Herbal remedy eyed to help stem alcoholism in SF's AIDS community

A common Asian plant could offer hope to San Francisco residents struggling with alcohol-use disorder, particularly those who are also battling HIV or AIDS.

The plant — kudzu — has long been used in Asian cultures as a traditional remedy for alcoholism. A new study underway at UCSF is looking at whether it might help reduce alcohol intake and alcohol-related sexual behavior among people at risk of HIV infection.

Previous research has already found that even as little as a single dose of kudzu can help reduce the speed and volume of alcohol consumption. By contrast, the existing medications used to treat alcoholism aren’t always as effective, people aren’t always able to stick with them and can have significant side effects.

“This has the potential to expand our options and strategies to help people,” said Glenn-Milo Santos, the lead researcher on the kudzu study.

There’s already a wealth of research documenting a link between heavy alcohol use and the risk of contracting HIV, said Santos, who is a professor in UCSF’s Department of Community Health Systems and in its Division of Prevention Science.

Nearly 30% of those living with HIV or AIDS worldwide suffer from alcohol-use disorder, according to a 2019 study published in BioMed Central . In developed countries, the average rate was 42%, with some studies finding even higher rates in the United States.

It’s unclear what the rate of alcoholism is among those with HIV in San Francisco. However, local experts who work with this population have seen the effects firsthand. And between 2018 and 2021, the proportion of deaths among those with HIV in The City that were related to alcoholic liver disease was just over 1%.

“All sorts of addictions are common in people living with HIV, but alcohol is definitely one of them,” said Dr. Monica Gandhi, the director of the UCSF Center for AIDS Research and the medical director of the HIV Clinic at San Francisco General Hospital.

Alcohol “can be cheap, it can be easy,” she said. “People want to stay under the radar.”

Santos said he first came across kudzu after getting the results from an at-home genetic test kit, similar to the types of kits sent out by companies like 23andMe. From that test, he found out he did not have the specific gene that helps metabolize alcohol. He said he already had an inkling he lacked that gene after experiencing the so-called “Asian flush.”

Asian flush is a condition predominantly found it people who — like Santos — are of East Asian descent. Such people break out in red flushes or blotches on their faces after consuming alcohol because their bodies don’t have the ability to process it.

“I just started doing a Google search about Asians and alcohol, and it was definitely a rabbit-hole Google search,” Santos said. “Then I encountered this herbal supplement, kudzu, and I found that it’s been previously used in East Asia to treat alcoholism.”

It’s unclear exactly how the herb works, he said, but there are a few different hypotheses. One is that taking kudzu with alcohol might change how alcohol affects people and dissuade them from drinking, he said. Another is that the herb could amplify and prolong the effects of one drink, making it feel like a person has drunk more.

“Sometimes I tell people, ‘It’s going to help you become a cheaper date,’” Santos said. “You would get more bang for your buck.”

The clinical trial on kudzu and alcohol use wrapped up recently, and Santos and his team are still going through the data. While the results aren’t in yet, he is excited about the herb’s potential to help those with alcohol-use disorder, particularly those who’ve tried to treat it with other medications.

There are a few existing FDA primary medications used to treat alcoholism, but they can have downsides, Gandhi said. A ntabuse blocks the processing of alcohol inside people’s bodies , but it makes people feel “really sick,” she said.

Another, called naltrexone — also often used for those who are dealing with narcotics dependence — has been shown to be effective for alcohol-use disorder, Gandhi said. However, it can have serious side effects, including liver damage .

Besides medication, the other main option for those dealing with alcohol-use disorder is 12-step treatment programs. But it can be difficult for those juggling medical appointments and medications used to treat HIV to commit to such programs, Gandhi said.

“Our treatments are really problematic,” she said.

Indeed, fewer than 10% of those who have alcohol-use disorder have undergone any kind of treatment for it — medication or otherwise — according to Santos.

Finding a way to treat alcohol-use disorder is important for those at risk of contracting or living with HIV and AIDS, Santos and others said. Alcohol is commonly used among those dealing with HIV as a simple way to ease their stress, Gandhi.

“Alcohol is a way to relax,” she said. “It can be used in coordinating dating and sex and meeting people.”

But this can transition to dependence, and can then be abused.

Billy Lemon, the executive director of the Castro Country Club, a sober community center for the LGBTQ+ community, said he has seen how alcoholism has affected this population firsthand, particularly those who were diagnosed with HIV back in the 1980s and ’90s.

“There was no real positive outlook for how to proceed, and so a lot of them became alcoholics or addicted in some sort of way,” said Lemon. “Substance-use disorder was an answer to a problem they didn’t have a solution for.”

Lemon’s center hosts meetings for those in the LGBTQ+ community who are “dual diagnosed,” whether with HIV and alcohol-use disorder or HIV and crystal meth addiction. The majority of those who attend who are still struggling with alcohol-use disorder are older, he said. That’s primarily because fewer younger people are being diagnosed with HIV, thanks to early use of PrEP, an HIV-prevention medication.

Those who are older and dealing with alcohol-use disorder can face complications with the combination of alcohol and their diagnosis, Lemon said.

“For somebody with a dual diagnosis, from substance-use disorder, from alcoholism, and HIV, that’s a whole other ballgame,” he said. “The body is constantly fighting off HIV, so if you are also compounding that with alcoholism or a substance-use disorder, the body is basically tapped and working hard to just maintain.”

Staying sober is key to maintaining their HIV medication regimen, Lemon said.

“If I am sober and have a clear head, I am much more likely to be medication-compliant and take the medication that helps me stay undetectable and live a better life.”