hypericum and HIV-Infections

Topics: Antidepressive Agents; Antidepressive Agents, Second-Generation; Antidepressive Agents, Tricyclic; Citalopram; Depression; Diagnosis, Differential; Female; HIV Infections; Humans; Hypericum; Mianserin; Middle Aged; Mirtazapine; Phytotherapy; Psychotherapy; Recurrence; Risk Factors; Selective Serotonin Reuptake Inhibitors; Socioeconomic Factors

Topics: Adult; Antidepressive Agents; Herb-Drug Interactions; Heterocyclic Compounds, 3-Ring; HIV Infections; HIV Integrase Inhibitors; Humans; Hypericum; Male; Oxazines; Piperazines; Plant Preparations; Pyridones

Natural health products (NHPs) (known as dietary supplements in the United States) are a popular form of self-care, yet many patients do not disclose their use to clinicians. NHP-drug interactions are known to occur and can harm patients and affect the efficacy of conventional treatment. Using the example of an HIV-positive adolescent who had been responding well to antiretroviral therapy but then experienced a sudden unexplained deterioration in her condition, we review (1) clinicians' obligation to inquire about complementary and alternative medicine (CAM) use when assessing, treating, and monitoring patients, (2) how clinicians' duty to warn about risks associated with treatment has evolved and expanded, and (3) patients' and parents' responsibility to disclose CAM use. It also addresses the responsibility of hospitals and health facilities to ensure that the reality of widespread CAM/NHP use is taken into account in patient care to effectively protect patients from harm.

Topics: Adolescent; Biological Products; Canada; Child; Complementary Therapies; Disclosure; Drug Interactions; Ethics, Medical; Female; HIV Infections; Humans; Hypericum; Informed Consent; Liability, Legal; Medical History Taking; Patient Safety; Physician-Patient Relations; Phytotherapy; Professional Role; United States

Transcription of the HIV-1 genome is controlled by the cooperation of viral regulatory proteins and several host factors which bind to specific DNA sequences within the viral promoter spanning the long terminal repeat, (LTR). Here, we describe the identification of a novel protein, p27(SJ), present in a laboratory callus culture of Hypericum perforatum (St John's Wort) that suppresses transcription of the HIV-1 genome in several human cell types including primary culture of microglia and astrocytes. p27(SJ) associates with C/EBPbeta, a transcription factor that regulates expression of the HIV-1 genome in macrophages and monocytic cells, and the viral transactivator, Tat. The association of p27(SJ) with C/EBPbeta and Tat alters their subcellular localization, causing their accumulation in the perinuclear cytoplasmic compartment of the cells. Fusion of a nuclear localization signal to p27(SJ) forces its entry into the nucleus and diminishes the capacity of p27(SJ) to suppress Tat activity, but does not alter its ability to suppress C/EBPbeta activation of the LTR. Results from binding assays showed the inhibitory effect of p27(SJ) on C/EBPbeta interaction with DNA. Finally, our results demonstrate that expression of p27(SJ) decreases the level of viral replication in HIV-1-infected cells. These observations suggest the potential for the development of a therapeutic advance based on p27(SJ) protein to control HIV-1 transcription and replication in cells associated with HIV-1 infection in the brain.

Topics: Astrocytes; Base Sequence; Cells, Cultured; Depression, Chemical; Gene Expression Regulation, Viral; Genetic Therapy; Genome, Viral; HIV Infections; HIV-1; Humans; Hypericum; Microglia; Molecular Sequence Data; Phytotherapy; Plant Proteins; Terminal Repeat Sequences; Transfection; U937 Cells; Virus Replication

Many people infected with HIV look to natural health products to supplement their conventional medical care, and clinicians, understandably, are concerned about drug interactions.

Topics: Anti-HIV Agents; Drug Interactions; Garlic; HIV Infections; Humans; Hypericum

Topics: Adult; Anti-HIV Agents; Diagnosis, Differential; Drug Interactions; Garlic; HIV Infections; Humans; Hypericum; Male; Phytotherapy; Plant Extracts; Risk Factors; Treatment Refusal

Topics: Anti-HIV Agents; Drug Interactions; Echinacea; Garlic; HIV Infections; Humans; Hypericum; Phytotherapy; Plants, Medicinal

Topics: Depression; Drug Interactions; HIV Infections; Humans; Hypericum; Male; Middle Aged; Nurse Practitioners; Patient Selection; Phytotherapy; Primary Health Care; Safety

Topics: Adult; Drug Interactions; Drug Monitoring; Drug Therapy, Combination; HIV Infections; Humans; Hypericum; Male; Middle Aged; Nevirapine; Phytotherapy; Plant Extracts; Plants, Medicinal; Reverse Transcriptase Inhibitors

Topics: Anti-HIV Agents; Drug Interactions; HIV Infections; Humans; Hypericum; Medical History Taking; Plants, Medicinal; Self Medication

Topics: Anti-HIV Agents; Drug Interactions; HIV Infections; Humans; Hypericum; Nevirapine; Phytotherapy; Plants, Medicinal; Reverse Transcriptase Inhibitors

Topics: Anxiety; Depression; Drug Interactions; Female; Herb-Drug Interactions; HIV Infections; HIV Protease Inhibitors; HIV Seronegativity; Humans; Hypericum; Indinavir; Male

Topics: Antidepressive Agents; Drug Antagonism; HIV Infections; HIV Protease Inhibitors; Humans; Hypericum; Indinavir; Plants, Medicinal

Topics: Antidepressive Agents; Depression; Drug Interactions; HIV Infections; HIV Protease Inhibitors; Humans; Hypericum; Indinavir; Phytotherapy; Plants, Medicinal

St. John's wort, an herbal treatment for depression, should not be combined with certain drugs, including some antiretrovirals. St. John's wort can speed up the body's elimination of some drugs. When HIV medications are used, blood levels could drop low enough to allow resistance to occur. So far, St. John's wort has been tested only with the protease inhibitor indinavir (Crixivan), but it is likely to affect other drugs in that class and possibly non-nucleoside reverse transcriptase inhibitors. This warning follows a study by the National Institutes of Health (NIH) on dosing and blood levels of indinavir in HIV-negative test subjects. More information on the study is available on The Lancet's Web site. The text of the FDA's advisory letter is included.

Topics: Depression; Drug Interactions; HIV Infections; HIV Protease Inhibitors; Humans; Hypericum; Indinavir; Plants, Medicinal

Topics: Anti-HIV Agents; Drug Interactions; HIV Infections; Humans; Hypericum