In 1992, when I was first introduced to herbs at an HIV seminar, I was skeptical in a way that most Americans are," says Phoenix PWA Mark Hoffman, health educator for AIDS Project Arizona and coordinator of the Being Alive Buyers Club in Phoenix. "I didn't want to get ripped off and I didn't know anything about how they worked. My knowledge base was zero."

Although Hoffman experimented with a Chinese herbal formula for the next year, the expense and apparent lack of results prompted him to stop when he went on 3TC. but in 1995, with his CD4 cells down to 66 despite being on what he viewed as his best-shot regimen (ddI and d4T), he decided to stop by the Southwest Botanical Conference. It was an eye-opener. "Learning about the active ingredients of herbs, I said, 'Wow, maybe there's something to this.'" Since 1995, the Yale-educated Hoffman has schooled himself in herbal medicine and done further experimenting. He tried SPV-30 (boxwood extract) as an antiretroviral and began using herbs to detoxify his liver. The results? "My liver function tests improved, and my health didn't deteriorate. But I also didn't have any increase in T-cells."

A year ago, with his viral load at 40,000, Hoffman changed his antiretroviral therapy (from three to five drugs) and added glycyrrhizin (licorice extract), bitter melon and SPV-30. His viral load dropped to 3,000, and his CD4s climbed to 522. Is it the herbs? "No," he says. "I think their antiviral effect is too weak for HIV in someone like me. But with antiretrovirals, they might tip the balance."

Hoffman's five-year odyssey from an herbal know-nothing to "the most knowledgeable man in the Southwest" (as a buyers club client dubbed him) is exceptional. but his path is typical: Many herb users are self-educated and experiment along the way to see what works.

Rick Elion, MD, is a Washington, DC physician and acupuncturist with extensive herbal training. In his large HIV practice, he recommends herbs as treatments for drug side effects and common infections. "I use Chinese formulas such as Clear Heat for chronic hepatitis, Marrow Plus for AZT-related anemia, and Asra-isatis (containing astragalus and isatis) for chronic herpes," he says. He also finds silymarin useful for elevated liver enzymes and garlic for sinus infections.

As to dosing, Elion says, "It's part art and part science. Just as with drugs, some herbs can be used chronically, while others should only be used intermittently."

Such herb-friendly HIV docs as Elion are hard to find. And if you want to try herbs, expert guidance on dosage, side effects, contraindications and drug interactions is highly recommended (see "Garden Variety" below). The most reliable info source for PWAs is licensed health-care practitioners -- including naturopathic physicians and acupuncturists -- with training in herbal medicine and knowledge of HIV disease.

Unfortunately, herbal advisers ignorant of HIV's effects have inappropriately recommended certain herbs because of their supposed antiviral properties. And although some, such as echinacea, might work well for your average cold or flu, there is a possibility of adverse effects in some PWAs (see "Power Plants" in this issue). The bottom line: Herbs that are useful for other viral illness may not be safe for HIV.

Would-be herb users are well advised to read up on the subject (see below). With basic grounding in botanicals, you'll be in a better position to evaluate any advice you get and the quality of the herbs you buy.

When selecting herb products, look for quality indicators: A list of active ingredients and their percentage of content (the higher, the better), glass bottles (these preserve herbs better than plastic) and a manufacturing lot number and expiration date (sign of careful production).

It's trite but true: An educated consumer gets better results. And remember, herbs may come from nature, but they pack a punch -- for good or for ill.

Herbal fact sheets can be obtained from Direct AIDS Alternative Information Resources (DAAIR), a New York City buyers club, at 888.951.5433 (or click on their website at www.immunet.org/daair). You can also call the Boston Buyers Club at 800.435.5586, or AIDS Project Los Angeles at 213.993.1612. Useful reference books include Herbs That Heal by Janet and Michael Weiner (Quantum Books/Cambridge, MA), Herbal Medicines: A Guide for Health Care Professionals by Newall, Anderson and Phillipson (Pharmaceutical Press/ London), and Herbal Prescriptions for Better Health by Don Brown (Prima Publishing/Rocklin, CA).