Traditional Chinese Medicine Can Improve the Immune Reconstruction of HIV/AIDS Patients

Abstract

Editor: There are ∼820,000 HIV-infected patients in China. More than half of the patients receiving highly active antiretroviral therapy (HAART) are treated with traditional Chinese medicine (TCM) at the same time. TCM is an aggregate of healing modalities that has originated and developed in China and has been used for >5,000 years to treat diseases.¹ TCM has been used to treat HIV/AIDS for >20 years. In the long-term clinical practice process, TCM has shown the ability to reduce CD4 cells and to alleviate the side effects associated with HAART.² It can improve the patients' life quality, protect liver function, alleviate clinical symptoms, and slow down the progression of HIV disease.^3
–5 Currently, an increasing number of Chinese HIV/AIDS patients are using TCM in combination with HAART.^6–7 Nevertheless, the mechanism of TCM in treating AIDS remains unclear. To investigate the mechanisms and targets of TCM in the treatment of HIV/AIDS patients, we designed the following experiments.

A prospective open-label 4-year-long pilot study, which included 207 HIV-1–infected patients, was conducted at the HIV outpatient clinic of the Beijing YouAn Hospital, between January 1, 2011 and December 30, 2014. Excluding patients who were lost follow-up, discontinued medication, incomplete clinical and laboratory data, 63 patients were involved in the study. Sixty-three patients with the mean age of 51.62 ± 20.13 (21–67) years were divided into HAART group, which was treated with tenofovir (TDF)/lamivudine (3TC)/efavirenz (EFV); and TCM-HAART treatment group treated with a combination of HAART and TCM (which consisted of Astragalus, Licorice, Atractylodes, Yam, Medlar, Codonopsis, and Salvia). The two groups were similar regarding gender (p = .730) and age (p = .409) distribution. Thirty-two patients were in the TCM+HAART group and 31 patients in the HAART group. The median HIV-1 RNA load and CD4+ cell absolute counts were (4.65 ± 0.72)Log10 copies/mL and 535.54 ± 120.15 cells/μL in HAART+TCM group, whereas the median HIV-1 load and CD4+ cell counts were (3.79 ± 1.31) Log10 copies/mL and 541.19 ± 161.24 cells/μL in HAART treatment group. No differences were observed in age and gender between TCM+HAART group and HAART group before treatment (p > .05).

In the process of HIV infection, T cells play an important role in controlling the pathogenesis of HIV-1 infection.⁸ The enhancement of the function of HIV-specific T cells is even more significant than the increase in the number of CD4+ T cells.⁹ The immune function of HIV-specific T cells was tested by ELISPOT. The data showed that the immune response of HIV-specific T cells in patients treated with TCM+HAART was significantly higher compared with HAART group. In the TCM+HAART group, 30/32 (94%) patients had peptide present, and the average magnitude of HIV-specific T cell responses was 5133.32 spot forming units (SFU)/10⁶ peripheral blood mononuclear cell (PBMC). In HAART group, 25/31 (81%) had peptide present, and the average magnitude of HIV-specific T cell responses was 3176.18 SFU/10⁶ PBMC. The magnitude of HIV-specific T cell responses in TCM+HAART group significantly increased compared with HAART group (p < .05). The results indicated that TCM enhanced HIV-specific T cell immunity in HIV/AIDS patients.

The recovery of the number of naive T cells is essential for the immune reconstitution of the body, since the naive T cells are derived from the thymus, and their recovery implies the recovery of the thymus function.¹⁰ Therefore, the increase in the proportion and number of naive T cells has far-reaching significance for the immune reconstruction of the body.^11,12 T cell subsets detected by flow cytometry, naive CD45RA+CD27+CD4+T percentage in TCM+HAART group was significantly increased compared with HAART group (p < .05). Moreover, naive CD45RA+CD27+CD8+T percentage in TCM+HAART group was significantly increased compared with HAART group (p < .05). These data showed that Chinese medicine has a good effect on enhancing immune reconstitution in HIV/AIDS patients.

In conclusion, we have demonstrated that TCM combined with HAART treatment can enhance HIV-specific T cell immunity and promote immune reconstitution in our study population of HIV/AIDS patients. There is increasing trend with therapy time prolonged. Taken together with the body of available literature, our results suggest a significant benefit of TCM combined with HAART treatment for HIV/AIDS patients, and serve to inform therapeutic strategies to face the continuing challenges of chronic HIV-infected individuals.

Footnotes

Authors' Contributions

W.H.L. and C.Y.L. performed experiments. X.H.L., X.W., and A.L. obtained patient samples. All authors contributed to data analysis and writing of the article.

Acknowledgments

We thank the group of Chinese medicine for the AIDS treatment group of Beijing Youan Hospital, who kindly cooperated with us in performing this study.

Author Disclosure Statement

All authors have no potential conflicts. All authors have submitted the ICMJE form for disclosure of potential conflicts of interest. Conflicts that the editors consider relevant to the content of the article have been disclosed.

Funding Information

This study was supported by the National Natural Science Foundation of China (81603552); Beijing health system high-level talent project (2015-3-100); Beijing Chinese Medicine Science and Technology Development Fund Planning Project (JJ2018-32); Beijing Liver Disease Research Institute Foundation (2018-2-1); specific prediction and early-stage diagnosis of molecular markers about liver cancer screening system and mechanism research platform (2016-2).

References

Wang

, Jin

, Wang

, Suo

: Long-term survival of aids patients treated with only traditional Chinese medicine. AIDS Res Hum Retroviruses, 2017; 33:90–92.

Zou

, Wang

, Liu

: Effect of traditional Chinese medicine for treating human immunodeficiency virus infections and acquired immune deficiency syndrome: Boosting immune and alleviating symptoms. Chin J Integr Med, 2016; 22:3–8.

Wang

, Zou

: Practices, challenges, and opportunities: HIV/AIDS treatment with traditional Chinese medicine in China. Front Med, 2011; 5:123–126.

, Liu

, Detels

: HIV-1 infection in commercial plasma donors in China. Lancet, 1995; 346:61–62.

Liu

, Yang

: Health related quality of life: Is it another comprehensive evaluation indicator of Chinese medicine on acquired immune deficiency syndrome treatment?. J Tradit Chin Med, 2015; 35:600–605.

Wang

, Yang

, Yuan

, Liu

: The antiviral and antimicrobial activities of licorice, a widely-used Chinese herb. Acta Pharm Sin B, 2015; 5:310–315.

Esposito

, Carli

, Del

, et al.: Sennoside A, derived from the traditional Chinese medicine plant Rheum L., is a new dual HIV-1 inhibitor effective on HIV-1 replication. Phytomedicine, 2016; 23:1383–1391.

Storcksdieck

GBM

, Niezold

, Hannaman

, Uberla

, Tenbusch

: The improved antibody response against HIV-1 after a vaccination based on intrastructural help is complemented by functional CD8+ T cell responses. Vaccine, 2016; 34:1744–1751.

Leibman

, Richardson

, Ellebrecht

, et al.: Supraphysiologic control over HIV-1 replication mediated by CD8 T cells expressing a re-engineered CD4-based chimeric antigen receptor. PLoS Pathog, 2017; 13:e1006613

10.

Matsushita

, Kimura

: Advance in treatment strategy and immune reconstruction against HIV-1 infection. Microbiol Immunol, 2002; 46:231–239.

11.

van den Broek

, Borghans

, van Wijk

: The full spectrum of human naive T cells. Nat Rev Immunol, 2018; 18:363–373.

12.

Patel

, Chorvinsky

, Albihani

, et al.: HIV-specific T cells generated from naive T cells suppress HIV in vitro and recognize wide epitope breadths. Mol Ther, 2018; 26:1435–1446.