Nigeria has an estimated 3.1 million people living with HIV (PLWH), accounting for nearly 10% of global HIV burden. Use of traditional medicines is high in the general population. Here, we sought to evaluate the use of herbal medicines amongst (PLWH), and undertake a country-wide analysis of herbal medicines used by PLWH for possible contamination with antiretrovirals (ARV).
Part A) large questionnaire-based survey of patients attending health centres in mixed rural and urban centres across 4 states. Data were collated and analysed using SPSS. Part B) country-wide (Fig. 1) collection of herbal samples for drug analysis. Investigators followed a standard protocol i) street vendors from a mixture of urban and rural settings were approached ii) a request for herbals for treatment of general pains, hepatitis, UTI, and febrile ailments on a background of HIV iii) herbals sold as powders or liquids were purchased iv) instructions for use, date and site were recorded. Analysis for efavirenz, nevirapine, lopinavir, darunavir, ritonavir, atazanavir, emtricitabine, tenofovir and lamivudine using validated LC-MS/MS methods was performed at the University of Liverpool.
Of 742 PLWH aged 2-91y, prevalence of herbal medication use was 41.8% (310). Use of herbals was significantly associated with educational attainment (31.8% in patients with little or no education, vs 43.8% and 44.8% in patients with secondary and tertiary education respectively; P= 0.037) and with employment status (44.9% of the employed vs 36.7% of unemployed patients used herbals; P= 0.01). Of those who took herbals, 45% did so prior to commencement of ARVs, 53.9% did so to cure HIV (46% with little effect while 5.1% believed themselves cured); influence of family or friends contributed to herbal intake in 75%. Of 138 herbal samples collected across 8 States, 3 (2%; all from large cities) contained measurable antiretrovirals. One sample contained tenofovir (0.2ng/mg powder) and emtricitabine (0.0065ng/mg powder), while two samples contained tenofovir (0.2 and 1.6ng/mg powder) and emtricitabine (0.123 and 0.00049ng/mg powder), with one of these also containing lamivudine (0.25ng/mg powder)
Herbal use amongst PLWH is widespread, poorly recorded and often precedes ARV therapy. Contamination with ARVs is worrying (particularly in untreated patients) given the potential for drug resistance.