title: Short-term garlic supplementation and highly active antiretroviral treatment adherence, CD4+ cell counts, and human immunodeficiency virus viral load.
abstract: BACKGROUND
  Human immunodeficiency virus (HIV)-infected individuals frequently have consumed garlic, a popular complementary supplement. Researchers rarely have studied garlic's association with antiretroviral therapies, however, even though that association is very relevant clinically.
  
  
  OBJECTIVE
  To examine associations of supplemental use of garlic with highly active antiretroviral treatment (HAART) adherence level and HAART effectiveness (HIV viral load and CD4+ cell counts) in HIV-infected women.
  
  
  METHODS
  The research team carried out a self-controlled, longitudinal study nested within the Women's Interagency HIV Study (WIHS). The team used a paired study design that allowed participants to serve as their own controls. The team first identified all of the studies visits in which the participant self-reported the use of a garlic supplement since her last visit (index visit). Then for each index visit, the team identified a matching visit (a control visit) using the following criteria: (a) the visit must be one for the same participant in which that participant reported no garlic supplementation; (b) the visit must immediately precede the index visit (less than 1 year apart); and (c) at the time of the control visit, the participant must have been using antiretroviral therapy identical to that used at the time of the index visit.
  
  
  METHODS
  Participants were persons using garlic supplementation who already were participants in the WIHS.
  
  
  METHODS
  The research team used a logistic regression model to examine the association between garlic supplementation and HAART adherence level. The team used a mixed linear model to examine the association of garlic supplementation with HIV viral load and CD4+ cell counts.
  
  
  RESULTS
  From October 1994 to April 2009, 390 HIV-infected women in the WIHS made 1112 visits at which they reported using garlic supplements. Seventy-seven HIV-infected women using HAART met the research teams selection criteria and contributed 99 pairs of visits for the study. Among the women who used garlic supplements, 22% were 50 years and older; 58% were black and non-Hispanic; and 23% had less than a high-school education. Neither use of garlic supplementation nor reasons for using garlic supplements were significantly associated with the HAART adherence level, HIV viral load, or CD4+ cell counts; however, use garlic as needed, a potential marker of a disease state, was significantly associated with higher viral load (P=.0003).
  
  
  CONCLUSIONS
  Short-term garlic supplementation did not impact HAART adherence level, HIV viral load, and CD4+ cell counts.
authors.affiliation: Department of Medicine, Georgetown University Medical Center, Washington, DC, USA. cl278@georgetown.edu
authors.forename: Chenglong
authors.initials: C
authors.lastname: Liu
authors.forename: Cuiwei
authors.initials: C
authors.lastname: Wang
authors.forename: Esther
authors.initials: E
authors.lastname: Robison
authors.forename: Alexandra M
authors.initials: AM
authors.lastname: Levine
authors.forename: Monica
authors.initials: M
authors.lastname: Gandhi
authors.forename: Rebecca
authors.initials: R
authors.lastname: Schwartz
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Weber
authors.forename: Daniel
authors.initials: D
authors.lastname: Merenstein
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000097:blood / Q000628:therapy*; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D016022:Case-Control Studies; D019587:Dietary Supplements; D005260:Female; D005737:Garlic; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D010349:Patient Compliance; D008517:Phytotherapy; D019562:Viral Load