A Call To Action:

A Manual for Homeopaths in the Treatment of Patients with HIV/AIDS

By:Rebecca Gower

TorontoSchool of Homeopathic Medicine

Independent Research Project

©2008
TABLE OF CONTENTS

Pages

  1. Introduction3-4
  2. Chapter One: The Pathophysiology of HIV/AIDS5-7
  3. Chapter Two: Stages of Disease8-11
  4. Chapter Three: Medications to Manage HIV/AIDS12-13
  5. Chapter Four: Literature Review14-26
  6. Chapter Five: ‘Hahnemannian Homeopathy27-31
  7. Chapter Six: Clinical Cases32-40
  8. Chapter Seven: Conclusions41-42
  9. Bibliography43-44

INTRODUCTION:

People living with HIV or AIDS have been using complementary therapies since the beginning of the epidemic. Prior to the advent of Highly Active Anti-Retroviral Therapy (HAART), HIV-positive people used complementary therapies to cope with acute and chronic symptoms as well as to boost immunity. Since the introduction of more effective allopathic medications, more HIV-positive patients continue to use complementary therapies “to improve general well-being, reduce symptoms and to manage the side effects of HAART.”[1]

Given well-documented interest in using complementary therapies by people living with HIV, the question remains as to why homeopathic medicine remains unknown and ignored within the AIDS movement. The American Homeopath Dana Ullman made this point very succinctly when he said; “it is both surprising and depressing that homeopathic medicine has been consistently ignored as a viable part of a comprehensive program in treating HIV-positive and AIDS patients.”[2] As the AIDS epidemic has created more awareness about the importance of our immune systems, Homeopathy’s history of successfully treating infectious diseases should be taken into consideration in fighting immune-related diseases such as HIV. We already know that some of the best homeopathic prescribers in the history of Homeopathy, such as Hahnemann, Lippe, and Boenninghausen, were able to cure people suffering from virulent infectious diseases with much lower death rates than their allopathic colleagues. Given the efficacy of ‘Hahnemannian Homeopathy’ in treating virulent epidemics that included scarlet fever, typhoid and cholera, I wonder why the homeopathic community in North America has not stepped up to the challenge of treating people affected by the greatest epidemic of our time?

There may in fact be several reasons to explain why people living with HIV are not accessing homeopathy such as financial limitations, lack of knowledge about the modality and stigma. Because of the success rates of the old masters of Homeopathy in treating all types of disease, but especially infectious disease, I want to examine the effectiveness of using ‘Hahnemannian Homeopathy’ or a more pure form of our art and science in the treatment of people living with HIV or AIDS. Even though we know the history of the efficacy of homeopathy, most of the homeopathic literature on HIV suggests that only the newer or more modern methods can be successful in treating often complex health histories common in HIV-positive people. This paper will focus on providing a manual for Homeopaths to utilize in the treatment of people living with HIV or AIDS that is based on the writings of Hahnemann and not based on the often appealing and speculative beliefs that are promoted by appealing and charismatic modern practitioners. I hope that this is a first step that will encourage more homeopaths to view HIV as any other chronic disease and increase the knowledge and reputation of our amazing medical system within the AIDS movement.

CHAPTER ONE:

THE PATHOPHYSIOLOGY OF HIV/AIDS:

As Homeopaths, it is important for us to have an understanding of the pathological processes of each chronic complaint our patients bring to us. It is the exact same issue in the treatment of patients living with HIV and/or AIDS. Although it is necessary to understand each individual’s unique expression of this disease, it is important to understand the basic pathology of the HIV virus for many reasons.A basic understanding of the suppressed immunity experienced by all HIV-positive patients and a basic comprehensionof how different classes of Anti-Retroviral Therapy work to fight the virus at different stages of its lifecycle provides an important background for any homeopathic prescription. It is also necessary to understand some of the common acute exacerbations that the virus can induce in people so that homeopaths can better manage these periods of illness.

Transmission and Epidemiology

The Human Immunodeficiency Virus (HIV) is a virus that is acquired through sexual contact, intravenous drug use or from mother to child transmission via the placenta. This means that the virus is transmitted through body fluids, especially blood, semen and vaginal fluid. It is important to note that a person can only be infected through direct contact in which the virus is able to get inside the body.[3] Typically, during the initial or primary infection, HIV levels are highest (106 copies/mL), and circulating CD4+ lymphocyte counts drop rapidly. Normal CD4+ counts are about 750/μL, and immunity is minimally affected if counts are greater than 500/μL.[4]

Pathophysiology of the Human Immunodeficiency Virus (HIV)

In order to be effective, all viruses need to gain entry into the human body. In the case of HIV, its preferred targets are lymphocytes or host T-cells through CD4 molecules and chemokine receptors.[5] T-cells are an important part of the immune system because they help facilitate the body’s response to many common but potentially fatal infections. And without enough T-cells, the body’s immune system is unable to defend itself against many infections.[6]Once HIV comes into contact with a T-cell, it must attach itself to the cell so that it can inject its genetic material into the cell. Specifically, attachment is a process of binding between the proteins on the surface of the virus and proteins that serve as receptors on the surface of the T-cell.[7] HIV uses one of two beta-chemokine receptors- CCR5 or CXCR4- to attach to the CD4 cell. The virus uses one of two sets of proteins (anti-receptors) called gp120 and gp41 in order to attach to the CD4 cells and the co-receptor(s). Once the virus has attached to one of the co-receptors of the CD4 cell, it penetrates the cells and releases its RNA and enzymes into the cell. In order to survive, viral replication must take place. This process is sometimes referred to as uncoating because the nucleocapsid which contains the viral RNA sheds its viral envelope. Uncoating is necessary so that the viral RNA can be converted into DNA. In order for this conversion to occur, an enzyme called reverse transcriptase copies HIV’s RNA which results in a pro-viral DNA.[8] Specifically, the single stranded viral RNA is transcribed into a double strand of DNA which contains instructions that HIV needs to hijack a T-cell’s genetic machinery to reproduce itself- it uses nucleotides (building blocks of DNA) from the cell cytoplasm.[9] Once the viral RNA has successfully penetrated the nuclear membrane and has been escorted to the nucleus, HIV uses the integrase enzyme to insert HIV's double-stranded DNA into the cell's existing DNA.[10] At this point, the HIV provirus is latent and is waiting for activation. Upon activation, this latent provirus instructs the cell to produce the necessary components of HIV.[11] “From the viral DNA, two strands of RNA are constructed and transported out of the nucleus. One strand is translated into subunits of HIV such as protease, reverse transcriptase, integrase, and structural proteins. The other strand becomes the genetic material for the new viruses.”[12]

Impact on Immunity

The main consequence of HIV infection is damage to the immune system, specifically loss of CD4+ T lymphocytes, which are involved in cell-mediated and, to a lesser extent, humoral immunity.[13] Antibodies to HIV are measurable usually within a few weeks after primary infection; however, antibodies cannot eliminate infection because the mutated forms of HIV which are generated are not controlled by the patient's current antibodies.[14]

Signs and Symptoms

There is a lot of variance in the experience of HIV infection among people. One common point of agreement is that most people remain relatively asymptomatic for long periods of time after the experience of seroconversion or primary acute infection. This is often called Acute Retroviral Syndrome (ARS). The experience of Acute Retroviral Syndrome is also varied because certain patients experience no symptoms while others have very clear symptoms which are indicative of primary infection. ARS usually begins around the fourth week of infection and can last from 3 to 14 days with symptoms such as fever, malaise, rash, arthralgia, generalized lymphadenopathy and sometimes aseptic meningitis.[15] In many situations, symptoms of primary infection or seroconversion are misdiagnosed as infectious mononucleosis or benign nonspecific viral syndromes. This is largely due to the fact that symptoms of ARS are so general that they are easily confused with symptoms of other ailments including influenza, malaria and even certain auto-immune conditions.

CHAPTER TWO:

THE STAGES OF DISEASE:

It is important to think of HIV as a continuum from initial infection to advanced AIDS. From our earlier discussion of the signs and symptoms of HIV, it was observed that there is a lot of variance in symptom expression. This is also true in regards to the time it takes for each individual to go through these stages. It is generally true that the progression of HIV disease is fairly slow, taking several years from infection to the development of severe immune suppression.[16]Acute Retroviral Syndrome (Primary Infection) is first stage of HIV infection that occurs following exposure to the virus.People with HIV are considered to be infectious immediately after viral infection.[17] This stage usually lasts a few weeks and it is during this time the virus first establishes itself in the body. The term acute infection refers to “the period of time between when a person is first infected with HIV and when antibodies (proteins made by the immune system in response to infection) against the virus are produced by the body (usually 6-12 weeks) and can be detected by an HIV test.”[18] This process is commonly referred to as seroconversion. Up to 70% of newly infected people will experience flu-like symptoms at this stage which can include fevers, chills, night sweats and rashes. After these symptoms abate, an infected person returns to feeling and looking completely well. It is important to note that there are a percentage of people who do not experience any symptoms of acute infection or will have symptoms so mild that they may not notice them.[19]

The Asymptomatic Stageis the longest stage of HIV disease. In fact, most patients, especially in resource rich countries, have a period of months and years during which they experience no symptoms or have symptoms that are intermittent and nonspecific.[20] Most patients will look and feel completely well during this period and the “only indication of being positive is through one of the HIV antibody tests or perhaps swollen lymph glands”.[21] HIV is very active during this stage and its activity in the body will continue to weaken the immune system. As the diseases progresses, some people become quite ill even if they have not yet been diagnosed with AIDS or the late stage of HIV disease. This sub-stage of disease is known as the ‘Early to Medium Stage’. As the virus is able to further compromise the immune system, many people experience mild symptoms of HIV such as skin rashes, fatigue, night sweats, slight weight loss, mouth ulcers as well as fungal skin and nail infections. In addition, patients may experience mild to moderate cytopenias such as thrombocytopenia, anemia and leucopenia.

The Symptomatic –AIDSis the last stage of HIV disease which occurs as the damage to the immune system becomes much more severe. An HIV-positive person is diagnosed with AIDS (as opposed to just being HIV-positive) when they have had one AIDS-defining illness (Opportunistic Infection) and the have a CD4 count below 200. According to the Centers for Disease Control and Prevention in the United States;

An AIDS diagnosis can be given to an HIV-positive person who has CD4 counts of less than 200 mm3 or a history of an AIDS-defining illness.[22]

In addition, an AIDS diagnosis can be made based on the intensity and frequency of symptoms of more common infections.[23] Some symptoms of opportunistic infections that are common in people with AIDS include; coughing and shortness of breath, seizures and lack of coordination, difficult or painful swallowing, signs of dementia or memory problems, severe and persistent diarrhea, fever, vision loss, nausea, abdominal cramps and vomiting; weight loss and extreme fatigue; severe headaches and even coma. Some examples of Opportunistic infections include Candidiasis, Pneumocystis Pneumonia (PCP), Mycobacterium Avain Complex (MAC) Cytomegalovirus (CMV) and toxoplasmosis.[24] This diagnosis does not necessarily mean that a person will die very shortly because of the accessibility of Highly Active Anti-Retroviral Therapy (HAART) in resource rich settings as well as allopathic medication and prophylaxis that can treat Opportunistic Infections.

Opportunistic Infections

Since HIV is now viewed as a chronic disease that has acute episodic flare-ups, it is important to have at least a basic understanding of the most common types of these episodes as they can be treated through acute homeopathic treatment. These acute episodes are called opportunistic infections because they occur as a result of the lowered or suppressed immunity that HIV causes upon the body. Specifically, “they are caused by organisms which do not ordinarily induce illness in people with normal immune systems, but take the opportunity to flourish in people with compromised immune systems.”[25] Many of these infections occur when the CD4 cells become lower than 250. It is important to note that many of the opportunistic infections can actually be quite serious and severe. Some of these infections, especially Kaposi’s Sarcoma and Pneumocystis Pneumonia (PCP), were the cause of death of many patients with AIDS before Highly Active Anti-Retroviral Therapy (HAART) became available in the mid-1990s. It would be difficult to include every Opportunistic Infection that a person living with HIV or AIDS might encounter. The following infections will be covered in this study; Candidiasis, Mycobacterium Avium Complex (MAC) and Pneumocystis Pneumonia.

Candidiasisis a common infection for people with HIV/AIDS. It is caused by the imbalance of a common type of yeast or fungus called Candida Albicans that naturally occurs in the body. In most cases, a healthy immune system can keep the balance between ‘good’ bacteria and fungus like Candida in check.[26] Candida can occur anywhere in the body, but it is most commonly found in areas where there are mucous membranes such as the vaginal tract, the rectum and the throat. In the throat, it is called thrush. When it spreads deeper parts of the throat it is called esophagitis. The fungus will look like white patches that are similar to cottage cheese or red spots. Other symptoms, especially of thrush, are sore throat, pain when swallowing and a loss of appetite. Candidiasis is commonly called a yeast infection or vaginitis in the vaginal region.Common symptoms in this area can include burning, itching and a thick/whitish discharge. A Candida infection is of concern because it can also become a systemic issue and lead to symptoms of joint pain, infertility, depression, mood swings depending on what part of the body has been infected by the imbalance of yeast. Mycobacterium Avian Complex (MAC)is a serious illness that the body is usually able to resolve on it own unless there is a suppressed immune system. MAC is caused by a common bacterium and is also known as Mycobacterium Avioum Intracellulare (MAI). This was a very common opportunistic infection prior to the development of more powerful anti-HIV Medications or HAART. It is believed that up to fifty percent of people with AIDS may develop MAC especially if their CD4 counts are lower than 50.[27] It usually occurs in the lungs, intestines, bone marrow, liver and spleen. While MAC can occur in a specific organ, such as the lungs, it can also be disseminated throughout the body. In such cases, it is called Disseminated Mycobacterium Avium Complex (DMAC). Symptoms of MAC can include;

  • high fevers
  • chills,
  • diarrhea,
  • weight loss
  • stomach aches,
  • fatigue and
  • anemia.

It can also cause blood infections (sepsis), hepatitis, pneumonia and other serious problems.

Pneumocystis Pneumonia (PCP), which is now called Pneumocystis Jaroveci Pneumonia, is the most common opportunistic infection in people with HIV. Without medical intervention, it is estimated that 85% of HIV-positive individuals would eventually develop this type of pneumonia. In the first fifteen years of the epidemic, it was the major killer of people with HIV. PCP is caused by a fungus which a healthy immune system is usually able to fight off and resolve on its own.[28] The fungus almost always affects the lungs causing a specific type of an aggressive and severe pneumonia. HIV-positive patients are especially at risk for PCP if they have CD4 counts below 300, 200 and have already had another opportunistic infection.[29] In addition, you are more likely to get this condition once you have already had it. Symptoms of PCP are;