Inflammation drives
cardiovascular disease (CVD) in individuals with underlying chronic inflammatory diseases, including People with HIV (PWH), independently of
dyslipidemia. Adjunctive treatments that lower
inflammation may be useful to lower CVD risk in such populations. There is very little data on the efficacy of Chinese herbal medicine (CHM) in reducing
inflammation in PWH to address its potential in reducing this CVD risk factor, therefore we evaluated its impact on inflammatory
biomarkers relevant to CVD risk in the general population. Six English and Chinese databases were searched for studies investigating CHM's effects on inflammatory
biomarkers relevant to CVD from respective inceptions to February 2022. A systematic review and meta-analysis of randomized controlled trials (RCTs) were conducted and the most-frequently prescribed herbs were identified. Thirty-eight RCTs involving 4,047 participants were included. Greater than or equal to 50% of included studies had a low risk of bias in five domains (random sequence generation, detection, attrition, reporting and other bias) and 97% had a high risk of performance bias. CHM provided significant additive effects on attenuating relevant inflammatory indices including
hs-CRP (SMD -2.05, 95% CI -2.55 to -1.54),
IL-6 (SMD -1.14, 95% CI -1.63 to -0.66) and TNF-α levels (SMD -0.88, 95% CI -1.35 to -0.41), but no significant effects on
hs-CRP were found between CHM and placebo when co-treating with Western drugs (MD 0.04, 95% CI -1.66 to 1.74). No severe adverse events were reported in CHM groups. The two most prevalent herbs present in formulae demonstrating reduction of at least one inflammatory
biomarker were Dan shen (Salviae Miltiorrhizae Radix et Rhizoma) and
Huang qi (Astragali Radix). CHM, in combination with standard anti-inflammatory medications, may depress
inflammation and reduce the risk of inflammatory conditions such as CVD. Rigorously-conducted trials and adequate reporting are needed to provide more robust evidence supporting the use of CHM to reduce CVD risk in people with underlying chronic
inflammation such as PWH.