leaf (MOL) powder is a product of the Moringa oleifera tree of theMoringaceae family 1. It is rich in proteins, minerals andmicronutrients 2, antioxidant compounds 3 andbeta-carotene 4. In developingcountries, different parts of the Moringa oleifera plant have been used asfood, fodder, as well as traditional medicine for asthma, anemia, diarrhea,respiratory disorders, tuberculosis and several other ailments 4. Itis one of the commonly used herbal supplements by human immunodeficiency virus(HIV) patients receiving antiretroviral therapy (ART) 5. A recent study in Zimbabwe showed that 68% ofpatients were consuming MOL powder with 81% of these patients receiving ART 6.Furthermore, 80% stated that they consumed it to boost their immune system 6.Another study in Ethiopia revealed that MOL powder was the second most commonlyused supplement with 20.
7% of patients having a CD4 count (microliter) of’<100 ?l', 36.7% having a CD4 count between '100-350 ?l' and52.7% having a CD4 count '>350 ?l’ 5. Despitethese widespread utilization, the impact of MOL powder on the immune system hasnot been extensively explored yet and thus empirical evidence is very limited. The jointUnited Nations Programme on HIV/AIDS (UNAIDS) 2016 report estimated that 36.7million people were living with HIV globally 7. Sub-Saharan Africawas home of 25.
5 million of these people with 19.4 million residing in Easternand Southern Africa 7. 1.
6 million were living in Kenya with 1million accessing ART, representing an overall coverage of 64% 7.Among these people, concurrent usage of MOL powder with ART is assumed to behigh. This can be demonstrated by the joint Moringa projects that have beeninitiated among patients 8. In addition, some HIV care facilitieshave started offering it with ART 9 .It is thus imperative to directour interests in assessing the effects of MOL powder on the immune system, aslittle research has been accomplished in this area.
5 in vivostudies, 3 conducted in India (2010 – 2012) 10 – 12, and 2 in Uganda(2015) 13, 14, showed that MOL powder had an immunomodulatory andproliferation potential in rats. In particular, there was an increment in whiteblood cells, lymphocyte and neutrophils count. This could suggest a probableimpact on the human immune system, which is not clearly established. However, arecent study revealed that MOL powder taken in combination with ART improvedthe body mass index, but, contrary to our expectations, there was nosignificant change in the lymphocyte count 9. Thus, we propose thisstudy to investigate the immunological effects of MOL powder on the immunesystem of patients receiving ART. Specific aims for this study are:· To determine whether MOL powder supplementation improvesthe immune system of patients receiving ART.· To investigate the incidence of grade three or fouradverse effects resulting from MOL powder co-administration with ART.
We formulate two hypotheses for this study:· MOL powder supplementation increases the CD4 count bymedian (X ?l) after every month in patientsreceiving ART. · There is no incidence of either grade three or fouradverse effects resulting from MOL powder interaction with ART. Our findings will have a number of fundamental publichealth implications, firstly, they will spearhead the implementation ofevidence based policies and practices among health care providers who aredistributing MOL powder to patients.
Secondly, they will inform patients on itssafety when taken with ART. And, lastly, they will avert self-care practices infuture among patients who may resolve to abandon the standard treatment regimenwith ART.