Meta-analysis of CAM therapies for HIV

HIV CAM 疗法的荟萃分析

• 批准号: 8451235
• 负责人: HENRY S SACKS
• 金额: $ 36.62万
• 依托单位: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-04-01 至 2015-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8451235
• 关键词: Adverse effects; Biological; Caring; Clinical; Clinical Research; Comorbidity; Complementary and alternative medicine; Complex; Cost Effectiveness Analysis; Data; Decision Analysis; Decision Making; Development; Economics; Evaluation; Goals; HIV; HIV Infections; HIV therapy; Health Policy; Internet; Judgment; Knowledge; Literature; Markov Chains; Medical; Medicine; Meta-Analysis; Methodology; Methods; Milk Thistle; Modality; Modeling; Monte Carlo Method; Observational Study; Opportunistic Infections; Patients; Probiotics; Provider; PubMed; Randomized Controlled Trials; Regimen; Reporting; Research; Research Design; Source; Stress; Techniques; Time; United States National Library of Medicine; Vitamin D; analytical method; base; conventional therapy; cost; design; improved; indexing; public health relevance; simulation; symptom management; systematic review

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.

描述（由申请人提供）：艾滋病毒感染的常规疗法取得了长足的进步，但它们仍然很复杂，昂贵且具有许多副作用。艾滋病毒感染患者正在使用许多补充和替代药物（CAM）疗法，但是实际上哪些（如果有）仍然不清楚，以及他们的使用是否具有经济意义的清晰度更不明显。确定适当治疗方法的最佳方法是随机对照试验（RCT）。但是，由于许多原因，在时间护理提供者需要做出决定的情况下可能无法获得确定的结果。如PubMed国家医学图书馆所索引的有关HIV的CAM疗法的医学文献呈指数增长，但是与其他类型的研究相比，RCT的数量虽然迅速增长，但仍相对较小。此外，在互联网和其他地方，还有大量且迅速增长的非标准和较少严格的信息来源，这可能会提供有用的信息，但难以访问，甚至更难评估。有许多技术在内，包括荟萃分析（通常称为系统评价），决策分析和成本效益分析，它们使用已经可用的信息，或可以估计的，试图为那些必须做出健康政策和治疗决策的人提供临时答案。最近，贝叶斯统计技术的发展和越来越多的使用是由于计算能力的增加以及基于模拟的方法（例如马尔可夫链蒙特卡洛（MCMC）方法）的发展所促进的。贝叶斯方法的主要优点是，它允许在单个相干模型中综合所有可用的证据来源（即RCT，观察性研究，专家判断）。这项研究的目的是使用这些技术在第一个报告HIV新的CAM治疗方式到临床医生可以做出以下四个决定之一的时间之后缩短滞后期：1。绝不应该或很少使用。 2。仅应在某些明显可识别的情况或患者中使用。 3。可以例行使用。 4。无法做出以上三个的选择，并指出了进一步的临床研究。 我们将主要集中于阐明使用CAM疗法作为辅助方法，这些辅助方法可能会延迟起点或与更昂贵的疗法（例如抗逆转录病毒术）进行症状管理，并用于治疗机会性感染和合并症，例如，与HIV相关，例如使用Vivamin d，Pivimin d，fivimin d，fivimin d，plivamin d，serge，serge shorge shorge as a intul as ars a ail aq aircal and are a emerer，以及其他。