Complementary Or Alternative Medicine?

Complementary and alternative medicine use decreases adherence to HAART in HIV-positive women. Owen-Smith A, Diclemente R, Wingood G. AIDS Care. 2007 May;19(5):589-93.

The Study

366 HIV-positive, mostly African-American women, aged 18-50 years in Alabama and Georgia who were enrolled in an intervention to reduce high-risk sexual behavior. Data collection at time of enrollment was used to identify participants as complementary and alternative medicine (CAM) users if they reported taking herbal or natural immunity boosters (Chinese herbs, mushrooms, garlic, ginseng or algae) or multivitamins, or if they reported using religious or psychic health or bodywork to treat HIV. Women were classified as non-adherent if they reported missing any doses of their HAART medication in the 30 days preceding baseline assessment. Logistic regressions models, adjusted for potential confounders, were used to investigate the relationship between CAM use and HAART adherence.

Results

From the abstract:

Commentary

The potential implications of these findings are, of course, profound and extensive. And, while one study with numerous obvious methodological limitations cannot support widespread changes in dealing with CAM, it should alert clinicians to exercise renewed vigilance regarding compliance in those cases in which patients use herbal, religious, or other alternatives to conventional evidence-based healthcare.

It should also serve as reminder that maintaining an open mind toward imaginable benefits of CAM does not preclude the possibility that such use of CAM may have deleterious effects. If nothing else, this study belies the casual, wishful “what could it hurt?” response I’ve occasionally heard from patients and other clinicians in regard to CAM.

Finally, as has been the case in many analogous situations, I hold the author’s recommendation that “health care providers and patients should have explicit dialogues about how to effectively integrate CAM practices into traditional treatment regimens” to be a necessary but not sufficient element in managing adherence to prescribed treatment.

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