The Pharmaceutical Journal
Vol 273 No 7329 p857
11 December 2004

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Multivitamins for HIV, fruit powder for osteoarthritis and kava for cheerfulness

Research published in the December issue of Focus on Alternative and Complementary Therapies is highlighted by Helen Bond

To evaluate the effect of multivitamins on disease progression of HIV a study of 1,078 pregnant women infected with HIV has been carried out in Dar es Salaam, Tanzania. It was found that women who took the multivitamin preparation were less likely to progress to the advanced stages of HIV disease, and maintained more favourable T-cell counts and viral loads. In addition, they experienced less oral and gastrointestinal HIV-related disease, less fatigue, had fewer rashes and acute upper respiratory tract infections. The study also found that vitamin A, alone or in combination with the multivitamin preparation, either provided no benefit or was associated with negative outcomes. The researchers concluded that the supplements delay the progression of HIV disease and provide an effective, low-cost means of delaying the initiation of anti-retroviral therapy in HIV-infected women.

What is FACT? FACT is an evidence-based journal that is a single point of reference for current information on complementary and alternative medicine (CAM) from around the world. Current literature is summarised and commented on by members of the FACT international editorial board. FACT also contains news, short reports, focus articles and debates on CAM. The full text of FACT is available by subscription and will be available online in 2005. Further information is here

FACT praises the study, which is based on previous observational studies that have implied a positive effect of multivitamins on HIV disease progression, and notes that it was well-designed, showing that vitamin supplementation could have a measurable impact in an area where anti-retroviral therapy is practically unavailable. FACT notes that the nutritional status of the women in the study is unknown, and that a better food supply could potentially produce the same results. However, although it would be of benefit to confirm the results of this trial with a larger sample size, the outcome of the study makes it hard to justify withholding multivitamins before further investigation is carried out.

Fruit powder for osteoarthritis

Hyben Vital, a proprietary capsule of the fruit powder of Rosa canina, has been studied for its effect on osteoarthritis. Ninety-seven patients suffering from osteoarthritis of the hip, knee, neck, shoulder or hand either received capsules containing the powder for three months followed by placebo for three months, or vice versa. Pain, stiffness and wellbeing were found to improve, and consumption of rescue medication was lower, during the taking of the fruit powder capsules for the group receiving the placebo first, but there was no difference found if patients received the powder first. At the end of the study, severity of joint pain was higher in the group receiving placebo first. The author concluded that R canina is effective in the treatment of osteoarthritis, and that the differences in the responses of the two groups may have been caused by a carryover effect of the powder.

FACT states that the study does not convincingly show the effectiveness of R canina powder in symptomatic osteoarthritis of mixed joints. It is noted that from the study it is unknown whether the groups were comparable (with regard to initial pain, duration of disease, duration of present suffering and number of joints affected), and that the true amount of analgesic requirement of the groups should have been considered. It is possible that osteoarthritic pain decreases or fluctuates with time: the greater improvement for patients receiving first placebo and then fruit powder might have been the result of natural causes, or this population might have had higher initial pain at the beginning of month four, thus a better chance to improve with time. FACT concludes that this was a well-conducted study, but that it does not provide convincing evidence of the clinical effectiveness of Hyben Vital.

In response to FACT’s commentary, the author of the study confirms that the missing information was available and that the matching of the groups was remarkably close. The author agrees that the study leaves unanswered questions, and suggests that a further trial of Hyben Vital is necessary.

Kava for cheerfulness

Researchers at the University of Hertfordshire have investigated kava for properties of mood enhancement and improved cognitive performance. Twenty healthy volunteers were given a single dose of kava extract or an indistinguishable placebo in capsules. The volunteers were measured for cheerfulness, seriousness and bad mood as traits and states, tested before and after treatment. Cognitive performance testing was carried out on computers: visual attention and recognition tasks were administered before and 60 minutes after treatment.

Compared with placebo, volunteers treated with kava showed a statistically significant improvement in cheerfulness. The improvement was seen in those with both more cheerful and less cheerful temperaments, the improvement being greater in the initially more cheerful group. Differences between treatments for seriousness and bad mood were not statistically significant. In the cognitive performance tests, visual attention was significantly improved in the group taking kava compared with the placebo controls and, for the item recognition task, subjects taking kava had significantly faster average reaction times and more correct responses than the placebo control.

FACT recognises that the improvements in cheerfulness and cognitive performance were encouraging. Additionally, despite the results for seriousness and bad mood not being statistically significant, the absence of deterioration in these mood parameters suggests that kava could be considered a viable alternative to conventional drug treatment for anxiety. FACT proposes that the findings are interesting since the effects of kava are apparently affected by the temperament of the volunteer, and suggests that the enhanced effect on cheerfulness in those with an already cheerful temperament requires confirmation in a substantially larger study.