Research

Matt Fritts email, Cindy C Crawford email, Deborah Quibell email, Amita Gupta email, Wayne B Jonas email, Ian D Coulter email and Adriana Andrade email

AIDS Research and Therapy 2008, 5:25doi:10.1186/1742-6405-5-25

Published: 22 December 2008

Abstract (provisional)

Background

India ranks third in the world in absolute burden of HIV. While increasing numbers of Government-sponsored clinics are providing free antiretroviral therapy (ART), its utility is limited by lack of affordability and acceptability and the requirement for lifelong administration. Allopathic practitioners in India are outnumbered by practitioners of traditional Indian medicine and homeopathy (TIMH), which is used by two-thirds of its population in rural areas to help meet its primary health care needs. However, little is known about TIMH use, safety or efficacy in HIV/AIDS management. These data suggest that India's community-based, culturally-relevant TIMH system, which is one of the largest indigenous medical systems in the world, remains an untapped ally in the fight against its HIV/AIDS epidemic. The purpose of this review was to assess the quality of peer-reviewed, published literature on TIMH for HIV/AIDS treatment and care.

Results

Of 160 original articles reviewed, 19 laboratory studies, 17 clinical studies and six previous reviews of the literature were identified that covered at least one system of TIMH, which includes Ayurveda, yoga, naturopathy, Unani medicine, and Siddha medicine and homeopathy. Most studies examined either Ayurvedic or homeopathic treatments. Only four of these studies were randomized controlled trials, and only 10 were published in MEDLINE-indexed journals. Overall, the studies reported positive effects and even cure and reversal of HIV infection, but frequent design flaws call into question their internal and external validity. Common reasons for poor methodological quality included lack of details on products and their standardization, small sample sizes, selection of inappropriate or weak outcome measures, and incomplete reporting of study results.

Conclusions

This review exposes a broad gap between the widespread use of TIMH therapies for HIV/AIDS, and the dearth of high-quality data supporting their effectiveness and safety. In light of the suboptimal effectiveness of vaccines, ART, barrier methods, and behavior change strategies for prevention and cure of HIV infection, it is both important and urgent to develop a rigorous research agenda that uses innovative methodologies to investigate, evaluate and maximize the role of TIMH in managing HIV/AIDS and associated illnesses in India.