A Study On The Effectiveness Of Treating HIV Patients With Traditional Chinese Medicine Based On Documental And Clinical Evaluation

Objective:To explore the effectiveness of traditional Chinese medicine(TCM)in the treatment of HIV infection,and to provide guidance for the future research of Chinese medicine in the treatment of AIDS.Methods:Searched literatures of Randomized Controlled Trials about TCM in AIDS treatment in the databases of China National Knowledge Infrastructure(CNKI),Wanfang Data,VIP,Pubmed and the book of The Fourth Essays Collection of AIDS treatment with Traditional Chinese medicine:Research Progress on the treatment of AIDS with TCM on the interval between Jan.1,1988 and Sep.30,2016;screened literature outcomes of CD4~+T lymphocyte counts,CD4/CD8 and HIV viral load.The extraction of included studies were as follows:the intervention measures,the purpose of treatment,disease staging,TCM syndromes,therapeutic principles of Chinese medicine,safety observation,intervention time and other information.Jadad Quality Score Table was used to assess the methodology quality of the included studies,Revman5.3 and GradeProfiler3.6 software were used to make meta-analysis of the outcomes of CD4~+T cells,CD4/CD8,HIV viral load and the evidence strength of the outcomes respectively.The preliminary efficacy of TCM intervention in HIV infection was obtained through the relevant analysis of the literature.On the basis of this,we made a retrospective clinical observation and analysis of the efficacy of HIV patients taking Chinese medicine QilingYiQi tablets combined with HAART(Highly Active Antiretroviral Therapy)drug for three years consecutively in the Sichuan Province Pilot projects of treating AIDS with TCM.Data reported in the literatures reports as a reference,we made statistics of indicator changes of CD4~+T cell count,points of symptoms and signs,weight,etc.over three years.Combined with the conclusions of the first two parts and clinical status,we then disscussed TCM thoughts about AIDS diagnosis and treatment.RESULTS:18 randomized controlled trials were included in a total of 1951 patients.Intervention measures included both Chinese medicine(CM)vesus placebo and CM combined with HAART vesus HAART(combined with placebo).Regardless of baseline stages,most of the studies were conducted to observe the effects of CD4~+T lymphocytes and/or CD4/CD8,HIV viral load,symptoms,signs or quality of life for the purpose.Disease stages involved in the studies were asymptomatic,morbidity stages and both stages.Different studies might have differd TCM syndromes and theuraputic principles,but the overall princple was strengthening resistance and exorcising pathogenic factors.No occurrence of safety incidents such as serious adverse drug reactions was found.The intervention time was up to no more than two years.The Jadad methodological quality score averaged 2.9 points.The results of meta-analysis showed that the effect of increasing or stabilizing CD4~+T cell count was significant(P<0.05)in the control groups regardless of CM vs.placebo groups or CM combined HAART vs.HAART(and placebo)groups.However,there were no significant differences in the efficiency of improving and stabilizing CD4~+T cells,the intervention of improving the CD4/CD8 and suppressing HIV viral load compared with the control groups(P>0.05).In the above studies,the intervention time of experimental groups which had significant clinical effects were almost within nine months.The clinical benefit CM combined with HAART was no better than that of HAART alone.The GRADE system evidence quality strength evaluation showed that the level of grade strength in the use of CM or CM combined with HAART for outcomes such as improving or stabilizing the CD4~+T cell count efficiency,CD4~+T cell count at the end of observations,CD4/CD8,and improving the efficiency of HIV viral load were"LOW".The level of grade strength of CM or CM combined with HAART for suppressing HIV viral load level were"Middle".In the clinical observation part of the study,Qiling Yiqi tablets combined with HAART drug intervention over three years of CD4~+T cells as a whole showed an increasing trend.CD4~+T cell counts increased at No.6,12,24,and 30 month after treatment compared with the initial time point(P>0.05)for those with baseline CD4~+T cells?200 cells/?l and from 200 to 350 cells/?l.The number of CD4~+T cells at No.6,12,18,24,30 and 36 month after treatment fluctuated compared with the initial time point(P>0.05)for those with baseline CD4~+T cells from 350 to 500 cells/?l.Compared with the literature data,the effect of Qi Ling Yiqi tablets combined with HAART in improving the number of CD4~+T cells did not reach the level recorded in the literature.The total scores of symptoms and signs at No.9,27,42 month decreased compared with those before treatment(P<0.05).The efficiencies of total score of symptoms and signs in No.9 and 42 month were 60.3%and 64.6%respectively compared with that those before treatment.The scores of Karlovsky in No.9,12,30,36,42 month were significantly higher than those before treatment(P<0.05).The weight of the patients in No.9,12,18,24,30,36 and 42 month was significantly higher than that before treatment(P<0.05).Conclusion:The intervention of TCM on AIDS,whether using CM alone or CM combined with HAART drug,could show effect of increasing or stabilizing CD4~+T cells in some stages.The included RCTs are deficient both in quantity and quality,affecting the evidence quality strength of the efficacy with TCM.In terms of clinical benefit of CD4~+T cells'increasement,both the use of CM alone and CM combined with HAART showed no better than HAART alone,especially for those whose baseline CD4~+T cells are over 350/?l.The efficacy of CD4~+T cells for those whose baseline CD4~+T cells over 350/?l were lower than that of less than 350/?l.Chinese medicine has no obvious antiviral effect.Only by combining CM with HAART,can the medicine have effect of virus suppression.The fact that CM could improve the clinical symptoms,signs and weight,etc.of HIV patients proves that CM could play a role in these areas.In the future,intervention of TCM to HIV patients should be focused on the improvement of clinical symptoms and signs,adverse reactions of western medicine,intervention of poor immune reconstruction in patients of AIDS stage and so on.