May 12, 2003
The term complementary and alternative medicines (CAM) has been used to denote a wide variety of pharmacologic and nonpharmacologic therapies. The most cited definition of CAM is an "intervention neither taught widely in medical schools nor generally available in U.S. hospitals." For this study, CAM was defined as any treatment not commonly provided by physicians or medical practitioners, and used in conjunction with or in place of standard medical treatments.
Canadian prevalence estimates for CAM use ranged from 15 percent to 52 percent between 1996 and 1997, an increase of approximately 20 percent since 1992 estimates. Out-of-pocket expenditures for 1996-1997 were estimated at CAD$3.8 billion (US$2.4 billion). In both Canada and the United States, increased utilization rates have been disproportionately reported by women, persons ages 25-40, people with higher socioeconomic status, income greater than US$50,000 or CAD$60,000, and those with a university education.
Reported CAM utilization rates are generally higher in special populations, including patients infected with HIV. Between 30 percent and 100 percent of patients with HIV in the United States and 18 percent to 39 percent of patients with HIV in Canada use some form of CAM. The present study was designed to determine the prevalence of CAM use by patients attending HIV clinics in Ontario, Canada, and to identify ways in which users and nonusers of CAM differed in relation to demographic and clinical characteristics, including use of conventional medications. Comparisons were also made to assess the impact of the CAM definition on reported utilization. Average monthly expenditures for CAM and the rate of CAM reporting to the physician managing HIV care were also evaluated.
In total, 77 percent of patients reported that they were using some form of CAM; this proportion increases to nearly 90 percent when micronutrients (vitamins, minerals and multivitamins) are included. Nearly all patients used CAM in conjunction with conventional medicine, with most also reporting the use of antiretroviral medications. Patients in this study frequently reported the use of CAM for general health and well-being, relaxation, stress relief and energy, possibly reflecting the improvements in conventional HIV therapy. Rather than for the direct treatment of HIV, CAM was often used to treat the physical and psychological effects of illness and the side effects of conventional drug therapies. Out-of-pocket costs ranged from CAD$0 to more than CAD$250 (US$180) per month.
Depending on the definition used for CAM, the prevalence of CAM use varies from 38 percent to 89 percent in this study. Predictors of CAM use also vary with CAM definition and include female gender, higher education, unemployment, higher viral load, and HIV risk group. The use of greater number of prescription and nonprescription drugs is also associated with the use of CAM. Problems remain in the interpretation and inclusion of various health activities and practices as CAM. One may question whether exercise, diet and other health promotion strategies should be considered CAM. These and other questions must be answered before a true idea of the prevalence and predictors of CAM use can be addressed in the HIV population or the population as a whole.
AIDS Patient Care and STDs
04.03; Vol. 17, No. 4, P. 155-168; Michelle D. Furler, B.Sc.Pharm.; Thomas R. Einarson, Ph.D.; Sharon Walmsley, M.D.; Margaret Millson, M.D., M.H.Sc.; Reina Bendayan, Pharm.D.