The Effect of Chinese medicine therapeutics on HIV/AIDS: A Systematic Review and Network Meta-Analysis

Hongxi Wu¹Qinglian Huang²Yiyang Liu¹Jiale Liang¹Zhenjin Huang¹Huiping Luo¹Rongxin Zhang³Ruting Wang^1*Yuanbo Song^3*Feng Jiang^3*

• ¹GuangXi University of Chinese Medicine, Nanning, China
• ²Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
• ³Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning, China

Background While antiretroviral therapy (ART) effectively suppresses HIV, incomplete immune reconstitution affects 20%-30% of adherent patients. Chinese Medicine (CM) demonstrates potential as a complementary therapy for Human Immunodeficiency Virus (HIV)/ Acquired Immune Deficiency Syndrome (AIDS), yet its long-term impact on immune recovery remains unestablished. This network meta-analysis (NMA) aimed to compare CM interventions for enhancing CD4⁺ T-cell counts and overall efficacy in HIV/AIDS management. Methods We systematically searched PubMed, Embase, Web of Science, and the Cochrane Library from inception to 27 August 2024 for randomised controlled trials (RCTs) and observational studies on CM for HIV/AIDS. Bayesian NMA was conducted using R 4.2.2 with BUGSnet 1.1.0 package. Surface under cumulative ranking (SUCRA) probabilities ranked interventions. Risk of bias was assessed with Cochrane ROB 2.0 for RCTs and Newcastle-Ottawa Scale for observational studies (PROSPERO: CRD42024560340). Results 34 studies (n=8,933 participants) evaluating 16 interventions were included. Key findings: For CD4⁺ restoration, Chinese herbal formulae plus ART significantly outperformed ART alone (MD=163 cells/μL, 95% CrI: 3.93–326.46), ranking first (SUCRA=0.92). Single herbs plus ART ranked second for CD4⁺ recovery (MD=178.54, 95% CrI: -188.57–553.24; SUCRA=0.85). In overall treatment efficacy (survival/quality of life), Chinese herbal formulae + Western medical therapy demonstrated the highest SUCRA (0.96). Acupuncture reduced ART-induced neuropathic pain (Gracely score MD=-0.7 vs sham). Conclusion CM-ART combinations—particularly Chinese herbal formulae with ART—optimize immune reconstitution in HIV/AIDS. Chinese herbal formulae plus ART represents the most effective CD4⁺ restoration strategy. These findings support integrating evidence-based CM into HIV care, but pharmacokinetic interactions and long-term safety require validation through multicenter trials.