The use of complementary and alternative medicine (CAM), a group of health care practices and products that are not considered part of conventional medicine, has increased in recent years, particularly among individuals with human immune deficiency virus (HIV). Assessing the prevalence and predictors of CAM use among HIV-positive populations is important because some CAM therapies may adversely affect the efficacy of conventional HIV medications. Unfortunately, CAM use is not comprehensively or systematically assessed among HIV-positive populations. Therefore, the aim of the present study was to evaluate the quality of the instruments employed in observational studies assessing CAM use among HIV-positive populations by examining the degree to which these studies (1) evaluated the psychometric properties of their CAM instruments and (2) assessed the multidimensional nature of CAM use.
Design:
A systematic review of studies was undertaken and specific review criteria were used to guide the inclusion of studies. Specifically, articles were included that were published in English and in a peer-reviewed journal between 1997 and 2007, recruited HIV-positive study participants, and assessed CAM use. Thirty-two (32) studies met these inclusion criteria.
Results:
Results suggest that CAM assessment among HIV-positive populations continues to be problematic. For example, approximately 20% of the studies assessed the reliability and 3% assessed the validity of the CAM instrument employed.
Conclusions:
CAM assessment—regardless of the specific study population—is a complex and challenging task. However, CAM instruments will not become more refined over time in the absence of rigorous psychometric evaluation. Future research must assess reliability and validity and report these data in a clear and nuanced manner.
Get full access to this article
View all access options for this article.
References
1.
Centers for Disease Control and Prevention. HIV Prevalence Estimates: United States, 2006. MMWR Morb Mortal Wkly Rep, 2008; 57:1073–1076.
2.
Owen-SmithA, DiclementeR, WingoodG. Complementary and alternative medicine use decreases adherence to HAART in HIV-positive women. AIDS Care, 2007; 19:589–593.
3.
National Center for Complementary and Alternative Medicine. What is CAM?http://nccam.nih.gov/health/whatiscam/. 2008 December 8.
4.
PhillipsKD, SkeltonWD. Effects of individualized acupuncture on sleep quality in HIV disease. J Assoc Nurses AIDS Care, 2001; 12:27–39.
5.
ShlayJC, ChalonerK, MaxMBet al.Acupuncture and amitriptyline for pain due to HIV-related peripheral neuropathy: A randomized controlled trial. Terry Beirn Community Programs for Clinical Research on AIDS. JAMA, 1998; 280:1590–1595.
6.
ZhouW, SunY, WuZ. Acupuncture ameliorates AIDS symptoms in 36 cases. J Tradit Chin Med, 2000; 20:119–121.
7.
BealJE, OlsonR, LaubensteinLet al.Dronabinol as a treatment for anorexia associated with weight loss in patients with AIDS. J Pain Symptom Manage, 1995; 10:89–97.
8.
BealJE, OlsonR, LefkowitzLet al.Long-term efficacy and safety of dronabinol for acquired immunodeficiency syndrome-associated anorexia. J Pain Symptom Manage, 1997; 14:7–14.
9.
GorterR, SeefriedM, VolberdingP. Dronabinol effects on weight in patients with HIV infection. AIDS, 1992; 6:127.
10.
ShabertJK, WinslowC, LaceyJM, WilmoreDW. Glutamine-antioxidant supplementation increases body cell mass in AIDS patients with weight loss: A randomized, double-blind controlled trial. Nutrition, 1999; 15:860–864.
11.
StruweM, KaempferSH, GeigerCJet al.Effect of dronabinol on nutritional status in HIV infection. Ann Pharmacother, 1993; 27:827–831.
12.
FawziWW, MsamangaGI, SpiegelmanDet al.Randomised trial of effects of vitamin supplements on pregnancy outcomes and T cell counts in HIV-1-infected women in Tanzania. Lancet, 1998; 351:1477–1482.
13.
KaiserJD, CampaAM, OndercinJPet al.Micronutrient supplementation increases CD4 count in HIV-infected individuals on highly active antiretroviral therapy: A prospective, double-blinded, placebo-controlled trial. J Acquir Immune Defic Syndr, 2006; 42:523–528.
14.
MikhailIS, DiClementeR, PersonSet al.Association of complementary and alternative medicines with HIV clinical disease among a cohort of women living with HIV/AIDS. J Acquir Immune Defic Syndr, 2004; 37:1415–1422.
15.
FairfieldKM, EisenbergDM, DavisRBet al.Patterns of use, expenditures, and perceived efficacy of complementary and alternative therapies in HIV-infected patients. Arch Intern Med, 1998; 158:2257–2264.
16.
SparberA, WoottonJC, BauerLet al.Use of complementary medicine by adult patients participating in HIV/AIDS clinical trials. J Altern Complement Med, 2000; 6:415–422.
17.
de MaatMM, HoetelmansRM, Math tRAet al.Drug interaction between St John's wort and nevirapine. AIDS, 2001; 15:420–421.
18.
PiscitelliSC, BursteinAH, WeldenNet al.The effect of garlic supplements on the pharmacokinetics of saquinavir. Clin Infect Dis, 2002; 34:234–238.
19.
SlainD, AmsdenJR, KhakooRAet al.Effect of high-dose vitamin C on the steady-state pharmacokinetics of the protease inhibitor indinavir in healthy volunteers. Pharmacotherapy, 2005; 25:165–170.
20.
JernewallN, ZeaMC, ReisenCA, PoppenPJ. Complementary and alternative medicine and adherence to care among HIV-positive Latino gay and bisexual men. AIDS Care, 2005; 17:601–609.
21.
KnippelsHM, WeissJJ. Use of alternative medicine in a sample of HIV-positive gay men: An exploratory study of prevalence and user characteristics. AIDS Care, 2000; 12:435–446.
22.
BangsbergDR, PerryS, CharleboisEDet al.Non-adherence to highly active antiretroviral therapy predicts progression to AIDS. AIDS, 2001; 15:1181–1183.
23.
AchillesR. Defining complementary and alternative health care: A Health Canada Publication. www.phac-aspc.gc.ca/publicat/pcahc-pacps/pdf/comp_define.pdf. 2006 October 30.
24.
CaspiO, SechrestL, PitlukHCet al.On the definition of complementary, alternative, and integrative medicine: Societal mega-stereotypes vs. the patients' perspectives. Altern Ther Health Med, 2003; 9:58–62.
25.
StandishLJ, GreeneKB, BainSet al.Alternative medicine use in HIV-positive men and women: Demographics, utilization patterns and health status. AIDS Care, 2001; 13:197–208.
26.
LengacherCA, BennettMP, KippKEet al.Design and testing of the use of a complementary and alternative therapies survey in women with breast cancer. Oncol Nurs Forum, 2003; 30:811–821.
27.
PinkertonS, HoltgraveD, LevitonLet al.Toward a standard sexual behavior data set for HIV prevention evaluation. Am J Health Behav, 1998; 22:259–266.
28.
MallenC, PeatG, CroftP. Quality assessment of observational studies is not commonplace in systematic reviews. J Clin Epidemiol, 2006; 59:765–769.
29.
National Health Service (NHS) Centre for Reviews and Dissemination, University of York. Undertaking Systematic Reviews of Research on Effectiveness: CRD's Guidance for Those Carrying Out or Commissioning Reviews. CRD Report #4, 2nd. York, UK: NHS Centre for Reviews and Dissemination, University of York, 2001.
30.
GagnonAJ, TuckJ, BarkunL. A systematic review of questionnaires measuring the health of resettling refugee women. Health Care Women Int, 2004; 25:111–149.
31.
NoarSM, ColeC, CarlyleK. Condom use measurement in 56 studies of sexual risk behavior: Review and recommendations. Arch Sex Behav, 2006; 35:327–345.
32.
KitchenhamB. Procedures for Performing Systematic Reviews, 2004.
33.
PaiM, McCullochM, GormanJDet al.Systematic reviews and meta-analyses: An illustrated, step-by-step guide. Natl Med J India, 2004; 17:86–95.
34.
National Center for Complementary and Alternative Medicine. Expanding Horizons of Health Care: Strategic Plan, 2005–2009. http://nccam.nih.gov/about/plans/2005/strategicplan.pdf. 2009 January 5.
35.
LadenheimD, HornO, WernekeUet al.Potential health risks of complementary alternative medicines in HIV patients. HIV Med, 2008; 9:653–659.
36.
KlimasN, KoneruAO, FletcherMA. Overview of HIV. Psychosom Med, 2008; 70:523–530.
37.
HsiaoAF, WongMD, GoldsteinMSet al.Variation in complementary and alternative medicine (CAM) use across racial/ethnic groups and the development of ethnic-specific measures of CAM use. J Altern Complement Med, 2006; 12:281–290.
38.
KakaiH, MaskarinecG, ShumayDMet al.Ethnic differences in choices of health information by cancer patients using complementary and alternative medicine: An exploratory study with correspondence analysis. Soc Sci Med, 2003; 56:851–862.
39.
McLaughlinLA, BraunKL. Asian and Pacific Islander cultural values: Considerations for health care decision making. Health Soc Work, 1998; 23:116–126.
40.
MurguiaA, PetersonRA, ZeaMC. Use and implications of ethnomedical health care approaches among Central American immigrants. Health Soc Work, 2003; 28:43–51.
41.
DwyerJT, Salvato-SchilleAM, CoulstonAet al.The use of unconventional remedies among HIV-positive men living in California. J Assoc Nurses AIDS Care, 1995; 6:17–28.
42.
FurlerMD, EinarsonTR, WalmsleySet al.Use of complementary and alternative medicine by HIV-infected outpatients in Ontario, Canada. AIDS Patient Care STDS, 2003; 17:155–168.
43.
KristoffersenAE, FonneboV, NorheimAJ. Use of complementary and alternative medicine among patients: Classification criteria determine level of use. J Altern Complement Med, 2008; 14:911–919.
