One double-blind trial has found that 990 mg per day of an extract of the leaves and stems of boxwood (Buxus sempervirens) could delay the progression of HIV infection (as measured by a decline in CD4 cell counts).⁴ No adverse effects directly attributable to the extract were reported. Taking twice the amount of boxwood extract did not lead to further benefits and may have actually decreased its usefulness.

A deficient level of dehydroepiandrosterone sulfate (DHEAS) in the blood is associated with poor outcomes in people with HIV.⁵ Large amounts of supplemental DHEA (dehydroepiandrosterone) may alleviate fatigue and depression in HIV-positive men and women. In a preliminary trial, men and women with HIV infection took 200–500 mg of DHEA per day for eight weeks.⁶ All participants initially had both low mood and low energy. After eight weeks of DHEA supplementation, 72% of the participants reported their mood to be “much improved” or “very much improved,” and 81% reported having significant improvements in energy level. DHEA supplementation had no effect on CD4 cell (helper T-cell) counts or testosterone levels.

Licorice has shown the ability to inhibit reproduction of HIV in test tubes.⁷ Clinical trials have shown that injections of glycyrrhizin (isolated from licorice) may have a beneficial effect on AIDS.⁸ There is preliminary evidence that orally administered licorice also may be safe and effective for long-term treatment of HIV infection.⁹ Amounts of licorice or glycyrrhizin used for treating HIV-positive people warrant monitoring by a physician, because long-term use of these substances can cause high blood pressure, potassium depletion, or other problems. Approximately 2 grams of licorice root should be taken per day in capsules or as tea. Deglycyrrhizinated licorice (DGL) will not inhibit HIV.

Because people with HIV infection or AIDS often have multiple nutritional deficiencies, a broad-spectrum nutritional supplement may be beneficial. In one trial, HIV-positive men who took a multivitamin-mineral supplement had slower onset of AIDS, compared with men who did not take a supplement.¹⁰Use of a multivitamin by pregnant and breast-feeding Tanzanian women with HIV did not affect the risk of transmission of HIV from mother to child, either in utero, during birth, or from breast-feeding.¹¹

The effect of multivitamins on people with HIV may be influenced by whether or not they are receiving modern medical therapy, known as highly active antiretroviral therapy (HAART). Studies conducted before HAART therapies were used showed that high-dose micronutrient supplements improved immune function, slowed disease progression, and decreased mortality. However, a recent double-blind trial found that, in people using HAART, the use of vitamins in amounts well above the Recommended Dietary Allowance (RDA), when compared with RDA amounts, had no effect on disease progression, but may have increased stress on the liver.¹² People who are receiving HAART therapy should consult their doctor regarding the appropriate amounts of vitamins to take.

The amino acid NAC (N-acetyl cysteine) has been shown to inhibit the replication of HIV in test tube studies.¹³ In a double-blind trial, supplementing with 800 mg per day of NAC slowed the rate of decline in immune function in people with HIV infection. NAC also promotes the synthesis of glutathione, a naturally-occurring antioxidant that is believed to be protective in people with HIV infection and AIDS.¹⁴

In a double-blind trial, the non-disease-causing yeast Saccharomyces boulardii (1 gram three times per day) helped stop diarrhea in HIV-positive people.¹⁵ However, people with severely compromised immune function have been reported to develop yeast infections in the bloodstream after consuming some yeast organisms that are benign for healthy people.^16,17 For that reason, people with HIV infection who wish to take Saccharomyces boulardii, brewer’s yeast (Saccharomyces cerevisiae), or other live organisms should first consult a doctor.

Selenium deficiency is an independent factor associated with high mortality among HIV-positive people.¹⁸ HIV-positive people who took selenium supplements experienced fewer infections, better intestinal function, improved appetite, and improved heart function (which had been impaired by the disease) than those who did not take the supplements.¹⁹ The usual amount of selenium taken was 400 mcg per day.

Selenium deficiency has been found more often in people with HIV-related cardiomyopathy (heart abnormalities) than in those with HIV and normal heart function.²⁰ People with HIV-related cardiomyopathy may benefit from selenium supplementation. In a small preliminary trial, people with AIDS and cardiomyopathy, 80% of whom were found to be deficient in selenium, were given 800 mcg of selenium per day for 15 days, followed by 400 mcg per day for eight days. Improvements in heart function were noted after selenium supplementation.²¹ People wishing to supplement with more than 200 mcg of selenium per day should be monitored by a doctor.

Blood levels of both zinc²² and selenium²³ are frequently low in people with HIV infection. Zinc supplements (45 mg per day) have been shown to reduce the number of infections in people with AIDS.²⁴ Zinc supplementation (12 mg per day for women, 15 mg per day for men) also slowed the decline in immune function in HIV-infected adults with low blood levels of zinc.²⁵

A preliminary trial of isolated andrographolides, found in andrographis, determined that while they decreased viral load and increased CD4 lymphocyte levels in people with HIV infection, they also caused potentially serious liver problems and changes in taste in many of the participants.²⁶ It is unknown whether andrographis directly killed HIV or was having an immune-strengthening effect in this trial.

Immune-modulating plants that could theoretically be beneficial for people with HIV infection include Asian ginseng, eleuthero, and the medicinal mushrooms shiitake and reishi. One preliminary study found that steamed then dried Asian ginseng (also known as red ginseng) had beneficial effects in people infected with HIV, and increased the effectiveness of the anti-HIV drug, AZT.²⁷ This supports the idea that immuno-modulating herbs could benefit people with HIV infection, though more research is needed.

Caution: Synthetic beta-carotene has been linked to increased risk of lung cancer in smokers. Until more is known, smokers should avoid all beta-carotene supplements.

Beta-carotene levels have been found to be low in HIV-positive people, even in those without symptoms.²⁸ However, trials on the effect of beta-carotene supplements have produced conflicting results. In one double-blind trial, supplementing with 300,000 IU per day of beta-carotene significantly increased the number of CD4+ cells in people with HIV infection.²⁹ In a second double-blind study, supplementing with natural mixed carotenoids equivalent to 120,000 IU of beta-carotene per day significantly prolonged survival times in adults with advanced AIDS who were also receiving conventional therapy and a multivitamin.³⁰ In another trial, however, 300,000 IU per day of beta-carotene had no effect on CD4+ cell counts or various other measures of immune function in HIV-infected people.³¹

Cat’s claw is another immuno-modulating herb. Standardized extracts of cat’s claw have been tested in small, preliminary trials in people infected with HIV, showing some benefits in preventing CD4 cell counts from dropping and in preventing opportunistic infections.^32,33 Further study is needed to determine whether cat’s claw is truly beneficial for people with HIV infection or AIDS.

Blood levels of coenzyme Q10 (CoQ10) were also found to be low in people with HIV infection or AIDS. In a small preliminary trial, people with HIV infection took 200 mg per day of CoQ10. Eighty-three percent of these people experienced no further infections for up to seven months, and the counts of infection-fighting white blood cells improved in three cases.³⁴

A controversy has surrounded the use of echinacea in people infected with HIV. Test tube studies initially showed that echinacea’s polysaccharides could increase levels of a substance that might stimulate HIV to spread.³⁵ However, these results have not been shown to occur when echinacea is taken orally by humans.³⁶ In fact, one double-blind trial found that Echinacea angustifolia root (1 gram three times per day by mouth) greatly increased immune activity against HIV, while placebo had no effect.³⁷ Further studies are needed to determine the safety of using echinacea in HIV-positive people.

Immune-modulating plants that could theoretically be beneficial for people with HIV infection include Asian ginseng, eleuthero, and the medicinal mushrooms shiitake and reishi. One preliminary study found that steamed then dried Asian ginseng (also known as red ginseng) had beneficial effects in people infected with HIV, and increased the effectiveness of the anti-HIV drug, AZT.³⁸ This supports the idea that immuno-modulating herbs could benefit people with HIV infection, though more research is needed.

In HIV-positive people with B-vitamin deficiency, the use of B-complex vitamin supplements appears to delay progression to and death from AIDS.³⁹ Thiamine (vitamin B1) deficiency has been identified in nearly one-quarter of people with AIDS.⁴⁰ It has been suggested that a thiamine deficiency may contribute to some of the neurological abnormalities that are associated with AIDS. Vitamin B6 deficiency was found in more than one-third of HIV-positive men; vitamin B6 deficiency was associated with decreased immune function in this group.⁴¹ In a population study of HIV-positive people, intake of vitamin B6 at more than twice the recommended dietary allowance (RDA is 2 mg per day for men and 1.6 mg per day for women) was associated with improved survival.⁴² Low blood levels of folic acid and vitamin B12 are also common in HIV-positive people.⁴³

Garlic may assist in combating opportunistic infections. In one trial, administration of an aged garlic extract reduced the number of infections and relieved diarrhea in a group of patients with AIDS.⁴⁴ Garlic’s active constituents have also been shown to kill HIV in the test tube, though these results have not been confirmed in human trials.⁴⁵

The amino acidglutamine is needed for the synthesis of glutathione, an important antioxidant within cells that is frequently depleted in people with HIV and AIDS.⁴⁶ In well-nourished people, the body usually manufactures enough glutamine to prevent a deficiency. However, people with HIV or AIDS are often malnourished and may be deficient in glutamine.⁴⁷ In such people, glutamine supplementation may be needed, along with NAC, to maintain adequate levels of glutathione. It is not known how much glutamine is needed for that purpose; however, in other trials, 4–8 grams of glutamine per day was used.⁴⁸ In a double-blind trial, massive amounts of glutamine (40 grams per day) in combination with several antioxidants (27,000 IU per day of beta-carotene; 800 mg per day of vitamin C; 280 mcg per day of selenium; 500 IU per day of vitamin E) were given for 12 weeks to AIDS patients experiencing problems maintaining normal weight.⁴⁹ Those who took the glutamine-antioxidant combination experienced significant gains in body weight compared with those taking placebo. Larger trials are needed to determine the possible benefits of this nutrient combination on reducing opportunistic infections and long-term mortality.

Iron deficiency is often present in HIV-positive children.⁵⁰ While iron is necessary for normal immune function, iron deficiency also appears to protect against certain bacterial infections.⁵¹ Iron supplementation could therefore increase the severity of bacterial infections in people with AIDS. For that reason, people with HIV infection or AIDS should consult a doctor before supplementing with iron.

Maitake mushrooms, which are currently being studied, contain immuno-modulating polysaccharides (including beta-D-glucan) that may be supportive for HIV infection.^52,53

People with AIDS have low levels of methionine. Some researchers suggest that these low methionine levels may explain some aspects of the disease process,^54,55,56 especially the deterioration that occurs in the nervous system and is responsible for symptoms such as dementia.^57,58 A preliminary trial found that methionine (6 grams per day) may improve memory recall in people with AIDS-related nervous system degeneration.⁵⁹

In a preliminary trial, a thymus extract known as Thymomodulin® improved several immune parameters among people with early HIV infection, including an increase in the number of T-helper cells.⁶⁰

Preliminary human clinical trials of European mistletoe injections into the skin have shown beneficial effects.^61,62 Oral mistletoe is very unlikely to have the same effects as injected mistletoe. Injectable mistletoe should only be used under the supervision of a qualified healthcare professional.

Immune-modulating plants that could theoretically be beneficial for people with HIV infection include Asian ginseng, eleuthero, and the medicinal mushrooms shiitake and reishi. One preliminary study found that steamed then dried Asian ginseng (also known as red ginseng) had beneficial effects in people infected with HIV, and increased the effectiveness of the anti-HIV drug, AZT.⁶³ This supports the idea that immuno-modulating herbs could benefit people with HIV infection, though more research is needed.

Immune-modulating plants that could theoretically be beneficial for people with HIV infection include Asian ginseng, eleuthero, and the medicinal mushrooms shiitake and reishi. One preliminary study found that steamed then dried Asian ginseng (also known as red ginseng) had beneficial effects in people infected with HIV, and increased the effectiveness of the anti-HIV drug, AZT.⁶⁴ This supports the idea that immuno-modulating herbs could benefit people with HIV infection, though more research is needed.

The Chinese herb bupleurum, as part of the herbal formula sho-saiko-to, has been shown to have beneficial immune effects on white blood cells taken from people infected with HIV.⁶⁵ Sho-saiko-to has also been shown to improve the efficacy of the anti-HIV drug lamivudine in the test tube.⁶⁶ One preliminary study found that 7 of 13 people with HIV given sho-saiko-to had improvements in immune function.⁶⁷ Double-blind trials are needed to determine whether bupleurum or sho-saiko-to might benefit people with HIV infection or AIDS. Other herbs in sho-saiko-to have also been shown to have anti-HIV activity in the test tube, most notably Asian scullcap.⁶⁸ Therefore studies on sho-saiko-to cannot be taken to mean that bupleurum is the only active herb involved. The other ingredients are peony root, pinellia root, cassia bark, ginger root, jujube fruit, Asian ginseng root, Asian scullcap root, and licorice root.

Caution: It is likely that there are many drug interactions with St. John's wort that have not yet been identified. St. John's wort stimulates a drug-metabolizing enzyme (cytochrome P450 3A4) that metabolizes at least 50% of the drugs on the market.⁶⁹ Therefore, it could potentially cause a number of drug interactions that have not yet been reported. People taking any medication should consult with a doctor or pharmacist before taking St. John's wort.

A 5% solution of tea tree oil has been shown to eliminate oral thrush in people with AIDS, according to one preliminary trial.⁷³ The volunteers in the study swished 15 ml of the solution in their mouths four times per day and then spit it out. This may cause mild burning for a short period of time after use.

In a preliminary trial, a thymus extract known as Thymomodulin improved several immune parameters among people with early HIV infection, including an increase in the number of T-helper cells.⁷⁴

Turmeric may be another useful herb with immune effects in people infected with HIV. One preliminary trial found that curcumin, the main active compound in turmeric, helped improve CD4+ cell counts.⁷⁵ The amount used in this study was 1 gram three times per day by mouth. These results differed from those found in a second preliminary trial using 4.8 or 2.7 grams of curcumin daily. In that study, there was no apparent effect of curcumin on HIV replication rates.⁷⁶

Vitamin A deficiency appears to be very common in people with HIV infection. Low blood levels of vitamin A are associated with greater disease severity⁷⁷ and increased transmission of the virus from a pregnant mother to her infant.⁷⁸ However, in preliminary ⁷⁹ and double-blind^80,81 trials, supplementation with vitamin A failed to reduce the overall mother-to-child transmission of HIV. HIV-positive women who took 5,000 IU per day of vitamin A (as retinyl palmitate) and 50,000 IU per day of beta-carotene during the third trimester (13 weeks) of pregnancy, plus an additional single amount of 200,000 IU of vitamin A at delivery, had the same rate of transmission of HIV to their infants as those who did not take the supplement. However, lower rates of illness have been observed in the children of HIV-positive mothers when the children were supplemented with 50,000–200,000 IU of vitamin A every two to three months.⁸²

Little research has explored whether vitamin A supplements are helpful at halting disease progression. HIV-positive children given two consecutive oral supplements of vitamin A (200,000 IU in a gelcap) in the two days following influenza vaccinations had a modest but significant decrease in viral load.⁸³ In one trial, giving people an extremely high (300,000 IU) amount of vitamin A one time only did not improve short-term measures of immunity in women with HIV.⁸⁴

In HIV-positive people with B-vitamin deficiency, the use of B-complex vitamin supplements appears to delay progression to and death from AIDS.⁸⁵ Thiamine (vitamin B1) deficiency has been identified in nearly one-quarter of people with AIDS.⁸⁶ It has been suggested that a thiamine deficiency may contribute to some of the neurological abnormalities that are associated with AIDS. Vitamin B6 deficiency was found in more than one-third of HIV-positive men; vitamin B6 deficiency was associated with decreased immune function in this group.⁸⁷ In a population study of HIV-positive people, intake of vitamin B6 at more than twice the recommended dietary allowance (RDA is 2 mg per day for men and 1.6 mg per day for women) was associated with improved survival.⁸⁸ Low blood levels of folic acid and vitamin B12 are also common in HIV-positive people.⁸⁹

In HIV-positive people with B-vitamin deficiency, the use of B-complex vitamin supplements appears to delay progression to and death from AIDS.⁹⁰ Thiamine (vitamin B1) deficiency has been identified in nearly one-quarter of people with AIDS.⁹¹ It has been suggested that a thiamine deficiency may contribute to some of the neurological abnormalities that are associated with AIDS. Vitamin B6 deficiency was found in more than one-third of HIV-positive men; vitamin B6 deficiency was associated with decreased immune function in this group.⁹² In a population study of HIV-positive people, intake of vitamin B6 at more than twice the recommended dietary allowance (RDA is 2 mg per day for men and 1.6 mg per day for women) was associated with improved survival.⁹³ Low blood levels of folic acid and vitamin B12 are also common in HIV-positive people.⁹⁴

Preliminary observations suggest a possible role for vitamin B3 in HIV prevention and treatment.⁹⁵ A form of vitamin B3 (niacinamide) has been shown to inhibit HIV in test tube studies.⁹⁶ However, no published data have shown vitamin B3 to inhibit HIV in animals or in people. One study did show that HIV-positive people who consume more than 64 mg of vitamin B3 per day have a decreased risk of progression to AIDS or AIDS-related death.^97,97 Clinical trials in humans are required to validate these preliminary observations.

In HIV-positive people with B-vitamin deficiency, the use of B-complex vitamin supplements appears to delay progression to and death from AIDS.⁹⁸ Thiamine (vitamin B1) deficiency has been identified in nearly one-quarter of people with AIDS.⁹⁹ It has been suggested that a thiamine deficiency may contribute to some of the neurological abnormalities that are associated with AIDS. Vitamin B6 deficiency was found in more than one-third of HIV-positive men; vitamin B6 deficiency was associated with decreased immune function in this group.¹⁰⁰ In a population study of HIV-positive people, intake of vitamin B6 at more than twice the recommended dietary allowance (RDA is 2 mg per day for men and 1.6 mg per day for women) was associated with improved survival.¹⁰¹ Low blood levels of folic acid and vitamin B12 are also common in HIV-positive people.¹⁰²

In test-tube studies, vitamin E improved the effectiveness of the anti-HIV drug zidovudine (AZT) while reducing its toxicity.¹⁰³Similarly, animal research suggests that zinc and NAC supplementation may protect against AZT toxicity.¹⁰⁴ It is not known whether oral supplementation with these nutrients would have similar effects in people taking AZT.

Whey protein is rich in the amino acid cysteine, which the body uses to make glutathione, an important antioxidant. A double-blind trial showed that 45 grams per day of whey protein increased blood glutathione levels in a group of HIV-infected people.¹⁰⁵ Test tube¹⁰⁶ and animal¹⁰⁷ studies suggest that whey protein may improve some aspects of immune function.