中医药治疗HIV感染/获得性免疫缺陷综合征疗效及安全性的系统评价/Meta分析的再评价

Overview of Systematic Review and Meta-analysis on Effectiveness and Safety of Traditional Chinese Medicine in the Treatment of HIV Infection/Acquired Immunodeficiency Syndrome

目的:评估、总结中医药治疗人类免疫缺陷病毒(HIV)感染/获得性免疫缺陷综合征(AIDS)的系统评价/Meta分析中疗效及安全性的证据质量。方法:检索多个中英文数据库,收集中医药治疗HIV感染/AIDS的系统评价/Meta分析(研究组干预措施为单独使用中医药或联合西医治疗;对照组干预措施为空白、安慰剂、模拟剂、西医治疗,或西医治疗联合安慰剂、模拟剂),检索时间限定为各数据库建库至2022年8月。根据纳入与排除标准筛选文献、提取数据。采用AMSTAR2量表评价纳入研究的方法学质量,采用GRADE工具对结局指标进行证据质量分级。结果:共纳入11篇文献,均显示中医药治疗HIV感染/AIDS的疗效优于对照组。AMSTAR2量表评价结果显示,5篇文献的方法学质量为“低”,6篇为“极低”。GRADE评价结果显示,纳入的38个结局指标中,2个结局指标为中等证据,24个结局指标的证据等级为低级,12个为极低级。中等质量的证据表明,中医药联合抗病毒治疗用于HIV感染/AIDS,患者的临床症状改善率、CD4细胞计数改善情况优于单纯抗病毒治疗。结论:目前的证据表明,中医药治疗HIV感染/AIDS有一定优势,安全性较高。鉴于大多数研究的方法学和证据质量均较低,尚需进一步验证。

OBJECTIVE:To evaluate and summarize the evidence quality of efficacy and safety of systematic review and Meta-analysis of traditional Chinese medicine(TCM)in the treatment of human immunodeficiency virus(HIV)infection/acquired immunodeficiency syndrome(AIDS).METHODS:A number of Chinese and English databases were retrieved to collect systematic review/Meta-analysis of the treatment of HIV infection/AIDS with TCM(intervention of study group was TCM alone or TCM combined with western medicine;intervention of control group was blank,placebo,mimic,western medicine treatment,or western medicine treatment combined with placebo and mimic).The retrieval time was from the establishment of the database to Aug.2022.The literature was screened and the data were extracted according to the inclusion and exclusion criteria.AMSTAR2 scale was used to evaluate the methodological quality of the included studies,and the GRADE tool was used to grade the evidence quality of the outcome indicators.RESULTS:A total of 11 studies were included,all of which showed that the efficacy of TCM in the treatment of HIV infection/AIDS was better than that of the control group.AMSTAR2 scale showed that the methodological quality of 5 studies was low,and that of 6 studies was very low.GRADE evaluation showed that among the 38 outcome indicators,2 outcome indicators were moderate,24 outcome indicators were low and 12 outcome indicators were very low.Moderate quality evidence showed that the improvement rate of clinical symptoms and CD4 cell count in HIV infection/AIDS patients treated with TCM combined with antiviral therapy was better than that of antiviral therapy alone.CONCLUSIONS:Current evidence shows that TCM has certain advantages and high safety in the treatment of HIV infection/AIDS.However,the methodological quality and evidence quality level of most of the studies are low,further verification is required.