Meta-analysis of CAM therapies for HIV

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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. PUBLIC HEALTH RELEVANCE: Many Complementary and Alternative Medicine (CAM) therapies are being used by patients with HIV infection, but which of them (if any) produce more benefit than harm is still unclear, and whether their use makes economic sense is even less clear. This proposal will use modern mathematical techniques to summarize the evidence about the usefulness of a variety of CAM therapies for problems common in people with HIV.