June 19, 2009
In the late 1980s in high-income countries, only one drug was available for the treatment of HIV/AIDS: AZT (zidovudine, Retrovir). It had to be taken six times daily and at high doses that caused serious side effects -- and it had limited effectiveness against HIV.
In 2009, HIV positive people living in these countries have a choice of combination therapy that has a record of improved safety and effectiveness compared to AZT monotherapy. Also, in people starting their first regimen, once-daily dosing is often an option.
Despite these enormous and favourable changes in anti-HIV therapy over the past 20 years, myths and misunderstandings about the safety of these therapies continue to circulate among some people who are at risk for or who have HIV infection.
Doctors in Los Angeles, California, recently reported the unfortunate case of a young HIV positive man who experienced life-threatening toxicity from a complementary therapy called Kombucha tea. Before we report their findings, we first present some background information on Kombucha.
According to the young man's emergency room physicians, this tea "is made by fermenting sugared black tea with a round, flat, grey fungus for a minimum of seven days." Although some people refer to this fungus as a Kombucha mushroom, it is really a mix of bacteria and several yeasts.
Kombucha and mice
To begin to document the effects of Kombucha tea, researchers in the United States performed experiments on mice. They found that the life span of the mice increased by 5%. However, this came at the price of a swollen liver and spleen, which suggests liver and spleen toxicity. Also, mice given Kombucha tea tended to not gain weight compared to mice that did not receive this substance. And Kombucha-treated mice appeared to have somewhat smaller brains. However, extensive blood tests, CAT scans, MRIs and other scans were not done, so the researchers could only provide a limited analysis of the effects of this alternative therapy on the animals.
Kombucha in people -- an absence of evidence
Unfortunately, there have not been any well-designed studies to assess the impact of Kombucha tea on the health of people. Kombucha tea is alleged to have a broad range of beneficial effects on the following health conditions:
There have also been claims that Kombucha tea can do the following:
Astonishingly, all of these claims for Kombucha's effect in people have been made in the absence of clinical trials.
The emergency room doctors' report concerned a 22-year-old man who had recently been diagnosed with HIV infection. He had a CD4+ count of 414 cells, was not taking any anti-HIV therapy and was otherwise well.
A month after his diagnosis he drank a litre of unpasteurized Kombucha tea. Four hours after this he developed a mild fever. The next day he developed the following symptoms:
As a result of his worsening condition, he sought care at the emergency department of a local hospital. Doctors there found that he had alarmingly high blood pressure. Lab tests of his blood revealed the following:
Confounded by his symptoms and in the absence of detectable germs, his medical team presumed that he was suffering from meningitis -- an inflammation of the tissues lining the brain and spinal cord. So they prescribed several antibiotics on the assumption that he was attacked by bacteria.
As his condition deteriorated, the man was transferred to the hospital's Intensive Care Unit (ICU). Doctors in the ICU added the antiviral drug acyclovir to his regimen because his symptoms were suggestive of viral meningitis. He was not given any antifungal drugs during his time in the hospital.
An unexpected turn
While in the ICU, much to his doctors' surprise, his symptoms began to resolve. In particular, his fever cleared. Within two days his symptoms disappeared as his blood returned to its normal pH balance and his kidneys improved. He was released from the hospital.
A week later he returned for observation and further laboratory testing. Doctors confirmed his recovery. His CD4+ count had surged to slightly more than 400 cells.
A month after his visit to the ER, cultures of his blood grew two different types of fungi.
The toxicity of Kombucha
In the past decade, scattered reports of toxicity linked to drinking Kombucha have been reported, including the following:
The young man's physicians issued the following caution:
"Kombuch tea may pose serious health risks, particularly to people with [weakened immune systems]." Although the doctors did not specify which groups of people have weakened immune systems, the following conditions or behaviours are associated with weakened immunity:
As well, Dr. Edzard Ernst, a Europe-based expert on complementary and alternative therapies, has reviewed data on the potential benefits and risks associated with Kombucha tea. He cautions that there is not enough evidence to support its use.
This article was provided by Canadian AIDS Treatment Information Exchange. Visit CATIE's Web site to find out more about their activities, publications and services.
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