Effect of Chinese herbal medicine therapy on risks of all-cause mortality, infections, parasites, and circulatory-related mortality in HIV/AIDS patients with neurological diseases

Abstract

Introduction: Long-term living with human immunodeficiency virus (HIV) and/or antiretroviral therapy (ART) is associated with various adverse effects, including neurocognitive impairment. Heterogeneous neurocognitive impairment remains an important issue, affecting between 15-65% of human immunodeficiency virus infection and acquired immunodeficiency syndrome (HIV/AIDS) patients and resulting in work performance, safety, and health-related outcomes that have a heavy economic burden. Methods: We identified 1,209 HIV/AIDS patients with neurological diseases during 2010-2017. The Kaplan-Meier method, log-rank test, and Cox proportional hazards model were used to analyze 308 CHM users and 901 non-CHM users within this population. Major CHM clusters were determined using association rule mining and network analysis. Results and Discussion: Results showed that CHM users had a 70% lower risk of all-cause mortality (adjusted hazard ratio (aHR) = 0.30, 95% confidence interval (CI):0.16-0.58, p < 0.001) (p = 0.0007, log-rank test). Furthermore, CHM users had an 86% lower risk of infections, parasites, and circulatory-related mortality (aHR = 0.14, 95% confidence interval (CI):0.04-0.46, p = 0.001) (p = 0.0010, log-rank test). Association rule mining and network analysis showed that two CHM clusters were important for patients with neurological diseases. In the first CHM cluster, Huang Qin (HQ; root of Scutellaria baicalensis Georgi), Gan Cao (GC; root of Glycyrrhiza uralensis Fisch.), Huang Lian (HL; root of Coptis chinensis Franch.), Jie Geng (JG; root of Platycodon grandiflorus (Jacq.) A.DC.), and Huang Bai (HB; bark of Phellodendron amurense Rupr.) were identified as important CHMs. Among them, the strongest connection strength was identified between the HL and HQ. In the second CHM cluster, Suan-Zao-Ren-Tang (SZRT) and Ye Jiao Teng (YJT; stem of Polygonum multiflorum Thunb.) were identified as important CHMs with the strongest connection strength. CHMs may thus be effective in treating HIV/AIDS patients with neurological diseases, and future clinical trials are essential for the prevention of neurological dysfunction in the population.

Keywords: Chinese herbal medicine; HIV/AIDS; mortality; network analysis; neurological diseases.

FIGURE 1

Flowchart for the enrollment of CHM and non-CHM users in HIV/AIDS patients with neurological diseases. Abbreviations: CHM, Chinese herbal medicine.

FIGURE 2

Follow-up times of CHM and non-CHM users in HIV/AIDS patients with neurological diseases. Abbreviations: CHM, Chinese herbal medicine.

FIGURE 3

Cumulative incidence of (A) all-cause mortality and (B) infections, parasites, and circulatory-related mortality between CHM and non-CHM users in HIV/AIDS patients with neurological diseases. Abbreviations: CHM, Chinese herbal medicine.

FIGURE 4

Network analysis for CHM prescription pattern in HIV/AIDS patients with neurological diseases. Single herb is presented as a green circle; herbal formula is displayed as a red circle. Bigger circle size shows the higher prescription frequency of CHM. The connection strength is shown as the line size and line color between CHM_X and CHM_Y. Thicker line represents the higher support value between CHMs. Darker line shows higher lift value. Abbreviations: CHM, Chinese herbal medicine; SZRT, Suan-Zao-Ren-Tang; YJT, Ye Jiao Teng; HQ, Huang Qin; HL, Huang Lian; GC: Gan Cao; JG: Jie Geng; HB: Huang Bai.