|
| LETTER TO EDITOR |
|
|
|
| Year : 2010 | Volume
: 42
| Issue : 1 | Page : 57 |
| |
Use of Tinospora cordifolia in HIV infection
Shahid Akhtar
Department of Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry - 605006, India
| Date of Web Publication | 12-Apr-2010 |
Correspondence Address:
Shahid Akhtar
Department of Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry - 605006
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0253-7613.62402
How to cite this article:
Akhtar S. Use of Tinospora cordifolia in HIV infection. Indian J Pharmacol 2010;42:57 |
Sir,
With reference to the research article entitled 'Immunomodulatory effect of Tinospora cordifolia extract (TCE) in Human immunodeficiency virus positive patients' [1] published in the May - June 2008 issue of Indian Journal of Pharmacology, there are some issues that need to be clarified by the authors. The baseline parameters of placebo and TCE groups indicate that some patients with CD4 count < 200 / µL were included in the study (289.5 ± 200.3 in TCE group and 282.9 ± 214.1 in placebo group). This is in contrast to the guidelines for initiation of highly active anti retroviral therapy (HAART) in HIV positive patients as laid down by the National AIDS Control Organization (NACO) and the Centre for Disease Control (CDC), Atlanta. [2],[3] Advanced HIV infection, as indicated by these low levels of CD4 counts, can rapidly progress to full blown AIDS or encourage opportunistic infections. The use of placebo as control in this trial also goes against the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects.
Paragraph 29 states -A placebo-controlled trial may be ethically acceptable, even if proven therapy is available, under the following circumstances:
- Where for compelling and scientifically sound methodological reasons its use is necessary to determine the efficacy or safety of a prophylactic, diagnostic or therapeutic method; or
- Where a prophylactic, diagnostic or therapeutic method is being investigated for a minor condition and the patients who receive placebo will not be subject to any additional risk of serious or irreversible harm.
All other provisions of the Declaration of Helsinki must be adhered to, especially the need for appropriate ethical and scientific review." [4]
In this trial, the patients were placed either on placebo or TCE. A more reasonable approach could have been placing the patients on HAART and using TCE as an add-on therapy.
The authors observe a significant decrease in the eosinophil count in the TCE group, which has been attributed to the immunomodulatory effects of the extract. There was a significant fall in the Hb% in the TCE treatment group. Was it an adverse drug reaction to TCE? The authors have not established the causality in the case of the death of a single patient in the TCE group. The statistical analysis using Kruskal Wallis test is also inappropriate for this kind of data. As compared to the placebo, TCE failed to demonstrate any significant advantage. Yet, at the end of the trial, the patients were offered treatment with TCE instead of being referred to an ART center.
| » References | |  |
| 1. | Kalikar MV, Thawani VR, Varadpande UK, Sontakke SD, Singh RP, Khiyani RK. Immunomodulatory effect of Tinospora cordifolia extract in human immuno-deficiency virus positive patients. Indian J Pharmacol 2008;20:107-10.  |
| 2. | Antiretroviral Therapy Guidelines for HIV infected Adults and Adolescents including Post-exposure. Available from: http://www.nacoonline.org/Quick_Links/Publication/.../Antiretroviral_Therapy_Guidelines_for_HIV_infected/htm . [last cited on 2008 Sep 30]. |
| 3. | Guidelines for using antiretroviral agents among HIV-infected adults and adolescents recommendations of the panel on clinical practices for treatment of HIV. Available from: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5107a1.htm . [last cited on 2008 Sep 30]. |
| 4. | World Medical Association declaration of Helsinki ethical principles for medical research involving human subjects. Available at http://www.wma.net/e/policy/b3.htm. [last cited on 2008 Sep 30]. |
| This article has been cited by | | 1 |
In silico Exploration of Dakshina Kannada Medicinal Plants as Anti-
SARS-CoV-2 Agents by Molecular Docking and Simulation Approaches |
|
| Jainey P. James, Divya Jyothi, Vinod Devaraji, Sneh Priya | | Letters in Drug Design & Discovery. 2023; 20(10): 1544 | | [Pubmed] | [DOI] | | | 2 |
Review of Antiviral Medicinal Herbs with Special Emphasis on COVID-19 |
|
| Syed Afrid, Syed Sagheer Ahmed, Prajwal S, Rupesh Kumar M, Govind Yadav | | Research Journal of Pharmacy and Technology. 2023; : 3038 | | [Pubmed] | [DOI] | | | 3 |
Relevance of ayurveda in coronavirus disease-2019 |
|
| Manish Mishra | | Medicine India. 2022; 1: 4 | | [Pubmed] | [DOI] | | | 4 |
Pharmacological Overview of <i>Tinospora cordifolia</i>, an Ethnologically Important Plant of Bangladesh |
|
| Gazi Monjur Murshid, Sukalyan Kumar Kundu, Md. Hossain Sohrab, Md. Abdul Mazid | | Pharmacology & Pharmacy. 2022; 13(03): 93 | | [Pubmed] | [DOI] | | | 5 |
Tinospora cordifolia: A Multipurpose Miracle Plant Having Medicinal Importance: A Review |
|
| Santoshi Malla, Lal Bista | | Matrix Science Pharma. 2021; 5(3): 54 | | [Pubmed] | [DOI] | | | 6 |
Repurposing potential of Ayurvedic medicinal plants derived active principles against SARS-CoV-2 associated target proteins revealed by molecular docking, molecular dynamics and MM-PBSA studies |
|
| Akalesh Kumar Verma, Vikas Kumar, Sweta Singh, Bhabesh Ch. Goswami, Ihosvany Camps, Aishwarya Sekar, Sanghwa Yoon, Keun Woo Lee | | Biomedicine & Pharmacotherapy. 2021; 137: 111356 | | [Pubmed] | [DOI] | | | 7 |
Tinospora cordifolia (Giloy): Phytochemistry, Ethnopharmacology, Clinical Application and Conservation Strategies |
|
| Pradeep Kumar, Madhu Kamle, Dipendra K. Mahato, Himashree Bora, Bharti Sharma, Prasad Rasane, Vivek K. Bajpai | | Current Pharmaceutical Biotechnology. 2020; 21(12): 1165 | | [Pubmed] | [DOI] | | | 8 |
The chemical constituents and diverse pharmacological importance of Tinospora cordifolia |
|
| Priyanka Sharma, Bharat P. Dwivedee, Dheeraj Bisht, Ashutosh K. Dash, Deepak Kumar | | Heliyon. 2019; 5(9): e02437 | | [Pubmed] | [DOI] | | | 9 |
Evaluation of antidiabetic and related actions of some Indian medicinal plants in diabetic rats |
|
| Raju N Patil,Ravindra Y Patil,Bharati Ahirwar,Dheeraj Ahirwar | | Asian Pacific Journal of Tropical Medicine. 2011; 4(1): 20 | | [Pubmed] | [DOI] | | | 10 |
Identification of novel anti-inflammatory agents from ayurvedic medicine for prevention of chronic diseases: "Reverse pharmacology" and "Bedside to bench" approach |
|
| Aggarwal, B.B., Prasad, S., Reuter, S., Kannappan, R., Yadav, V.R., Park, B., Kim, J.H., (...), Sung, B. | | Current Drug Targets. 2011; 12(11): 1595-1653 | | [Pubmed] | | | 11 |
Evaluation of antidiabetic and related actions of some Indian medicinal plants in diabetic rats |
|
| Patil, R.N., Patil, R.Y., Ahirwar, B., Ahirwar, D. | | Asian Pacific Journal of Tropical Medicine. 2011; 4(1): 20-23 | | [Pubmed] | | | 12 |
Authorsę reply |
|
| Kalikar, M.V., Thawani, V.R., Varadpande, U.K., Sontakke, S.D., Singh, R.P., Khiyani, R.K. | | Indian Journal of Pharmacology. 2010; 42(1): 57-58 | | [Pubmed] | |
|
|
|
|
|
|
|
|
