Echinacea and HIV or AIDS

• Antiviral Drug Interactions
• Dangerous Immune System Effects?

HIV is a viral infection that suppresses the immune system. Without antiviral treatment it can worsen to AIDS, a life-threatening condition where the immune system is barely working to protect the body against other infections. As an immune boosting herb, echinacea is one of the most common herbs people who are HIV-positive take to protect them against opportunistic infections. But can echinacea really help?⁽¹¹⁷⁾

Antiviral and Immune-Boosting Effects

Multiple lab tests have shown that extracts from E. purpurea inhibits HIV viral replication activity by 50% with little to no toxicity on cells. This anti-HIV effect is linked to the cichoric acid component of E. purpurea.⁽²⁵⁾

In controlled clinical studies, blood drawn from trial participants with AIDS treated with echinacea extracts demonstrated that the herb enhanced natural killer (NK) immune cell function (as compared to tested blood from healthy subjects). NK cells are crucial to the immune system's antiviral activities.⁽¹¹⁾

Safety Concerns

Echinacea's reputation as a natural immune-booster makes it a popular herbal supplement for patients with HIV. Patients may also feel it reduces side effects of antiviral drug treatments. But is it safe?⁽¹¹⁸⁾

Antiviral Drug Interactions

Echinacea stimulates the production of metabolizing enzymes in the liver, including those that break down antiviral drugs used to treat people who are HIV positive. Theoretically, this could cause the body to break the antiviral drugs down too fast and lead to dangerously low levels in patients. For this reason many experts warn HIV patients to not take echinacea.^(118, 119)

However, results of 2 open clinical studies indicate that taking E. purpurea supplements is likely safe to use with drugs used to treat HIV.

The studies involved:

• 15 people with HIV taking the antiretroviral drugs darunavir and ritonavir. Patients were given 500 mg of echinacea root extract every 6 hours daily for 2 weeks.⁽¹²⁰⁾
• 15 people with HIV taking the antiretroviral drug Etravirine. Patients were given 500 mg of echinacea root extract every 8 hours daily for 2 weeks.⁽¹¹⁹⁾

The echinacea supplements did reduce levels of antiviral drugs in patients. However, echinacea did not significantly reduce concentrations of any of the antiviral drugs and did not interfere with treatment.^(119, 120)

Dangerous Immune System Effects?

Clinical trials have shown that echinacea can boost the immune system. However, it has also been suggested that echinacea's stimulation of certain inflammatory proteins in lab studies may make the disease worse in AIDS patients.^{(1, 11, 22)}

There are some isolated reports where echinacea was associated with a flare-up of a serious systemic autoimmune disease (lupus). This has led experts to advise caution when using echinacea with conditions that involve the immune system — including HIV infection.^{(1, 11, 22)}

Bottom Line

Herbal supplements are often not standardized for active ingredients and compounds can vary species to species or because of growing conditions. There have been no clinical studies showing echinacea is unsafe for people with HIV or AIDS. However, despite recent clinical studies in HIV positive patients that showed no harm, experts still warn against taking echinacea.^{(99, 100, 121)}