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SAfAIDS Discussion Forum: Gundamiti
Fungai Machirori, Southern Africa AIDS Information Dissemination Service (SAfAIDS)
August 02, 2007

On Wednesday 25 July 2007, the Southern Africa HIV and AIDS Information Dissemination Service (SAfAIDS) held a discussion forum on Gundamiti, a new herbal preparation reported to significantly lower viral load and increase CD4 counts in people living with HIV (PLHIV).

The main objectives of the discussion were to afford people living with HIV, nutritionists and AIDS Service Organisations (ASOs) a space to seek clarification on the status of Gundamiti, and its future in HIV and AIDS management in Zimbabwe. And as the facilitator, Dr. Madzingire added, another of the important objectives was to come to a greater understanding of treatment guidelines for Gundamiti, as well as build consensus about the herb among the respective government departments and drugs control council on it.

To begin the discussion, Dr. Peter Mashava, the key researcher of Gundamiti, gave a brief background of the process of identifying Gundamiti as an effective anti-HIV herbal remedy - a process that began in 1992. Mashava explained that in his search for a herbal preparation that could show activity against the virus, he had sampled over 600 of the 5 000 plant species found in Zimbabwe, thereafter identifying Gundamiti as a herb suitable for testing with HIV positive human volunteers. "After we had identified the herb as having anti-HIV activity, we wanted to understand if it worked in a human being, and the answer is yes," stated Dr. Mashava.

The findings presented at the discussion forum involved 12 HIV positive individuals whose collective drops in levels of viral load (some to undetectable levels) and accompanying rises in CD4 counts were very significant, and drew gasps of surprise from the audience. One study participant who was reported to have had a viral load as high as nearly 1,3 million had results which showed a drop to just under 3 500 within a 2-month period. "The virus is not doing what it would naturally do, that is, it is not continuing to multiply until the person eventually succumbs," noted Mashava.

The study made the same observation of the herb's efficacy against certain opportunistic infections (OIs) such as herpes zoster, Candidiasis, diarrhoea, and skin rash. "Generally speaking, we do get Gundamiti helping with opportunistic infections," noted Mashava.

After this introduction, the discussion was opened to the floor, with Dr. Duri, in his role as key discussant being the first to critique Mashava's presentation. Duri is a lecturer with the Chemistry department at the University of Zimbabwe. On the whole, Duri said he was comfortable with the findings, but mentioned that he felt that the research was limited by certain factors including the fact that extensive liver function tests had not been carried out on participants. As Mashava had mentioned earlier, one of the first organs to respond negatively to drugs is the liver, which is why certain liver (and kidney) tests were carried out in the research, to monitor the potential toxicity levels of Gundamiti. Dr. Duri's other concern was that Karposi's Sarcoma, a cancer and OI, had been excluded from the list of potential OI indicators against Gundamiti.

Some forum participants viewed the results sceptically because of the perceived inadequacy of the sample size of 12 people and "unscientific" methodology used. As one medical practitioner challenged, "For you to expect me to appreciate such results without talking about sample sizes, you need to convince us better." However, Mashava made the emphasis that more extensive studies were limited by available funding.

Lynde Francis, the Director of The Centre, also bemoaned this unrelenting quest for scientific evidence by medial practitioners, using the example of data collected from her own herbal studies at The Centre. She said these had often been regarded as anecdotal, and unscientific. "Give us the money and we'll make it scientific," she said, reiterating Mashava's point.

Duri, in response to the same argument, supported the research arguing that one had to at least start somewhere, even if initial findings were not deemed to be scientifically acceptable. "I get bothered when someone doesn't question the scientific nature of ARVs, yet you don't know what they do and do not do," he said, alluding to the fact that Gundamiti should be given just as equal a chance as other anti-HIV medications.

But the most burning issues that the audience had about Gundamiti pertained to how exactly the herb is used. One participant, Bertha Shoko, a health reporter with the Standard newspaper, asked, "Is Gundamiti for life, just like ARVs?" To this Mashava responded by saying that it was not yet clear whether it would be safe to stop taking the herbal product after having started taking it. This was because, as he'd previously mentioned, there was uncertainty as to whether Gundamiti was actually killing the HI virus, or merely preventing it from replicating. "If you do have the virus, and it is hiding in your nervous system, and not the blood, it might build up again," he warned of ceasing to take the herb. Study findings had also found that the use of both ARVs and Gundamiti increased toxicity levels within the liver and kidney, and mixing of the two was not advised.

Alice Moyo of the Catholic Relief Services (CRS) wanted to know the amounts of the herb that people needed to take. The initial response to this question by Mashava was that dosing was 675mg - to which most of the audience responded that they did not understand what these quantities represented. This and other instances showed that, at times, the discussion became 'elevated' to a technical and scientific level above the general understanding of the audience.

Mashava added that Gundamiti is initially extracted from its plant source and ground into a powder, and dispensed in capsule form. These capsules are taken two at a time, three times daily. To one contributor's question of the cost of Gundamiti, Mashava stated that it would cost about Z$600,000 for a full month's course. No food restrictions were recommended for those taking Gundamiti, although a healthy diet was encouraged for general health.

In terms of accessibility, Edmore Mutimodyo of the Zimbabwe AIDS Network (ZAN), asked the question, "Is Gundamiti readily available on the market?" Mashava stated that it was available in small quantities, but not enough to distribute to the whole country. "We are hoping we can produce sufficient Gundamiti for everyone who wants it," further noted Mashava. " We aren't saying ARVs are out, but we just want to provide alternatives." He also spoke of efforts to have a factory built for further production of the herb at the UZ premises.

In terms of its legality, Gundamiti has not yet been registered with the Medicines Control Council of Zimbabwe. But because it is not a drug, but rather a herbal remedy, it can be distributed without any problems. Mashava has filed a patent for it in 15 countries to avoid people abusing its preparation. He added that it had been accepted by the Ministry of Health and Child Welfare, while other leading agencies such as the World Health Organization Africa Region (WHO/AFRO) had been instrumental in funding research into Gundamiti.

However, just as it appeared that the audience was beginning to accept the concept and research behind Gundamiti, Frederick Mandizvidza, the Chief Executive Office of the African Institute of Biomedical Science and Technology, spoke up against the drug's supposed viral load decreasing abilities saying that the laboratory reports obtained by his institute had contradicted those that were eventually presented by Mashava. "Viral loads, which are referred to as having been reduced by as much as ninety per cent, have not. There was only one person [in the institute's studies] who had a slight reduction. The rest have had them [viral loads] increased or maintained," said Mandizvidza. He added that his organisation had taken measures to speak with the Ministry of Health, and had given Deputy Minister, Edwin Muguti, the document supporting their argument.

Mashava suggested that the discrepancies had been due to the fact that two different viral load machines had been used on the studies and that the results that Mandizvidza spoke of were at least two years old, and were not based on the most recent findings. Earlier, Dr Zichawo, a private medical practitioner who had been involved in the Ministry's own study of Gundamiti, had mentioned that there was a problem with the accuracy in the measuring of Zimbabwe's CD4 test machines - a point which might have validated Mashava's argument about similar problems with viral load test machines. But while Zichawo's study had revealed similar results as those obtained by Mashava, he admitted doubt about Gundamiti's claims. "I am still unconvinced that it has any anti-viral activities," he aid. "We need to look for funding for a proper scientific study with suitable controls," he added. Another participant asked, "Are you measuring the labs, or measuring the data," as it appeared that discussion might turn into a 'mudslinging' between the two conflicting laboratory reports. She suggested a tiebreaker for the problem, in the form of a third independent laboratory that could verify results.

But one participant brought the audience back to the reality of the gravity of HIV. "It is very interesting that we dying while we are arguing," noted Martha Tholanah of the Zimbabwe National Network for People Living with HIV and AIDS (ZNNP+). She also added that the discussion might have lost some of its concern among urban dwellers - its main target - because, in her own words, "Rural people use herbal medications and are doing well.'

To bring the discussion to an end, the facilitator put it to the floor to chart the way forward on Gundamiti and civil society's role. Participants agreed that more liaisons were needed between the researchers and civil society. The need for arbitration in the conflicting laboratory results was highlighted, because as one contributor noted, "The reputation of a very good research centre is at stake." And, indeed, the reputation of an apparently useful herbal remedy. In conclusion, Mashava added that he would be happy to work with anyone to produce more of the product, and urged, in particular, the media to fulfil its social responsibility to inform the public of this new anti-HIV option that is on the market.

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