Important note: Information in this article was accurate in 2008. The state of the art may have changed since the publication date.
Sunday Times (Johannesburg) - November 30, 2008
Bobby Jordan, jordanb@sundaytimes.co.za
A wild shrub that is common in gardens across the country is about to be tested as a medicine on people living with HIV/Aids.
The plant is thought to boost immune systems to delay the progression of full-blown Aids and is a well-known medicine among traditional healers.
It is the first time a South African traditional medicine has received national health authority approval for testing on people with HIV/Aids, and researchers hope it might help prolong the healthy period before antiretroviral treatment. The trial is being conducted in conjunction with the American National Institute of Health.
The red-flowering Sutherlandia has finally been given the thumbs up by the Medicines Control Council and will be dispensed to test groups of HIV-positive people in South Africa, in a carefully managed trial.
The plant has already been successfully tested in phase one clinical trials conducted on HIV-negative people, showing no adverse health side effects.
But the herb is not without controversy. It has come under fire from some quarters for alleged toxicity. Questions have also been raised over the involvement of senior political figures in the lucrative herbal medicine trade.
The Treatment Action Campaign's Rebecca Hodes expressed concern that trials such as this may conflate so-called immune-boosting supplements and evidence-based biomedical interventions.
She said the hype around immune boosters might overshadow the crucial importance of antiretroviral therapy.
"Propagating this notion that boosters will protect you and save you from having to take ARVs feeds into the notion that ARVs are toxic," said Hodes.
Nevertheless, the new phase-two trial, to be conducted in several South African hospitals, is big news among the research community.
Professor Quinton Johnson, head of the South African Herbal Science and Medicine Institute at the University of the Western Cape, said clinical trials of traditional medicine were the best way to confirm or deny the alleged health benefits of substances used daily by many South Africans.
"It's a big deal. This has never been done before. It took me and my team three years to get the approval.
"Now we are enrolling our patients to try to understand, in the first instance, if Sutherlandia would be safe with patients with first stage HIV," he said.
The trial will be conducted jointly by a local consortium that includes the Medical Research Council and the powerful American National Institute of Health, which, three years ago, pledged R20-million towards the study of South African traditional medicine.
Initial toxicity studies of Sutherlandia on non-human primates have already been carried out by the MRC. It has also conducted several observational studies of traditional healers who have used the plant to treat HIV/Aids patients.
Tests have shown that Sutherlandia, also known as kankerbossie or unwele, may be useful in the fight against other conditions such as hypertension and heart disease.
Researchers have found disease-fighting chemicals in local plants, but South Africa has yet to develop a single human health medicine due to the massive cost involved. By contrast, foreign companies have developed several medicines based on active ingredients discovered in South African plants.
MRC president, Professor Anthony Mbewu, said South Africa was progressing towards its own drug development.
"In the past, if people found a chemical in a plant, they sold it and licensed it to an overseas pharmaceutical company.
"The Department of Science and Technology is trying to establish systems whereby we could develop our own drugs."
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