Abstract
OBJECTIVE: To comprehensively evaluate randomized controlled trials (RCTs) investigating the effects of moxibustion on people with human immunodeficiency virus (HIV) disease. METHODS: A systematic search was conducted across eight electronic databases up to August 20, 2024. The primary outcome were all-cause mortality and acquired immunodeficiency syndrome (AIDS)-related mortality. Two authors independently screened titles and abstracts, and extracted data onto a pre-designed datasheet. Discrepancies were resolved through consensus. The Cochrane risk-of-bias tool 2.0 was used to assess methodological quality, Meta-analysis was performed when appropriate, and the quality of evidence was assessed through Grading of Recommendations, Assessment, Development and Evaluations approach. RESULTS: Eleven RCTs (n = 834) on moxibustion for HIV/AIDS were included, focusing on individuals with HIV infection (5 RCTs, n = 426), AIDS patients (3 RCTs, n = 223), or both (3 RCTs, n = 185). Complications identified included diarrhea (5 RCTs), pulmonary infection (1 RCT), anxiety and depression (1 RCT) and peripheral neuropathy (1 RCT). The risk of bias in the included RCTs was assessed as either high or uncertain. No trial reported mortality or the incidence of AIDS-related complications following treatment. Wheat-grain sized cone moxibustion was associated with increased CD4+ counts in patients with lung infections [1 RCT, n = 36, mean difference (MD) = 78.83 cells/μL]. Individual studies reported improvements of quality of life, as measured by the World Health Organization Quality of Life-Brief Version (WHOQOL-BREF) and WHOQOL HIV instrument, with various moxibustion types, but clinical heterogeneity prevented data pooling. Additionally, some studies reported symptom improvement, each using different criteria for symptom improvement. Moxa stick moxibustion plus Western Medicine compared with Western Medicine alone showed a non-significant trend towards improved symptom resolution [2 RCTs, n = 125, risk ratio = 1.19, 95% confidence interval (0.99, 1.43)]. Moxibustion plus antiretroviral therapy (ART) may reduce gastrointestinal adverse events compared to ART alone [1 RCT, n = 100 14% vs 32%, P < 0.05]. The quality of evidence was low to very low. CONCLUSION: This systematic review suggests that moxibustion as an adjunct therapy may have potential benefits in improving immune function and quality of life for HIV/AIDS patients. Limited quality of evidence precludes definitive conclusions, and further high-quality research is needed.