Evaluation of the effect of Artemisia Annua L. and Moringa Oleifera Lam. on CD4 count and viral load among PLWH on HAART at Mbarara Regional Referral Hospital: A Double-Blind Randomized Controlled Clinical Trial

Abstract

Background: Initiation of HAART among people living with HIV (PLWH) having a CD4 count ≤ 350cells/μl, produces poor immunological recovery, putting them at a high risk of opportunistic infections. Artemisia annua and Moringa oleifera are among the herbs commonly consumed by PLWH on HAART to boost their immunity, but their clinical benefits and potential interactions with ARVs remain unknown. This study investigated the effect of A.annua and M.oleifera on CD4 count, viral load, and other clinical and haematological indices among PLWH on HAART at an HIV clinic in Uganda. Methods: 282 HIV-positive participants on HAART with a CD4 count ≤ 350cells/μl were randomized in a doubleblind clinical trial to receive daily, in addition to their routine standard of care; 1) A.annua leaf powder, 2) A.annua plus M.oleifera, and 3) routine standard of care only. Our primary outcome was change in the CD4 count at 12 months. Secondary outcomes included change in viral load, complete blood count, renal function tests, liver function tests, ARV plasma levels, and quality of life (QoL). Participants were followed up for a year and outcomes were measured at baseline, 6 and 12 months. Results: At 12 months of patient follow-up, administration of A.annua + M.orifera plus routine standard of care produced an absolute mean CD4 increment of 105.06 cells/μl, (P < 0.001), while administration of A.annua plus routine standard of care registered an absolute mean CD4 increment of 60.84 cells/μl, (P = 0.001) compared to the control group. The viral load reduced significantly (P = 0.022) for participants on the A.annua + M.orifera compared to those receiving standard of care only. There were significant differences in White blood cell count (P = 0.03), platelet count (P = 0.025), perceived QoL (P < 001) among participants who received A.annua + M.oleifera compared to those who received standard of care only. There were no significant differences in the other secondary outcomes. Conclusion: A combination of A.annua and M.oleifera leaf powders taken once a day together with the routine standard of care produced significant improvement in CD4 count, viral load suppression, WBCs, platelets, and quality of life among individuals on HAART.