TreatmentUpdate60; Volume 7, No. 6 - June 1995
Sean Hosein

At an HIV/AIDS conference in San Francisco last summer, acupuncturist Susan Paul presented preliminary information on her use of QHS-related compounds in the treatment of "very early" PCP. Ms. Paul describes early PCP as "fatigue, lack of appetite and rapid [breathing] with a sense of chest constriction. At this stage there is no cough, and chest X-ray and sputum cultures will be negative." She has treated 13 subjects with PCP who could not tolerate standard anti-PCP therapy and who developed "very early" PCP. She prescribed the Seven Forests brand of Bellamoconda 15 (3 tablets, 3 times a day) and the Brion brand of QHS (2 grams, 3 times/daily) using loose, single granules. According to her regimen, "therapy is continued until the patient has been totally cleared of all symptoms for 7 to 10 days."

* RESULTS

She has not found any side effects with this therapy, noting that no patient experienced diarrhea. Ms Paul is currently monitoring 6 additional subjects who cannot tolerate standard anti-PCP prevention. These subjects have an average of 96 CD4+ cell counts and over a 3-month period have not developed PCP or toxo. Ms Paul notes that QHS also appears to prevent oral fungal infections.

* LONG TERM OBSERVATION

When questioned at the conference about long term results from her original group of 13 patients, Ms Paul said that 4 subjects no longer use the herb. One subject developed dementia and is dying; another developed the life-threatening brain infection 'crypto' (Cryptococcal meningitis); a third developed severe rectal warts, seizures and Kaposi's sarcoma. She has not been able to locate the 4th subject. One of her subjects took 20 times the normal dose and developed nerve damage.

* QUALITY CONTROL

We cannot verify the purity of the product used by Ms. Paul's subjects. Moreover, even doctors in Southeast Asia concede that factories manufacturing QHS may not produce a highly pure product. There are also some problems with her definition of PCP, as subjects could have been infected with other microbes.

* PROBLEMS

One possible problem with QHS is the way it is supposed to work. In treating patients with malaria, QHS causes the release of highly active molecules called free radicals. As patients with HIV/AIDS may have weakened defences against free radicals, chronic therapy with QHS may pose some risk. In experiments on mice with malaria, removing vitamin E (an antioxidant) from their diet increased the antimalarial activity of QHS. Trials with short courses or intermittent use of QHS may be one way to test this idea.

According to Chinese research, QHS appears to boost CMI (cell-mediated immunity)--one part of the immune system that is weakened by HIV infection. This may be useful because many of the infections seen in AIDS can only be kept in check by CMI.

Clearly, better studies need to be designed to test QHS' potential for some of the infections seen in AIDS. The quality of QHS used in Southeast Asia seems good enough for treating malaria, and perhaps researchers might consider this when making decisions about which form of the drug to use.

REFERENCES:

1. Saah AJ, Hoover DR, Peng Y, et al. Predictors for failure of Pneumocystis carinii pneumonia prophylaxis. Journal of the American Medical Association 1995;273(15):1197-1202.

2. Holfels E, McAuley J, Mack D, et al. In vitro effects of artemisin ether, cycloguanil hydrochloride (alone and in combination with sulfadiazine), quinine sulfate, mefloquine, primaquine phosphate, trifluoperazine hydrochloride and, veridical on toxoplasmosis gondii. Antimicrobial Agents and Chemotherapy 1994;38(6): 1392-1396.

3. Paul S. Herbal prophylaxis for PCP. Presenters handbook HIV/AIDS and Chinese Medicine II, San Francisco, July 22-24, 1994.

4. Levander DA, Ager Al, Morris VC and May RG. Quinghaosu, dietary vitamin E, selenium, and cod-liver oil: effect on the susceptibility of mice to the malarial parasite Plasmodium yoeli. American Journal of Clinical Nutrition 1989;50:346-352.

5. Meshnick SR, Yang Y-Z, Lima V, et al. Iron-dependent free radical generation from the antimalarial agent artemisinin (quinghaosu). Antimicrobial Agents and Chemotherapy 1993;37(5):1108-1114.

6. Weinberg GA. Iron chelators as therapeutic agents against Pneumocystis carinii pneumonia. Antimicrobial Agents and Chemotherapy 1994;38(5):997-1003.

7. Haque S, Khan I, Haque A and Kasper L. Impairment of cellular immune response in acute murine toxoplasmosis: regulation of interleukin 2 production and macrophage- mediated inhibitory effects. Infection and Immunity 1994;62(7):2908-2916.

8. Hien TT and White NJ. Quinghaosu. Lancet 1993;341:603-608.

950601
CATE6007

Copyright © 1995 - TreatmentUpdate. Reproduced with permission. Reproduction of this article (other than one copy for personal reference) must be cleared through the Editor, The Canadian AIDS Treatment Information Exchange, 555 Richmond St. West, Suite 505, Box 1104, Toronto, ON, M5V 3B1 • Phone: 416-203-7122 • Toll Free: 1-800-263-1638 • Fax: 416-203-8284  http://www.catie.ca