Hypericin Update

AIDS TREATMENT NEWS reported about hypericin, a chemical in the St. John's wort plant which has shown antiretroviral activity in laboratory and animal tests, in issues number 75, 74, and 63. In the last two months, a number of people have started using commercially- available St. John's wort extracts which have been tested and found to contain significant amounts of hypericin. It is too early to be confident that the treatment is valuable, but the results continue to look good:

* Of the handful of people who were P24 antigen positive before starting hypericin, and had another P24 test after using it and reported the results to us, every one either became P24 negative, or had a greatly reduced antigen level. Some were using AZT in addition to hypericin, others were not using AZT. (Note: as we went to press we heard of two cases in which P24 antigen failed to improve after use of hypeicin. We do not know how long it was used, or what dose.)

P24 antigen, a measure of HIV activity, only occasionally becomes negative without treatment. AZT is known to reduce its level.

* Almost everybody whose results have been reported to us has had at least one dramatic, unexpected improvement in symptoms (except of course for those who were asymptomatic, who had nothing to improve). However, many have also had other symptoms which failed to improve.

Our current impression from the few cases reported so far is that improvements might be most likely to be seen in increased energy level and reduced fatigue, neuropathy, certain cases of diarrhea but not other cases, weight loss, and (as already discussed) P24 antigen levels. T-cell counts seem to improve, very slowly if they start from very low values, more rapidly otherwise.

Dr. David Payne in Mesa, Arizona, who has the most experience with hypericin with 70 patients now using it, believes that improvements are least like in symptoms which may be autoimmune, such as low platelet levels or certain skin rashes. We have also heard of other symptoms failing to improve (for example, one case of KS, and one case of diarrhea), but there are too few reports so far for a pattern to have developed.

* We have not heard of any case of a person believed to have been harmed by St. John's wort extracts. We have received one report of slightly increased sensitivity to sunlight, and several of drowsiness, especially with large doses.

AIDS TREATMENT NEWS #75 reported one case of a patient taken off of hypericin extracts by his physician because his liver enzymes were found to be too high. Since then we have heard of another case of elevated liver enzymes; this patient was using many drugs, in addition to hypericin. There is no way to be sure whether or not the hypericin (St. John's wort extract) was responsible. However, Dr. Payne has found no evidence of any such problem in his 70 patients using hypericin, even though he has been looking for it.

As a precaution, we continue to urge that anyone using hypericin be monitored by a physician, with the monitoring including a blood-chemistry panel.

Doses

There is still much uncertainty about the best dose and schedule for using hypericin.

Dr. Payne has increased his dose slightly, from 120 drops a day of the Hyperforat tincture to 160. (Some of his patients are using a different brand, Yerba Prima St. John's wort tablets, which is less expensive and easier to obtain in the United States.)

Because animal studies suggest that less frequent or intermittent doses might work better, some of Dr. Payne's patients are trying an intermittent schedule. They are taking two of the tablets every four hours on Monday and Tuesday only, and no hypericin during the rest of the week. (The four- hour schedule does not include the middle of the night, so the total dose comes to ten tablets each day, 20 total for the week. Hypericin is believed to be eliminated slowly from the body, so some will remain for several days or weeks.)

As more information about hypericin becomes available, we will report it.

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