Chinese herbal medicine for carriers of the hepatitis B virus: an updated systematic review and meta-analysis.

More than a third of the world's population is infected with the hepatitis B virus (HBV) and 5% are thought to be HBV carriers, putting them at risk of developing serious liver diseases. The treatment of liver diseases with Chinese herbal medicines (CHM) dates back 2,500 years and the aim of this analysis was to evaluate the efficacy and safety of CHM for HBV carriers compared to Western medicine (WM) or placebo and to summarize the most commonly used herbs. Several databases, such as Pubmed, Embase and the Chinese database CNKI, were used to evaluate randomized, controlled trials (RCTs) focused on CHM treatment for HBV carriers up to 2013. We performed a systematic review and meta-analysis on the herbs and their effect on hepatitis B viral proteins (HBeAg, HBsAg) and HBV DNA. Subgroups were examined based on the study design and pooled risk ratios (RRs) were estimated with 95% confidence intervals (CIs). For the meta-analysis, we focused on 11 out of 52 RCTs (Jadad ≥ 2) and found that CHM was more effective than placebo for HBeAg seroconversion when combined with WM (RR 4.67, 95% CI 1.36-15.98; P = 0.01; P = 39%); Radix Astragali was the most commonly used herb. Those that received CHM were more prone to adverse events; however, they were mild and reversible. The risk of bias was assessed with regards to blinding, incomplete outcome data and publication bias. It should be noted that, due to the poor methodological quality of the studies and the small number of RCTs, the results cannot fully support the use of CHM in the treatment of HBV carriers. To conclude, CHM may be used to treat HBV carriers, but rigorously designed RCTs with long-term follow-ups are required to further evaluate the benefits and safety of CHM.