. At no point during the interview did we use the term “alternative therapy” or any such term to avoid value judgments about what therapies might be “alternative”. On interview, the patients were asked about the use of vitamins, herbal therapies, dietary supplements, off-label prescription medications, and any other supplements in the past year, using open-ended questions. Off-label prescription medications were described as medications that were generally available only by prescription but that the patient was able to obtain in another manner. We asked patients specifically if they had visited an acupuncturist, herbalist, massage therapist, or other provider in the past year. We then asked open-ended questions about use of other therapies not already discussed or visits
Complementary Therapies in Medicine (2003), 11, 39–41 doi: 10.1016/S0965-2299(02)00108-5
© 2003 Elsevier Science Ltd. All rights reserved.
39
40 Complementary Therapies in Medicine Table 1
Reported use of CAM by 160 HIV positive patients also taking conventional drugs
Pattern Ritual remedy from Buddhist templeb (MOR PRA)c New regime, biophysical approachb (CHEE WA JIT)d Thai traditional herb remedyb (YAR MOR) Chinese traditional herb remedyb (YAR TIAB) Vitamin supplement Dietary supplement Folk remedyb (Yar Klang Ban)e Off-label prescription medications Massage Superstitious remedyb (YAR PEE BOK, MOR POA and others)f
Numbera
Percenta
128 102 84 80 78 54 28 22 15 11
84.2 67.1 55.3 52.6 51.3 35.5 18.4 14.5 9.9 7.2
a
Most patients reported usage of more than one CAM. Since in Thailand these remedies are already prepared from the suppliers and the patients actually cannot get the information on the particular herbal preparations, details are not available. c Provided by the abbot of the Buddhist temple, called MOR PRA. Patients are usually given holy water with which to prepare the remedy. d Regime comprising mainly vegetarian diet, ingestion of several herbs, meditation and coffee enema. e Provided by the village elder, differs according to villages, called MOR KLANG BAN. f Herbal preparations individually selected for each patient by a lay-person, called MOR POA, by divination. The remedy is considered to be directly dictated by the spirit (PEE BOK). b
to other practitioners not specifically queried earlier. Descriptive statistics were used for the responses.
RESULTS There were 160 HIV-infected patients (107 males and 53 females) included in this study. Of these, 152 (95%) used CAM, and 124 (78%) visited a CAM provider. Patterns of use of different CAMs are shown in Table 1. Most cases (134, 83.75%), used more than one CAM (a mean ± S.D. of 2.4 ± 1.5 treatments/person using CAM). Of the 152 who used CAM, the most common source of information on therapies was friends (85 cases, 56%), followed by family (37 cases, 24%) and the media (26 cases, 17%). Of interest, there were also four cases (2.5%) in which patients gained information from health care workers. The 124 patients who saw CAM providers made a median of four visits per year to these providers compared with 12 visits per year to their primary care physician and nurse practitioner.
DISCUSSION The rate of CAM use among HIV-infected patients in our population was very high, being consistent with those of earlier studies.2–4 Unlike a previous study in St. Louis,5 all patients who used CAM providers made more visits to conventional physicians than to the CAM provider. Furthermore, we observed a higher rate in our population, confirming our hypothesis. Due to the oriental culture, CAM is part of folklore among the general population. Concerning the pattern of treatment, also unlike the previous studies,6 the most common treatment was ritual remedy (MOR PRA) from the Buddhist temples, followed by a treatment regime that is new to
Thailand, a Biophysical approach (CHEE WA JIT). The use of dietary supplements and vitamins was found in a relatively small percentage. The difference in pattern observed in our study can be explained by the difference in culture, since traditional treatments are part of the folklore in Thailand. Such CAM use might have benefits for patients, for example offering additional opportunities for persons living with HIV to be proactively involved in their treatment. However, doctors should be careful not to misconstrue side effects or drug interactions that may be caused by therapies they have not prescribed. In conclusion, physicians working with AIDS patients in Thailand should be aware that their HIV-infected patients commonly seek alternative therapies, which may interact with conventional medication, without informing their doctors.
ACKNOWLEDGEMENTS The author would like to thank Professor Pairnt Deesudjit, STD Clinic, Chulalongkorn Memorial Hospital and the other medical personnel of the hospital who helped this study.
REFERENCES 1. Dwyer JT, Salvato-Schille AM, Coulston A, Casey VA, Cooper WC, Selles WD. The use of unconventional remedies among HIV-positive men living in California. J Assoc Nurses AIDS Care 1995; 6: 17–28. 2. Greenblatt RM, Hollander H, McMaster JR, Henk CJ. Polypharmacy among patients attending an AIDS clinic: the utilization of prescribed, unorthodox, and investigational treatments. J Acquir Immune Defic Syndr 1991; 4: 136–143. 3. Anderson W, O’Connor BB, MacGregor RR, Schwartz JS. Patient use and assessment of conventional and alternative therapies for HIV infection and AIDS. AIDS 1993; 7: 561–566.
The use of CAM by HIV-positive patients in Thailand 4. Cassileth BR, Lusk EJ, Strouse TB, Bodenheimer BJ. Contemporary unorthodox treatments in cancer medicine. Ann Intern Med 1984; 101: 105–112. 5. Rowlands C, Powderly WG. The use of alternative therapies by HIV-positive patients attending the St. Louis AIDS Clinical Trials Unit. Mo Med 1991; 88: 807–810.
41 6. Fogelman I, Lim L, Bassett R et al. Prevalence and patterns of use of concomitant medications among participants in three multicenter human immunodeficiency virus type I clinical trials. J Acquir Immune Defic Syndr 1994; 7: 1057–1063.