Neuropsychiatric aspects of HIV disease progression: Impact of traditional herbs on adult patients in Zimbabwe

Abstract

This cohort study examined the impact of phytotherapy (PT; traditional herbs) on neuropsychiatric aspects of HIV disease progression to antibody immunodeficiency syndrome (AIDS), CD4 counts, and viral load in adult patients in Harare, Zimbabwe. This is a community-based and nonintervention cohort study. The study was conducted in and around Harare City from June 1996 to May 1998. One hundred and five volunteers participated in the study. They were seen at the baseline and then followed up on a 3-month basis. The volunteers were interviewed, underwent physical examinations, and had blood drawn for laboratory tests, including the chest X-rays. The outcome measures were: prevalence of mental disorders and depressive symptoms, diagnosis of AIDS, and changes in CD4 cell counts and plasma HIV-I RNA concentrations. Instruments used were the Brief Psychiatric Rating Scale (BPRS), Montgomery–Asberg Depression Rating Scale (MADRS), Structured Interview Diagnosis of Dementia According to the DSM-IV (SIDAM), and Centre for Disease Control and Prevention (CDC) criteria as measurement tools. The findings were that patients on the PT had a mean (S.D.) age of 34.5 (7.4) years, whereas those on conventional therapy were a bit older with a mean (S.D.) age of 36.4 (6.6) years, range 19–55 years. The overall prevalence of psychiatric disorders according to the DSM-IV diagnostic criteria at the baseline was 44.8% ( n=47, 95% CI=35.3–54.3) and by the end of the 6 months follow-up was 36% ( n=18, 95% CI=23–49). The relative risks of psychiatric diagnoses were less in patients on PT ( P=.046), including the diagnoses of depression ( P=.035), than those on conventional therapy. Mean levels of a reported symptom of suicidal thoughts according to the MADRS were lowest in patients on PT than those on conventional therapy ( F=5.44, P=.022). Finally, PT is protective against psychiatric disorders in our patients. However, our findings did not support HIV-I disease progression to AIDS in these patients.