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RESEARCH INVENTION JOURNAL OF RESEARCH IN MEDICAL SCIENCES 4(2):8-16, 2025

©RIJRMS Publications

ONLINE ISSN: 1115- 6198

Print ISSN: 1597-3107

Page | 8
https://doi.org/10.59298/RIJRMS/2025/42816

Exploring Ethnopharmacology: Medicinal Plants in

Managing HIV-Associated Wasting Syndrome
Awafung Emmanuel
Department of Electronics and Biomedical Engineering, Kampala International University Uganda
Email: [email protected]

ABSTRACT
HIV-associated wasting syndrome (HIV-ASS) remains a significant complication among individuals
living with HIV/AIDS, characterized by severe involuntary weight loss and muscle wasting. Despite the
availability of antiretroviral therapies (ART), many patients in developing regions continue to suffer from
the syndrome due to ART-related toxicities, limited healthcare access, and socio-economic barriers. This
study explores the ethnopharmacological knowledge and practices related to the use of medicinal plants
in managing HIV-ASS among a homogenous community residing near a national park in southwest
Zambia. By documenting traditional herbal remedies, methods of preparation and administration, and
knowledge transmission mechanisms, this research aims to illuminate overlooked but potentially effective
plant-based interventions. The study also addresses the historical, biological, ethical, and clinical
dimensions of plant-based treatments, critically analyzing the gaps between in vitro and in vivo efficacy
and the implications of bioprospecting and ethical stewardship. It highlights the need for integrated
healthcare models that recognize traditional medicine's role in community-based HIV care, and calls for
systematic validation of herbal remedies to bridge traditional knowledge and modern medical practice.
Keywords: Ethnopharmacology, HIV-associated wasting syndrome, Traditional medicine, Medicinal
plants, Antiretroviral therapy, Indigenous knowledge, Zambia.
INTRODUCTION
HIV-1 is a retrovirus that is the cause of AIDS, a chronic immune deficiency disorder. The pathogenesis
of this disease is attributed to the loss of CD4+ T-helper lymphocytes and other immune cells, resulting
in opportunistic infections, among other complications. In the 1970s, the social stigma associated with
HIV/AIDS led to a plight for treatments that were more natural and less socially stigmatizing, fuelling
the growth of ethnopharmacology regarding ASS. Plant preparations that promoted appetite or muscle
mass gain or that supported healthy weight were absorbed from information given to clinical researchers
either directly from patients or indirectly via practitioners. This growth of ethnopharmacological
research on ASS in turn fuelled a growth of interested cohort studies worldwide on medicinal-plant-based
treatments in diverse populations. However, unlike with HIV, this research context is largely ignored in
clinical contexts and is scarcely known to bioethicists globally. Medications in the background that need
to be benchmarked against medicinal-plant-based treatments are in vitro–in vivo incoherent and
inconsistent; thus, ASS management is in vitro–in vivo incoherent and consistent. Biological diversity in
the foreground is the same, but it is not publicly appreciated. HAD approaches depend on parallel
consultations and sampling of treatment knowledge on the same illnesses in different populations.
Simultaneously, HAD approaches are locally destructive and globally pro-poorly sustainable, as the
vicinage of the plants used by the population studied is poor worldwide. Medicine focused on competitive
advantage is biased; it biases clinical practice and is clinically pro-marginalized and locally selective, as it

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ignores the bioprospecting potential of less popular knowledge and resource-poor populations. All this
raises many questions about southwest Zambia's use or legacies of medicinal-plant-based treatments for
managing ASS. Hence, the present study aims to document the hitherto undocumented medicinal plants,
various modes of preparation, methods of administration, and knowledge transmission pertaining to the
use of medicinal plants for managing ASS in a homogeneous population settled close to a national park in
southwest Zambia [1, 2].
Understanding HIV-Associated Wasting Syndrome Page | 9
HIV is one of the most devastating epidemics of the modern era. By utilizing the effective global response
to HIV, it has been estimated that there are around 36.7 million people living with HIV/AIDS worldwide.
Following HIV infection, the gradual depletion of the immune cell population (T-lymphocytes) (CD4+ T-
cells) occurs over a period of time. The immune system is thus left in an immune suppressed state which
facilitates HIV opportunistic infections and the development of AIDS. Other long-term consequences of
chronic HIV infection include metabolic disorders, cardiovascular complications, and HIV-associated
neurocognitive disorders. The presence of co-infections significantly increases the morbidity and
mortality of HIV in affected individuals. Wasting syndrome is another complication of chronic HIV
infection which remains poorly managed despite the best treatment available. Wasting syndrome is a
gradual loss of lean body mass which mainly consists of skeletal muscle loss. It can occur with or without
the presence of other metabolic disorders. Wasting syndrome leads to a compromised quality of life, poor
treatment adherence and healthcare costs, as well as premature death and a loss of economic activity. In
the absence of ARTs, the life expectancy is only around 1–3 years. In the presence of ARTs, the quality of
life is improved for up to 10–20 years. However, these medications do not affect most long-term
consequences and significant health risks remain. Wasting syndrome can occur at any stage of HIV
infection and information regarding its occurrence in patients is often lacking. This leads to the use of a
large number of alternative medicines to manage wasting syndrome [3, 4].
Ethno pharmacology: An Overview
Ethnopharmacology studies the interactions between different ethnic groups and their local flora,
particularly focusing on plant-based medicinal uses. It seeks alternative drugs, especially phytochemicals
from traditional medicine, validating and isolating bioactive compounds for effective treatment regimens.
Over the past three decades, antiviral drug development primarily targeted viral enzymes of RNA and
DNA viruses. HIV-associated Wasting Syndrome (WAS) continues to significantly burden public health,
particularly in developing countries, where 90% of HIV-affected individuals reside. WAS, characterized
by weight loss in HIV patients, is better assessed through Body Mass Index (BMI) than mere body
weight. Although antiretroviral therapy (ART) has improved outcomes for HIV-1-infected individuals,
the combination of ART, the prevalence of TB infection, and anti-HAART toxicity can lead to severe
weight loss or additional health risks. ARV therapies also negatively impact quality of life. Vaccination
appears promising, yet no vaccine candidate has successfully passed phase II trials, and immunizing high-
risk populations may inadvertently foster more virulent strains. Numerous studies aim to extract
bioactive compounds from local practices in developing countries to alleviate HIV symptoms and enhance
life quality. Ethnopharmacology now plays a crucial role in addressing HIV/AIDS challenges,
necessitating a review of its contributions to understand the trade-offs and future opportunities. The
field’s principles, strengths, limitations, and opportunities must be clarified to promote systematic
research in drug discovery and development [5, 6].
Role of Medicinal Plants in Traditional Medicine
The acceptance of herbal medicines for disease management has grown in developing countries due to
limited government support for modern healthcare. Traditional practitioners, or herbalists, serve as
primary care providers, especially for the underprivileged and those in remote areas, including for
HIV/AIDS management. There is an emerging recognition of their role in global prevention and
treatment efforts. Interestingly, even in resource-rich nations, many individuals with HIV/AIDS seek
traditional healers for treatment. This study aims to gather data on the plants and preservation methods
employed by traditional practitioners in Uganda for managing HIV/AIDS and related conditions. It
records the use of 47 plant species across 27 families, with roots (42.6%), leaves (37.2%), and stems (7.5%)
being the primary parts used for treatment. Preservation methods included drying (83%), boiling (51%),
underground storage (45%), and liquid storage (30%). Opportunistic infections often accompany AIDS,
contributing significantly to mortality in developing regions. However, information about medicinal
plants for managing these infections is limited, particularly in Northern Uganda where the HIV epidemic

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is on the rise. This research documents the plant species and biological activities of commonly used
varieties by the local population in district Bannu, aiming to support further studies on their safe and
rational use [7, 8].
Historical Context of Medicinal Plant Use
Managing Aids-Associated Wasting Syndrome with Medicinal Plants
The use of herbal preparations for sickness management dates back hundreds of years. Noma, a gangrene
form affecting the mouth and face, has been noted since antiquity. Ancient texts, including the Egyptian Page | 10
papyrus of Smith (circa 1600 BC) and Sanskrit recipes in the Indian Materia Medica, contain references to
medicinal plants. A Sumerian clay tablet from 2600 BC lists about 40 plants with medicinal uses.
Egyptian records from roughly 4500 years ago mention 25 herbs and other substances, such as milk and
honey. In 1760, Dr. William Storkson identified Absolom tree bark for gonorrhea treatment and a
pulverized plant for worm discharges. Traditional herbal medicine remains prevalent today, with up to
80% of populations in some countries relying on it for primary healthcare, especially in developing
tropical areas where modern medicines are scarce. Estimates suggest 25% of modern medications have
roots in ethnopharmacological plant sources. Some phytomedicines have shown effectiveness as
hypotensives and in managing AIDS-associated wasting syndrome. However, scientific validity regarding
the efficacy and safety of these folkloric remedies is largely unexplored across different ethnicities and
regions. This lack of verification creates challenges for their safe and effective use in treating and
preventing various diseases. Yet, an understanding of their pharmacology, ethnography, chemistry, and
toxicology could aid in discovering novel compounds for developing safer, more effective drugs without
current side effects [9, 10].
Mechanisms of Action of Medicinal Plants
The human immunodeficiency virus (HIV) is a retrovirus that attacks various components of the immune
system and may lead to acquired immunodeficiency syndrome (AIDS) if left untreated. Despite extensive
research and treatment options available today, HIV is still a major global health issue, particularly in
sub-Saharan Africa (SSA), which has been the most affected region. Antiretroviral therapy (ART) for the
management of HIV infection have tremendously aided in controlling the disease. While ART is an
effective treatment, it is associated with several drawbacks as some patients experience side effects and
toxicities. ART medications are not widely available and affordable in many developing countries. More
importantly, ART is not curative and patients on HAART will remain lifelong patients. Data from
various studies show that low-weight patients are less compliant to ART and develop opportunistic
infections. This is usually as a result of a decrease in weight and muscle wasting that follows chronic
opportunistic infections which also includes HIV. This issue termed HIV-associated wasting syndrome is
common in HIV positive patients. Wasting syndrome in turn increases the risk of opportunistic infections
which activates the cycle that exacerbates the HIV condition. Problematic are the side effects associated
with current medications used. Therefore new ways to manage HIV-associated wasting syndrome in a
more patient-friendly, low-cost and safe manner than the existing ones are needed. While the initial
target of ethnopharmacological investigation was solely the use of traditional folk medicines to manage
human diseases, it is clear that the field has evolved with the advent of novel research and technological
advancements in medicinal plant studies. This review discusses the case for the use of ethnopharmacology
in the search for novel medicinal plants in the management of HIV-associated wasting syndrome and the
potential mechanisms of action of proposed remedies [11, 12].
Key Medicinal Plants for HIV-Associated Wasting
The significant medicinal plants used in managing HIV/AIDS-associated wasting syndrome are as
follows, arranged alphabetically by genus. **Gardenia ternifolia Smith** (Rubiaceae) is a shrub or small
tree up to 10 m tall found in East Africa, with bitter leaves and bark used to brew beer and as a poison
antidote. **Moringa oleifera Lam.** (Moringaceae), an erect tree 10–12 m high, has thin, deeply grooved,
yellowish-brown bark, and dark-green leaflets. **Annona muricata Lin.** (Annonaceae) is a small tree
with thick, glossy, oval leaves, producing a round, edible fruit with custard-like pulp, and seeds used in
traditional medicine for infections. **Zingiber officinale Roscoe** (Zingiberaceae) is an herbaceous plant
reaching 1 meter, with edible swollen underground rhizomes and pale yellow flowers. Commonly
cultivated in tropical regions, ginger serves as a spice and food preservative, with decoctions used as tonic
for coughs and colds, although excessive use may cause gastrointestinal issues [13, 14].

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Clinical Evidence Supporting Medicinal Plant Use
Many HIV-positive people in developing countries rely on herbal medications to treat their HIV disease,
as AIDS and its associated symptoms can be managed and improved using a variety of herbal medicines.
A study involving semi-structured interviews with free list and cognitive mapping techniques was
conducted among HIV-positive people living in Lesotho to investigate the use of herbal medicine among
them. A lay person's exploitation of herbal medicine for HIV-positive patients was examined, and the
frequency of use of such medicines seven days prior to the interviews was analyzed. Among 78 Page | 11
respondents, 73% used herbal remedies, mostly in combination with ART. Four herbs were frequently
taken, two of which were also the most important, namely medicinal plants and herbal medications
consisting of multiple herbs. People seeking ART tended to use more effective herbal medications. People
using herbal medications perceived their needs to be unmet. Although medical herbalists improved the
perception, they perceived their needs to be met. Similarly, traditional healers were perceived to be
undesirable to visit and were rarely seen. For a developing country, frequent use of herbal medicine for
HIV-positive patients and its potential influences on ART comprehensibility were reported. Patients in
Lesotho described herbs they use with or without complementary or alternative medicine as information
seeking after being diagnosed. They mentioned perceived efficacy or efforts to find information, perceived
information safeness, perceived privacy, and retrieval difficulty based on the experience of seeing friends
using herbs, or pre-existing knowledge from environmental information. Herbal medications targeting
care for mothers and children with ART and herbs believed to inhibit viral replication were also
mentioned. Herbal medicines intended to care for body strength, blood restoration, common cold, cough,
and fever were mentioned. Projected usage perceptions included reduced ART effects and delayed
initiation of ART. Concerns to be avoided when seeking information about herbal medicines included
secrecy and confidentiality, distance, and inability to recall the herb name [15, 16].
Challenges in Ethno pharmacological Research
Investigating plants in ethnopharmacology presents challenges that impact both the research process and
outcomes. One of the main issues is communication, which hinders access to information about plants
used in traditional medicine. While some published literature aggregates knowledge about specific plants,
comprehensive compilations remain scarce, especially for many countries. Most of the available literature
is in European languages, creating a barrier for traditional medical practitioners who speak local
languages. Prioritizing the compilation of knowledge in these languages is crucial, as many researchers
lack access to the existing literature. Additionally, it is important to verify the bioactivity of listed plants,
focusing on high-activity extracts, and standardizing bioassays based on vital traditional uses of these
plants. Ethnopharmacological research often depends on bioassays to identify promising plants, but the
quality of many studies is low, sometimes based only on preliminary bioassays, neglecting plants that may
have unknown activity. The bioassay-guided fractionation of active extracts often results in rediscovery of
known compounds, leading to skepticism about its effectiveness in uncovering new substances from
traditional medicine. Despite these challenges, investigating medicinal plants can lead to effective
treatments for diseases such as HIV/AIDS and related wasting syndrome. This syndrome manifests as
unexplained weight loss, muscle wasting, diarrhea, chronic fatigue, and inflammatory neuropathy in HIV
patients, caused by neuroendocrine regulation impairments. Chronic HIV infection can disrupt
hypothalamic neuropeptides like pro-opiomelanocortin and agouti-related protein, affecting cortisol and
growth hormone regulation. Studies on HIV-1 transgenic rats indicate loss of integrity in the arcuate
nucleus and a significant reduction in proinsulin mRNA, which is crucial for blood glucose regulation.
This dysregulation can also lead to diabetes and frequent hypoglycemic episodes, as observed in a
significant percentage of HIV-infected patients [17, 18].
Ethical Considerations in Medicinal Plant Research
The research examined 33 plant species exhibiting in vitro antiviral activity against HIV-1. Information
on medicines and treatments was gathered from 15 practitioners, while healing plants were identified
over 12 consultations. Three species—Euphorbia spp., Huernia hystrix, and Sutherlandia frutescens—are
indigenous to South Africa and previously shown to be effective against cachexia, body fat loss, and HIV-
related issues. Ethnopharmacology emerged as a vital research area, emphasizing the significance of
plants from cultures without written languages. In the U.S., researchers began publishing on
ethnopharmacology as a source for new compounds, but this generated controversy over ethical
information disposal and bioresource use. Ethnopharmacological researchers faced criticism, and
legislation was enacted to regulate knowledge and resources. Brazil experienced similar controversies

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that prompted laws to address unethical biodiversity research. An international symposium on tropical
medicinal plants in 1980 sought to establish research protocols and practices. This conference emphasized
respecting indigenous cultures and their knowledge while advocating for resource and knowledge
reciprocity. The protocol also highlighted the safeguarding of intellectual property and sacred sites. With
growing genomic sequence data from human microbiomes and plant genetic materials, corporate interests
emerged as new threats. Farmers and indigenous groups sought to assert their ancestral rights to genetic
resources, reflecting ongoing challenges from past ethnobiological and bioprospecting issues amidst Page | 12
evolving contexts [19, 20].
Regulatory Framework for Medicinal Plants
Traditionally, the use of plants as medicine is central to African culture, passed down orally, which risks
loss as elders pass away. African traditional medicine manages various diseases, including HIV/AIDS,
alongside modern treatments and is used in divination and religious practices. Its cultural significance is
closely tied to social and religious beliefs, facilitating healing within structures of injustice and possessing
bioremedial capabilities. This complex cultural importance helps contextualize its current transformative,
researchable, and scientific relevance. Medicinal plants are defined as those with actual or potential
therapeutic value. Traditional medicine encompasses the knowledge, skills, and practices originating from
diverse cultures for preventing, diagnosing, or treating physical and mental ailments. Ethno-
pharmacology examines medicinal plants biologically, pharmacologically, and chemically, focusing on
active compounds and their effects, relying on local communities' knowledge of medicinal flora.
Ethnopharmacological studies initiate with ethnobotanical research, plant collection, and species
selection. In recent years, southern Africa's herbal remedies have garnered increasing scientific interest,
leading to new discoveries and the utilization of biodiversity for research. The significance of developing
and protecting the genetic resources of traditionally used plants has been highlighted. Without
conservation efforts, certain medicinal plants risk extinction. Traditionally, African communities
accumulated and selectively shared knowledge of medicinal flora, sometimes keeping sacred information
secret. The knowledge of beneficial plants has attracted pharmaceutical companies, providing locals
economic incentives to exploit their flora. Sustainable drug discovery and herbal treatment development
hinge on genetic protection. Before exploration, biodiversity hotspots should be inventorized to ensure
protection. The patenting of natural resources by industrialized nations has sparked debates on bio-piracy
and bioprospecting, leading to the creation of databases to identify ‘ownership’ of natural products and
efforts to safeguard traditional knowledge. Ultimately, indigenous populations, the original users of these
resources, seek to share in the benefits derived from their utilization [21, 22].
Case Studies: Successful Applications
The management of HIV-associated wasting syndrome (WAS) has recently revived interest in
ethnopharmacology and medicinal plants due to their historical use and demand for natural therapies [23-
25]. This study focuses on polyherbal remedies derived from medicinal plants traditionally used by HIV-
positive individuals. A preclinical investigation was conducted on extracts from six selected plant species
for their efficacy in WAS, aiming for standardization and commercialization. The plants were chosen
based on ethnobotanical surveys and consultations with traditional healers in Lesotho. Methanol extracts
of these species were tested in vitro on C2C12 myoblast and myotube cells and in mouse models for their
anti-cachectic effects [26-28]. The study screened for active phytoactive principles to guide the selection
of effective fractions. Intellectual property rights, patenting, and the integration of commercial delivery
systems for herbal products were also discussed. A new 12-herb ethnomedicinal formulation, EPE
(Ethnomedicinal Plants Extract), was launched by community partners HERB-DESIGN and SHEBA
health groups, collectively known as SOWERS [28-32]. An eight-herb formulation containing six
promising bioactive extracts with anti-HIV and anti-WAS activity was developed for community
delivery. The EPE extracts and herbal capsules are expected to initiate the path towards
commercialization, serving both WAS treatment and potentially leading to further innovations in
management [23, 24].
Integration of Medicinal Plants in Modern Healthcare
Recent research indicates that traditional African medicinal plants may enhance modern ART for HIV
and related infections. Even with population migration, local communities retain rich knowledge of these
plants, often passed down through oral traditions [33-34]. This study aimed to document such plants
used in HIV-AIDS care in Eastern Cape, South Africa. Data was gathered via herbalist discussions,
interviews, field tours, and participant observation. Comparing the knowledge of HIV-positive individuals

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with that of professional herbalists revealed that field interviews significantly increased the diversity of
documented medicinal plants. Seven previously unknown HIV-related plants were identified, underlining
the importance of capturing traditional knowledge, which might otherwise be lost [35-38]. The study
advocates for incorporating field interviews into ethnobotanical research, suggesting that local
knowledge continuity is crucial amid globalization and rural development. Many plants reported to
possess anti-HIV effects were previously unrecognized by scientists, highlighting the necessity of further
research on both known and newly discovered species. Ultimately, supporting local knowledge systems Page | 13
can enhance the collection and use of traditional medicine, addressing global health challenges in
developing regions [38-42].
Future Directions in Ethno pharmacology
In this review, plant substances with anti-HIV action are explored. A search was conducted for plants
reported to show anti-HIV activity in cell-based or non-cell-based assays. Additionally, plants with anti-
HIV action have been claimed to address neurocognitive impairment associated with the infection status,
but their status is less explored [43-46]. The current review highlights the role of these plants in the
treatment of HAND, classes of their secondary metabolites involved in anti-HIV activity, and their
preclinical and clinical status. From the studies reviewed, 319 bioactive compounds from 56 plant families,
including numerous unreported compounds, were identified. Fifty-three plants also inhibited HIV-1
infection of human naïve C–CD4 T-cells. Several medicinal plants modulate factors involved in HIV
latency and reservoirs, and 88 plants address neuropathogenesis of HAND. In translational research,
focusing on holistic therapy according to biological systems, the WHO has advocated for better
understanding of “High-Throughput Natural Products” to target new ailments [43-46]. A better
understanding of “Reverse Pharmacology” approaches to target undiscovered/unused receptor
interactions of marketed drugs has highlighted the need for ethnomedicines toward neglected diseases.
Safety, efficacy, and quality-resilient adjuvant drug mixtures derived from medicinal plants used in
traditional practice have shown promising clinical outcomes. More billion-dollar markets have also been
outsourced for the last few decades from Europe to Asian/Middle Eastern nations. Few metabolite-target
approaches from natural products with specific olfactory cyclodehydrogenase enzymes have also recently
seeded significance to early million-dollar clinical-phase preclinical biomedical research industries [27,
28].
CONCLUSION
The management of HIV-associated wasting syndrome in resource-limited settings continues to
challenge both patients and healthcare systems. This study demonstrates that ethnopharmacological
approaches, grounded in traditional knowledge, provide viable complementary options for managing
HIV-ASS. Medicinal plants such as Moringa oleifera, Annona muricata, and Zingiber officinale play
significant roles in improving patient outcomes by enhancing appetite, strengthening the immune system,
and alleviating related symptoms. However, the clinical utility of these herbal treatments remains under-
recognized, and their mechanisms of action inadequately studied. Bridging the gap between traditional
knowledge systems and modern biomedical frameworks is essential for sustainable, equitable healthcare.
Ethical considerations must guide bioprospecting and benefit-sharing to protect indigenous intellectual
property and biodiversity. Moving forward, interdisciplinary collaborations are needed to validate
traditional remedies, ensure quality control, and develop safe, standardized formulations that can be
integrated into HIV care protocols globally.
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CITE AS: Awafung Emmanuel (2025). Exploring Ethnopharmacology: Medicinal Plants in

Managing HIV-Associated Wasting Syndrome. RESEARCH INVENTION JOURNAL OF
RESEARCH IN MEDICAL SCIENCES 4(2):8-16.
https://doi.org/10.59298/RIJRMS/2025/42816

This is an Open Access article distributed under the terms of the Creative Commons Attribution License
(http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium,
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