**9. Complementary and alternative therapies**

It is a common feature that people living with HIV or AIDS across the world resort to products and practices that are not presently considered to be part of conventional anti-retroviral medicine. When these are used together with conventional anti-retroviral medications, they are referred to as complementary therapies and if used as a stand-alone modality instead of conventional medications, they are referred to as alternative therapies [167]. A plethora of complementary and alternative strategies are available from all over the world which pre‐ dominantly involves the use of natural products and/or mind and body practices. Herbal


**Table 6.** Immune based therapies being developed against HIV

**8. Immune based therapies**

234 Trends in Basic and Therapeutic Options in HIV Infection - Towards a Functional Cure

antigens (Table-6)[6, 165].

Since the discovery of HIV repeated attempts to achieve effective protection using conven‐ tional methods of immunoprophylaxis have resulted in outright failure. The failure of the preventive strategies has lead to the concept of 'immunotherapy' or 'immune based therapy'. This strategy involves in the manipulation of the immune system in a therapeutic motive to eliminate the already acquired infection, rather than preventing new infection. The immune based therapies involve in enhancing the potency of the immune system to counteract HIV by reducing inflammation, preventing immune activation by HIV-1 or promoting effective immune responses against HIV. The different modalities used to achieve this effect can be broadly classified into non-HIV antigen specific therapies and those which use the HIV

None of the immune based therapies have provided satisfactory results so far. Among the available methods of immunotherapy, HIV specific CTL induction using the dendritic cells is of recent interest and appears to be a promising strategy. Recent studies reveal that a thera‐ peutic vaccine using autologous monocyte-derived dendritic cells pulsed with heat-inactivat‐ ed whole HIV, stimulated anti-HIV immune response and shifted the virus/host balance in favor of the host when administered to patients on HAART with CD4+ T-cell count >450 cells/ mm. At week 12 after ART interruption, 55% of people in the vaccinated group represented decrease of their viral load by at least 10-fold or 90%, compared with just 9% in the control group receiving non-pulsed DCs. These proportions dropped to 35% and 0%, respectively at week 24. This significant decrease in plasma viral load observed in vaccinated recipients was associated with a consistent increase in HIV-1-specific T cell responses. These data indicate that HIV-1-specific immune responses are elicited by the therapeutic DC vaccination. This could significantly reduce plasma viremia after ART interruption in HIV patients chronically infected but controlled with sufficiently high CD4 numbers. Thus, this study warrants further investigation with new candidates and/or new optimized strategies of vaccination toward the final goal to achieve a functional cure of HIV infection. Although heat-inactivated whole HIV was used as the antigen in this strategy, direct expression of the mRNA derived from patient's cells can also be considered using DCs in the immune therapy which expects highly precise

antiviral efficacy targeting not only HIV but also non-viral antigens [166].

It is a common feature that people living with HIV or AIDS across the world resort to products and practices that are not presently considered to be part of conventional anti-retroviral medicine. When these are used together with conventional anti-retroviral medications, they are referred to as complementary therapies and if used as a stand-alone modality instead of conventional medications, they are referred to as alternative therapies [167]. A plethora of complementary and alternative strategies are available from all over the world which pre‐ dominantly involves the use of natural products and/or mind and body practices. Herbal

**9. Complementary and alternative therapies**

remedies derived from the ancient medical science forms of different countries are the most widely sought after modality of complementary or alternative therapies. The various mind and body techniques include spirituality, meditation, yoga and other body manipulatory procedures, acupuncture and energy therapies [168].

Observations across the globe reveal that 30 - 90% of the HIV infected patients seek for complementary or alternative therapies of which, majority are females and educated individ‐ uals [169, 170]. The usefulness of these therapies is controversial. Spiritual methods such as prayer, faith healing and meditation are found to improve the psychological state by helping to overcome anxiety, depression and stress thereby providing a feeling of well being [171]. The compound IGM-1, obtained from herbs used in traditional medicine was observed to alleviate the symptoms of HIV infection but did not have any effect in reduction of viremia or improving the immune status. Many of the other Chinese herbal medicines tested were found to be unsatisfactory in altering the viral and immune parameters [172]. To much despair, several studies have highlighted the deleterious effects of complementary and alternative medicines. Recent reports indicate that patients on concurrent complementary therapy have reduced adherence rate to conventional anti-retroviral therapeutic regimens [173]. Homeopathy, a traditional health system has been proven ineffective for the treatment of HIV infection and has been disregarded by the WHO [174]. Herbal preparations containing St. John's Wort and those containing garlic extracts reduce the therapeutic levels of conventional anti-retrovirals. Apart from reducing the efficacy, many other herbal preparations have also been observed to increase the HAART related side effects [169].

Despite these assumptions, complementary and alternative therapies cannot be totally overlooked. This is due to the fact that natural compounds with antiretroviral property such as indirubin monoxime and tanshinone II A have been isolated from herbal medications [80, 81]. Meta analyses on the efficacy of herbal preparations have yielded only inconclusive results but not ineffective [172, 175]. Hence rigorous clinical trials including large study population are required to refute or accept the potential benefits of these therapeutic modalities. National Centre for Complementary and Alternative medicine, a division of the National Institute of Health, USA is an organization dedicated for research in alternative and complementary medicines and thus provides funding to various studies in this field [167].
