Meta-analysis of CAM therapies for HIV

描述(申请人提供)：艾滋病毒感染的传统疗法已经取得了很大的进步，但它们仍然复杂、昂贵并且有许多副作用。许多补充和替代医学(CAM)疗法正在被艾滋病毒感染患者使用，但其中哪些(如果有的话)实际上是有益的仍不清楚，而且它们的使用是否具有经济意义就更不清楚了。确定适当处理的最佳方法是随机对照试验(RCT)。然而，由于许多原因，在护理提供者需要做出决定的时候，可能不会有明确的结果。由国家医学图书馆在PubMed中编制的关于艾滋病毒CAM疗法的医学文献正在呈指数级增长，但随机对照试验的数量虽然增长迅速，但与其他类型的研究相比仍然相对较少。此外，互联网和其他地方有大量且迅速增长的非标准和不那么严格的信息源，它们可能提供有用的信息，但很难获取，甚至更难评价。有许多技术，包括荟萃分析(通常称为系统审查)、决策分析和成本效益分析，它们使用已有的或可以估计的信息，试图为那些必须做出卫生政策和治疗决策的人提供临时答案。近年来，随着计算能力的提高和基于模拟的方法的发展，如马尔科夫链蒙特卡罗(MCMC)方法的发展，贝叶斯统计技术得到了迅速的发展和越来越多的使用。贝叶斯方法的主要优点是，它允许在一个统一的模型内综合所有可用的证据来源(即随机对照试验、观察性研究、专家判断)。这项研究的目的是使用这些技术来缩短HIV新的CAM治疗模式首次报告后的滞后期，直到临床医生可以做出以下四个决定之一：1.它永远不应该或很少使用。2.只应在某些明显可识别的情况或病人中使用。3.它可以被常规使用。4.不能在上述三种药物中选择一种，建议进行进一步的临床研究。 我们将主要集中于澄清CAM疗法作为辅助疗法的使用，这些辅助疗法可能会推迟开始或与更昂贵的疗法(如抗逆转录病毒药物)协同使用的必要性，用于症状管理，以及用于治疗与艾滋病毒相关的机会性感染和共病，例如，随着数据的出现，使用维生素D、益生菌、水蓟、减压和其他药物。

DESCRIPTION (provided by applicant): Conventional therapies for HIV infection have made great progress, but they remain complex, expensive and have many side effects. Many Complementary and Alternative Medicine (CAM) therapies are being used by patients with HIV infection, but which of them (if any) are in fact beneficial is still unclear, and whether their use makes economic sense is even less clear. The optimal method of determining appropriate treatments is the randomized control trial (RCT). However, for many reasons, definitive results may not be available at the time care providers need to make decisions. The medical literature dealing with CAM therapies for HIV, as indexed by the National Library of Medicine in PubMed, is growing exponentially, but the number of RCTs, while growing rapidly, still remains relatively small compared to other types of studies. In addition, there is a large and rapidly growing variety of non-standard and less rigorous information sources, on the Internet and elsewhere, which may provide useful information, but are difficult to access and even more difficult to evaluate. There are a number of techniques including meta-analysis (often called systematic review), decision analysis and cost-effectiveness analysis, which use information which is already available, or which can be estimated, to attempt to provide interim answers for those who must make health policy and treatment decisions. Recently, there has been rapid development and increasing use of Bayesian statistical techniques, facilitated by the increase in computing power and the development of simulation based approaches such as Markov chain Monte Carlo (MCMC) methods. The main advantage of a Bayesian approach is that it allows the synthesis of all the available sources of evidence (i.e., RCTs, observational studies, expert judgment) within a single coherent model. The goal of this research is to use these techniques to shorten the lag period after the first report of a new CAM treatment modality for HIV to the time when clinicians can make one of the following four decisions: 1. It should never or rarely be employed. 2. It should be employed only in certain clearly identifiable circumstances or patients. 3. It can be routinely employed. 4. The choice of one of the above three cannot be made and further clinical research is indicated. We will focus primarily on clarifying the use of CAM therapies as adjuncts that may delay the need to start, or synergize with, more expensive therapies such as antiretrovirals, be used for symptom management, and in treatment of the opportunistic infections and comorbidities associated with HIV, e.g., use of Vitamin D, probiotics, milk thistle, stress reduction, and others as data emerge.