Abstract
The survival of patients with HIV has greatly improved, due to Anti-Retroviral Therapy (ART). However, long-term HIV survivors often develop serious bone abnormalities, possibly due to the interplay of osteoblasts, osteoclasts, HIV ad ART. We evaluated in a nation-wide study in Taiwan the effect of Chinese herbal medicine (CHM) on overall mortality in HIV patients with osteoporosis or fractures. Enrollment period was between 1998 and 2011. Patients with osteoporosis or fractures before the HIV infection, and those with less than 14 days CHM use, were excluded. This left 498 patients, 160 CHM users, 338 without CHM. Univariate Kaplan-Meier and multivariate Cox regression analysis were used to compare the overall mortality in these 2 groups. Due to the nature of Chinese medicine, CHMs inevitably varied. We therefore also used rule mining and network analysis to determine which major CHM clusters were prescribed to the patients. CHM users had a much Lower mortality (hazard ratio (HR) = 0.43, 95% confidence interval (CI): 0.24–0.77, p < 0.005) and higher survival (p = 0.004, log-rank test). Although the CHMs greatly varied, network analysis identified one main cluster of strongly related CHM combinations (Chuan-Xiong-Cha-Tiao-San (CXCTS), Gan-Cao (GC; Glycyrrhiza uralensis Fisch.), Liu-He-Tang (LHT), Huang-Qin-Tang (HQT), Jia-Wei-Ping-Wei-San (JWPWS), and Dang-Gui-Long-Hui-Wan (DGLHuiW)). CHM as an additional treatment strongly improves overall survival in HIV-infected patients with osteoporosis and fractures.
Highlights
With antiretroviral therapy (ART), HIV-positive and negative patients have similar lifespans (Pham and Mesplede, 2018; Zhang et al, 2019)
The multivariate Cox proportional hazard model showed that patients had a higher risk of overall mortality per year increase in age after adjusting for gender, Chinese herbal medicine (CHM) use, and Charlson comorbidity index (Table 2; adjusted hazard ratio: 1.02, 95% confidence interval (CI): 1.00–1.04, p 0.0173)
Long-term living with HIV and Anti-Retroviral Therapy (ART) use in HIV-infected patients are associated with adverse effects including bone related abnormalities
Summary
With antiretroviral therapy (ART), HIV-positive and negative patients have similar lifespans (Pham and Mesplede, 2018; Zhang et al, 2019). Long-term living with HIV and ART use in HIV-infected patients are associated with adverse effects. These adverse effects include hyperlipidemia, cardiovascular disease, bone related abnormalities, diabetes, and renal disease (Kwong et al, 2006; De Wit et al, 2008; Capeau et al, 2012; Achhra et al, 2016; Grant et al, 2016; Hoy and Young, 2016; Ahmad et al, 2017; Dorjee et al, 2017; Hoy et al, 2017; Tsai et al, 2017; Nan et al, 2018)
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