An Analytical Assessment of Critical Drug-Herb Interactions in HIV-Positive Patients Using Traditional Medicines in Benue State

Traditional medicine use among HIV-positive patients receiving antiretroviral therapy creates interaction risks that may compromise viral suppression. This study analytically assessed the prevalence, nature, and clinical significance of drug-herb interactions in HIV-positive patients using traditional medicines in Benue State, North Central Nigeria. A cross-sectional analytical study was conducted at antiretroviral treatment clinics at two hospitals in Makurdi among 220 adult HIV-positive patients. Structured interviews identified all herbal and traditional products used. Drug-herb interactions were systematically assessed using Stockley's Herbal Medicines Interactions and the Natural Medicines comprehensive database. Viral load and CD4 count data were extracted from patient records for interaction risk quantification. Results showed concurrent traditional medicine use in 67.3 percent of patients. Disclosure of traditional medicine use to ART clinicians occurred in only 14.9 percent. Clinically significant drug-herb interactions involving enzyme-induction or pharmacokinetic interference were identified in 44.3 percent of concurrent users. St. John's Wort equivalents from local plant preparations, used in 18.6 percent of herbal users, were associated with significant CYP3A4 induction risk for protease inhibitors. Detectable viral loads were significantly more common in patients with CYP-inducing herbal interactions (p < 0.01). The study provides original analytical evidence on drug-herb interaction risk in HIV patients in Benue State and recommends mandatory herbal product history-taking at all ART clinic visits, structured counselling, and pharmacist-led interaction assessment protocols. Keywords: drug-herb interactions, HIV-positive patients, antiretroviral therapy, Benue State, traditional medicines