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

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 syn-drome (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 in-ception 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, Assess-ment, 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 signif-icant 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.(c) 2023 Korea Institute of Oriental Medicine. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ )