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Review
. 2023 Mar;12(1):100918.
doi: 10.1016/j.imr.2022.100918. Epub 2022 Dec 23.

Chinese herbal medicine for drug-induced liver injury in patients with HIV/AIDS: A systematic review of randomized controlled trials

Xiao-Wen Zhang  1 , Jing Li  2 , Wen-Bin Hou  1 , Yue Jiang  3 , Ruo-Xiang Zheng  1 , De-Hao Xu  4 , Chen Shen  1 , Nicola Robinson  1   5 , Jian-Ping Liu  1   6
Affiliations
Review

Chinese herbal medicine for drug-induced liver injury in patients with HIV/AIDS: A systematic review of randomized controlled trials

Xiao-Wen Zhang et al. Integr Med Res. 2023 Mar.

Abstract

Background: To explore the effectiveness and safety of Chinese herbal medicine (CHM) for drug-induced liver injury (DILI) in patients with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS).

Methods: A systematic search was made of eight databases (Pubmed, Cochrane Library, Web of Science, Embase, CNKI, Wanfang, VIP, Sinomed) and two trial registries (WHO ICTRP, ClinicalTrials.gov) from inception to September 2022. The effect size was presented as risk ratio (RR) or mean difference (MD) with their 95% confidence interval (CI). The Cochrane Risk of Bias and Grading of Recommendations, Assessment, Development and Evaluations (GRADE) tools were used for quality appraisal.

Results: Ten randomized controlled trials (RCTs) involving 732 participants were included. Comparing CHM alone with routine treatment, the CHM group showed lower aspartate aminotransferase (MD=-11.47 U/L, 95%CI[-13.05, -9.89], low certainty), lower alanine aminotransferase (MD=-2.68 U/L, 95%CI[-4.27, -1.08], low certainty), lower total bilirubin (MD=-4.31 mmol/L, 95%CI[-5.66, -2.96], low certainty), lower bilirubin direct (MD=-3.19 mmol/L, 95%CI[-3.87, -2.51], low certainty), and higher effective rate (assessed by symptoms and liver indicators) (RR=1.13, 95%CI[1.06, 1.20], low certainty). A significant difference was also found in CHM plus routine treatment versus routine treatment in the previous outcomes. No significant difference was found on helper T cells among these comparisons. Only one RCT reported safety of CHM and found no adverse reaction during the trial.

Conclusions: CHM may improve the liver function indices and effective rate for HIV/AIDS patients with DILI. However, the sample size was small and quality was low. Larger-samples of high-quality trials are needed.

Keywords: Acquired immunodeficiency syndrome; Chinese herbal medicine; Drug-induced liver injury; Human immunodeficiency virus; Systematic review.

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Figures

Fig 1
Fig. 1
PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) flow chart of literature searching and screening.
Fig 2
Fig. 2
Risk of bias graph of the included RCTs.
Fig 3
Fig. 3
Forest plot of AST (U/L) after Chinese herbal medicine treatment.
Fig 4
Fig. 4
Forest plot of ALT (U/L) after Chinese herbal medicine treatment.
Fig 5
Fig. 5
Forest plot of TBiL (mmol/L) after Chinese herbal medicine treatment.
Fig 6
Fig. 6
Forest plot comparing CHM treatment with routine treatment on DBiL (mmol/L).
Fig 7
Fig. 7
Forest plot of effective rate after Chinese herbal medicine treatment.
Fig 8
Fig. 8
Forest plot comparing CHM treatment with routine treatment on CD4+(mm−3).
See this image and copyright information in PMC

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