Abstract
BACKGROUND: Although 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 randomized 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: A total of 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% Bayesian credible interval [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 plus Western medical therapy demonstrated the highest SUCRA (0.96). 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. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024560340, PROSPERO CRD42024560340.