Exploring the impact of Chinese medicine on CD4 cell counts in people living with HIV by mixed-effects model: a retrospective cohort study based on propensity score matching.

BACKGROUND

CD4 cells are the targets of human immunodeficiency virus (HIV). If left untreated, HIV enters CD4 cells and replicates, ultimately leading to the death of the infected cells. The loss of these cells impairs immune function. As Chinese medicine (CM) can be used to treat people living with HIV (PLHIV), it is important to explore the long-term effects of CM on the CD4 cell count of PLHIV.

METHODS

An open-label study was conducted using data from conventional medical records. PLHIV who met the criteria and were treated with CM (CM group) and not treated with CM (non-CM group) were propensity-score matched in a 1:1 ratio and followed for 10 years; their CD4 cell counts were collected at baseline and every year thereafter. Linear mixed-effects models (LMEMs) were used to assess the effects of CM on the CD4 cell count, and subgroup and sensitivity analyses were performed to provide further insights.

RESULTS

A total of 1,908 PLHIV were enrolled in this study. No differences in baseline characteristics were observed between the CM and non-CM groups. Univariate LMEM analysis showed that CD4 cell count increased significantly more in the CM group than in the non-CM group (estimate and 95% CI: 1.33; 0.84-1.81; P < 0.05). Multivariate LMEM analysis also demonstrated a similar trend (estimate and 95% CI: 2.97; 1.91-4.02; P < 0.05). Subgroup analysis indicated that CM supported higher CD4 cell counts across almost all subgroups and particularly among women and those with lower baseline CD4 cell counts. Subsequent sensitivity analyses further confirmed the positive effects of CM on CD4 cell count among PLHIV.

CONCLUSIONS

CM might be associated with maintaining higher CD4 counts on top of existing ART regimens, especially in those with a lower baseline CD4 cell count.