Quiz

Do you take vitamins or herbal supplements?

If so, take our quick quiz and see what works, what doesn’t and what could be harmful.

While antiretroviral treatments are very effective at controlling HIV, they are not a cure and can sometimes have nasty side-effects. Our research has shown over 50% of HIV-positive people in the UK also take vitamins or herbal supplements to help boost their immune system, improve health or reduce the unpleasant side-effects of their drugs.

However, many of these supplements have not been fully tested and while some may offer benefits, others may cause real harm. As a result, UKfAR is now conducting research to try to evaluate which of these supplements are worth taking and which are harmful or have no health benefits.

Vitamin and Supplement Quiz

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Question 1

Though expensive, the antioxidant Co-enzyme Q10 will increase your CD4 count.

	True
	False

Question 1 Explanation:False. No properly conducted clinical trial has shown co-enzyme Q10 to have any effect on CD4 counts. However, recent research on isolated cells has suggested that some elements of co-enzyme Q10 may have some beneficial effects in preventing antiretroviral drug-induced neuropathy (Cherry et al., 2010).

Question 2

Taking selenium supplements strengthens your immune system and may boost CD4 numbers.

	True
	False

Question 2 Explanation:True (probably). In a randomised controlled trial, patients who received selenium supplements of 200 micrograms per day for 9 months showed reduced viral load and consequently increased CD4 counts compared to placebo, with no adverse effects noted (Hurwitz et al., 2007).

Question 3

A multivitamin supplement may increase CD4 counts.

	True
	False

Question 3 Explanation:True. A study in Tanzania found that multivitamin supplements delayed the progression of HIV disease and resulted in higher CD4 counts (Fawzi et al., 2004). However this study was performed in pregnant women in a developing country, who were not receiving any antiretroviral therapies. There is currently no evidence that HIV positive people in the UK, who are on successful ARV therapy and eat a balanced diet, will benefit from multivitamins.

Question 4

Garlic supplements can stop your antiretroviral drugs working properly.

	True
	False

Question 4 Explanation:True, but only in the case of the protease inhibitor saquinavir (marketed as InviraseTM), when garlic supplements can reduce the amount of the drug circulating in the body by about half.

Question 5

Echinacea, the common cold remedy can reduce the effectiveness of some antiretroviral drugs.

	True
	False

Question 5 Explanation:False. A recent study reported Echinacea supplements affected the levels of the protease inhibitors darunavir-ritonavir in individual patients (Molto et al, 2011). They found that this did not affect the overall effectiveness of the drugs and concluded that use of Echinacea with darunavir-ritonavir was safe and well tolerated

Question 6

The plant extract Acetyl–L-carnitine helps reduce the damage sometimes caused to nerves by anitretroviral drugs.

	True
	False

Question 6 Explanation:False (probably). Many of the initial studies looking at the effects of Acetyl–L-carnitine were positive at first, but scientifically flawed. Only one controlled study showed a very modest increase, which on further examination was no different to placebo (Phillips et al., 2010).

Question 7

St John’s Wort supplements should be avoided if you are taking some antiretroviral drugs.

	True
	False

Question 7 Explanation:True. St John’s Wort (Hypericum perforatum) significantly reduces the effectiveness of all protease inhibitors and non-nucleoside reverse transcriptase inhibitors. St John’s Wort can also reduce the effectiveness of other medicines, including the oral contraceptive pill. It is important to let your pharmacist know if you are taking St John’s Wort.

Question 8

Taking herbs and vitamins regularly will also help you stick to your antriretroviral drugs regime.

	True
	False

Question 8 Explanation:False. Somewhat surprisingly, evidence has suggested that women who routinely use complementary or alternative therapies were 1.69 times more likely to report missing antiretroviral drugs (Owen-Smith et al., 2007).

Question 9

Milk thistle (Silybum marianum), as well as being good for your liver, also helps boost CD4 numbers.

	True
	False

Question 9 Explanation:False. No clinical trials have been performed on Milk Thistle and CD4 counts. However on-going clinical trials have reported Milk Thistle may be useful in the treatment of liver damage.

Question 10

Zinc supplements have been shown to be good at keeping CD4 levels up.

	True
	False

Question 10 Explanation:True – if you are zinc deficient. In people already deficient in zinc, patients who received supplements of 12-15mg zinc per day for 18 months were about 75% less likely to see their CD4 cell count drop below 200 cells/mm3 or fail to recover adequately after starting antiretroviral therapy (Baum et al, 2010).

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