Tertiary prevention interventions for patients with stroke in African countries: a systematic review

Repetitive transcranial magnetic stimulation (rTMS) is a promising adjunct in stroke rehabilitation, with increasing focus on the supplementary motor area (SMA) for its role in motor and language network reorganization. This systematic review evaluated randomized controlled trials (RCTs) assessing rTMS targeting the SMA or modulating its connectivity to improve motor and language outcomes in adults after ischemic or hemorrhagic stroke. A comprehensive literature search was performed across PubMed, Web of Science, and Google Scholar, focusing on peer-reviewed RCTs published in English. Studies were eligible if they involved adults with stroke at any recovery stage and assessed rTMS targeting or analyzing the SMA. Two independent reviewers screened records, extracted data, and assessed risk of bias using the Cochrane Risk of Bias 2.0 tool. The review adhered to PRISMA guidelines and was registered in PROSPERO (CRD420251051684). Among 74 screened for full text, five RCTs were included. Across studies, rTMS interventions targeting the SMA or modulating SMA-related networks improved motor and language outcomes in stroke patients. Neuroimaging measures consistently demonstrated increased SMA activation and strengthened SMA-primary motor cortex (M1) connectivity after rTMS, which correlated with clinical improvements. Balance and postural control outcomes showed the most consistent benefits, while upper-limb motor and language improvements varied in magnitude and follow-up duration. Heterogeneity in studies, small sample sizes, and concerns about randomization and reporting limit our ability to draw definitive conclusions. SMA-targeted or network-level rTMS appears to facilitate functional recovery after stroke, supported by neuroimaging evidence of brain network reorganization. Further large, standardized RCTs are necessary to establish optimal protocols, confirm efficacy, and assess long-term outcomes.

Objectives To evaluate the effectiveness of robot-assisted gait training using virtual reality(VR) on balance and gait ability in persons with stroke. Design A systematic review and meta-analysis of randomised controlled trials. Methods Two reviewers independently screened studies, extracted data, and assessed risk of bias using the Cochrane Risk of Bias 2.0 tool. Random-effects meta-analyses were conducted using mean differences (MD) or standardised mean differences (SMD) with 95% confidence intervals (CI). Data sources were Pubmed, Embase, Cochrane Library and Web of Science searched between February 2013 and February 2025. The study eligibility criteria included randomised controlled trials (RCTs) involving stroke survivors. The intervention was robot-assisted gait training (RAGT) combined with VR. The control group included conventional physical therapy or RAGT without VR. Outcome measures included balance (BBS, TUG) and gait ability (10MWT). Results Eight randomised controlled trials involving 233 participants were included. Robot-assisted gait training using virtual reality significantly improved balance as measured by the Berg Balance Scale (MD = 4.05, 95% CI 1.72–6.37) and Timed Up and Go test (MD = −3.71, 95% CI −5.91 to −1.51), and gait ability assessed by the 10-Meter Walking Test (SMD = −1.86, 95% CI −2.53 to −1.20). Heterogeneity was moderate to high across outcomes. Conclusions This study confirmed that robot-assisted gait training using virtual reality is an effective intervention for improving balance and gait in stroke rehabilitation. However, findings should be interpreted with caution due to heterogeneity and the limited number of included studies. PROSPERO registration CRD420251138038

ObjectiveThe aim of this study was to evaluate the completeness of reporting of exercise adherence and exercise interventions delivered as part of clinical trials of post-operative total knee replacement (TKA) rehabilitation.Design: Scoping reviewLiterature searchA literature search was conducted in PubMed, EMBASE, AMED, CINAHL, SPORTDiscus and Cochrane Library.Study selection criteriaAll randomized controlled trials (RCT) that examined post-operative exercise-based interventions for total knee arthroplasty were eligible for inclusion. Studies that were multifactorial or contained exercise interventions for both hip and knee arthroplasty were also included.Data synthesisThe definition, type of measurement used and outcome for exercise adherence were collected and analyzed descreptively. Quality of reporting of exercise interventions were assessed using the Consensus for Exercise Reporting Tool (CERT) and the Cochrane Risk of Bias Tool.ResultsThere were a total of 112 RCTs included in this review. The majority of RCTs (63%, n = 71) did not report exercise adherence. Only 23% (n = 15) of studies provided a definition of adherence. RCTs were of poor quality, with 85% (n = 95) of studies having high or unclear risk of bias. Reporting of exercise interventions was poor, with only 4 items (of 19) (21%) of the CERT adequately reported (88–99%), with other items not fulfilled on at least 60% of the RCTs. There were no RCTs that had fulfilled all the criteria for the CERT.ConclusionThe RCTs included in this study poorly reported exercise adherence, as well as description of the post-operative TKA rehabilitation intervention. Future RCTs should use valid and reliable measures of adherence and a proper tool for reporting of exercise interventions (e.g., CERT, TiDER).Pre-registrationOSF:https://osf.io/9ku8a/

e16616 Background: Within the field of medicine, artificial intelligence (AI) is used to optimize diagnostic capacity, treatment planning, and prognostic evaluation. Research on AI has advanced significantly, but a comprehensive evaluation of the utility of AI in genitourinary (GU) oncology remains underexplored. We sought to conduct a bibliometric study of existing literature and a systematic review of randomized controlled trials (RCTs) to describe the state of the science regarding the use and applications of AI in GU oncology. Methods: We searched MEDLINE (Ovid), Embase (Ovid), and CINAHL Ultimate databases using search terms relevant to the concepts of GU oncology and AI. We excluded non-English papers, non-human studies, review articles, and articles using AI in manuscript writing. Our bibliometric study described articles from 2013-2023 using the term AI, and we categorized manuscripts by study type and cancer type. We also conducted a systematic review of RCTs assessing the use of AI in GU oncology. We used Covidence for screening and data extraction. Two authors independently reviewed all papers and Cochrane Risk of Bias (RoB) Tool 2.0 was used to assess for bias in the RCT studies. Results: The initial search identified 2,409 articles. After abstract review, 1,220 articles remained: 962 retrospective articles, 175 prospective studies, 79 with combined retrospective/prospective methods, and 4 RCTs. We also categorized studies by cancer type: 923 prostate, 274 renal, 194 urothelial, 8 testicular, and 2 penile cancers. AI-related articles grew exponentially from 14 in 2013 to 362 in 2023, with substantial growth starting in 2019 (92 that year). For our systematic review, we identified 4 RCTs: 1 in bladder cancer (BCa) and 3 in prostate cancer (PCa). Among the 4 RCTs, 2 focused on AI-based diagnostics, and the other 2 analyzed AI’s role in prognosis prediction and treatment planning. Of the diagnostic studies, 1 demonstrated that a neural network analyzing urinary biomarkers outperformed traditional methods in BCa diagnosis. The other demonstrated AI-enhanced imaging’s superior efficiency in detecting PCa. The third article demonstrated AI’s prognostic value in automated bone scan index for evaluating bone metastasis in PCa. The fourth study showed improved operational efficacy of AI-generated treatment plans compared to conventional brachytherapy planning in PCa. The 4 RCTs had varying levels of risk of bias, primarily due to the randomization process and deviations from intended interventions. Conclusions: Our bibliometric analysis of AI in GU oncology demonstrates the growing recognition of AI’s potential to enhance cancer care. Our systematic review identified four RCTs that highlight the diverse applications of AI and showcase AI’s ability in diagnostics and treatment planning. Collectively, this work provides information about the promise of AI in oncology while improving clinical outcomes.

BackgroundNon-alcoholic fatty liver disease (NAFLD) is a common liver disease that may progress into, in the absence of proper treatment, severe liver damage. While the optimal pharmacotherapy for NAFLD remains uncertain and the adherence to lifestyle interventions is challenging, the use of herbal medicines such as traditional Chinese medicines (TCMs) to manage the condition is common. The evidence about TCMs in the management of NAFLD is continuously developing through randomized controlled trials (RCTs). This study aims to identify and evaluate the emerging evidence about the efficacy and safety of TCMs for NAFLD.MethodsA systematic literature search was conducted to identify RCTs which investigated TCMs in the management of NAFLD published in 6 electronic databases including PubMed, the Cochrane Library, EMBASE, Web of Science, Scopus and China National Knowledge Infrastructure since inception to September 2020. RCTs comparing TCMs with no treatment, placebo, non-pharmacological and/or pharmacological interventions were included irrespective of language or blinding. The quality of reporting was evaluated using the Consolidated Standards of Reporting Trials Statement extensions for Chinese herbal medicine Formulas (CONSORT-CHM). Risk-of-bias for each study was assessed using the Cochrane risk of bias tool.ResultsA total of 53 RCTs involving 5997 participants with NAFLD were included in this review. Each included RCT tested a different TCMs giving a total of 53 TCMs identified in this study. Based on the evaluation of the RCT results, TCMs might have various beneficial effects such as improving TCM syndrome score, liver function, and body lipid profile. A range of non-serious, reversible adverse effects associated with the use of TCMs were also reported. However, no conclusion about the efficacy and safety of TCMs in NAFLD can be made. The quality of reporting was generally poor and the risks of bias was mostly uncertain in all trials.ConclusionsThere is some evidence from RCTs that supported the effectiveness and safety of TCMs for NAFLD. However, no conclusive recommendations can be made due to the questionable quality of the RCTs. Improvement in the RCT protocol, the use of a larger sample size, a setting of multicenter, and a more focused approach in selecting TCMs are recommended for developing high quality evidence about the use of TCMs in managing NAFLD.

Bias in the measurement of the outcome is associated with effect sizes in randomized clinical trials on exercise therapy for chronic low back pain: a meta-epidemiological study

Although several randomized controlled trials (RCTs) have examined the efficacy of rotavirus vaccines, few have comprehensively assessed their reporting quality and risk of bias. This study aimed to evaluate the reporting quality and methodological rigor of RCTs on rotavirus vaccines using the CONsolidated Standards Of Reporting Trials (CONSORT) 2010 checklist and the Cochrane Risk of Bias 2.0 (RoB 2.0) tool. We systematically searched PubMed and Cochrane Central for phase 3 randomized controlled trials of rotavirus vaccines administered as monotherapy. Reporting quality was assessed using the CONSORT 2010 checklist and risk of bias was evaluated with the Cochrane RoB 2.0 tool across five domains to determine overall methodological rigor. A total of 29 phase 3 RCTs were included after screening 1,066 records. Most trials were conducted in Asia and funded by industry. Adherence to the CONSORT 2010 checklist was high for trial design and outcome reporting but poor for protocol availability, allocation concealment, and blinding procedures. Overall, 62% of studies had a low risk of bias, while 34% were rated high. Trials published after 2010 and those with low risk of bias showed significantly higher reporting quality. Adherence to the CONSORT 2025 guidelines is essential for future rotavirus vaccine trials, enhancing the quality of individual studies while reinforcing the broader evidence base that informs immunization strategies and public health policies.

BackgroundThe efficacy of meditation-based therapies for attention deficit/hyperactivity disorder (ADHD) across the lifespan remains uncertain.ObjectiveTo conduct a systematic review and meta-analysis of randomised controlled trials (RCTs) assessing the efficacy of...

Introduction People living with dementia (PLWD) take five more medications on average than those without dementia. This can increase the risk of medication-related harm, defined as any negative outcome, harm or injury caused by taking a medication. The aim of this systematic review was to identify studies that reported the prevalence of medication-related harm in PLWD and to assess its impact by evaluating various outcomes. Methods Twelve databases were searched from date of inception to April 2023. Papers published in English, reporting on the prevalence and/or adverse outcomes of medication-related harm in PLWD using any study design were eligible for inclusion. Methodological quality was assessed using the Cochrane Risk of Bias 2 tool for randomised controlled trials (RCTs) or the Risk of Bias in Non-randomised Studies of Exposures for non-randomised studies. A meta-analysis was conducted to determine combined hazard ratios (HRs) and 95% confidence intervals (CIs) on studies with similar harm-related outcomes using Review Manager software. Results Ninety-seven studies were included in the review; 93 were non-randomised studies and four were RCTs. Quality assessments found all four RCTs and the majority of non-randomised studies (n = 58) to be at a low risk of bias. Adverse health outcomes, including hospitalisations and mortality, were most frequently reported (n = 45 studies), with psychoactive medications (such as antipsychotic medications) being the most implicated class of medicines (n = 54 studies). Analysis showed that the use of antipsychotics was associated with a significantly increased mortality risk in six studies (n = 25,715 participants; HR = 1.42; 95% CI 1.10–1.84; p = 0.008). Conclusion This systematic review is the first to report the impact of medication-related harm among PLWD, with evidence to suggest that antipsychotic medication use is associated with mortality. However, the included studies had high heterogeneity, which made it difficult to draw comparisons between studies.

Background:An overview of systematic reviews (SRs) and a network meta-analysis (NMA) were conducted to evaluate the comparative effectiveness of acupuncture and related therapies used either alone, or as an add-on to other irritable bowel syndrome (IBS) treatments.Methods:A total of eight international and Chinese databases were searched for SRs of randomized controlled trials (RCTs). The methodological quality of SRs was appraised using the AMSTAR instrument. From the included SRs, data from RCTs were extracted for the random-effect pairwise meta-analyses. An NMA was used to evaluate the comparative effectiveness of different treatment options. The risk of bias among included RCTs was assessed using the Cochrane risk of bias tool.Results:From 15 SRs of mediocre quality, 27 eligible RCTs (n = 2141) were included but none performed proper blinding. Results from pairwise meta-analysis showed that both needle acupuncture and electroacupuncture were superior in improving global IBS symptoms when compared with pinaverium bromide. NMA results showed needle acupuncture plus Geshanxiaoyao formula had the highest probability of being the best option for improving global IBS symptoms among 14 included treatment options, but a slight inconsistency exists.Conclusion:The risk of bias and NMA inconsistency among included trials limited the trustworthiness of the conclusion. Patients who did not respond well to first-line conventional therapies or antidepressants may consider acupuncture as an alternative. Future trials should investigate the potential of (1) acupuncture as an add-on to antidepressants and (2) the combined effect of Chinese herbs and acupuncture, which is the norm of routine Chinese medicine practice.

IntroductionCurrent evidence synthesis of prehabilitation studies in colorectal surgery is based on results of randomized controlled trials (RCT). Although RCTs are the gold standard for effectiveness research, observational studies probably better reflect real-life practice. The aims of the current study were to compare observational studies to RCTs regarding the association between prehabilitation and postoperative outcomes, and characteristics of included patients and interventions. MethodsA systematic search was conducted in PubMed, Embase, and CINAHL (until September 2023). Observational studies and RCTs investigating prehabilitation before colorectal surgery and reporting postoperative complications and/or length of stay (LoS) were included. Two reviewers independently assessed the risk of bias using the Cochrane Risk of Bias 2 tool for RCTs and the Cochrane ROBINS-I tool for observational studies. Meta(regression)-analyses were performed for postoperative complications and LoS. ResultsPooled results showed a statistically significant reduction in postoperative complications (OR 0.54; 95 % confidence interval (CI) 0.40 to 0.72) and LoS (mean difference (MD) −1.34 CI -2.57 to −0.12) after prehabilitation in observational studies but not in RCTs (complications OR 0.95; CI 0.53 to 1.72; LoS MD 0.16 CI -0.52 to 0.83). Patients included in observational studies were older and more often had an ASA score ≥3. In a meta-regression analysis, these characteristics were not statistically significantly associated with the main outcomes. ConclusionObservational studies in a real-life setting showed that prehabilitation can reduce postoperative complications and LoS. To further explore the real-life effectiveness of prehabilitation, specific observational study designs, like a target emulation trial could be used.

PurposeAlongside being contraceptives, progestins have been investigated as potential anti-inflammatory and analgesic therapies for use in painful gynaecological conditions. This review aims to synthesise evidence pertaining to the efficacy of progestins as analgesics for use in endometriosis, fibroids and pre-menstrual syndrome (PMS).MethodsWe conducted a systematic review of the extant literature investigating the analgesic efficacy of progestins compared to any comparator interventions for individuals with the three specified gynaecological conditions. The search was carried out across the PubMed and CENTRAL databases on 7 April 2024 for randomised control trials (RCTs) published in the peer-reviewed literature from 2000 onwards. Data pertaining to analgesic efficacy, assessed by changes in pain indices/scores before and after treatment, were synthesised narratively. Data pertaining to adverse effect frequency and changes in bone mineral density (BMD) were also synthesised narratively. Risk of bias was assessed using the Cochrane risk of bias 2 tool.ResultsThe primary search identified 1220 potentially eligible RCTs of which 21 were ultimately included; 19 RCTs related to endometriosis, two related to fibroids and zero related to PMS. Quality assessment identified nine studies to be at a low risk of bias, nine studies with some concerns surrounding bias and three studies to be at a high risk of bias. The included studies represented a total of 2745 participants of whom 1317 were treated with a progestin and 1428 received a comparator intervention. In 18 of the 19 studies concerning endometriosis, progestins produced a statistically significant reduction in pain, further, in five instances progestins were more efficacious in reducing pain than comparator interventions. In both studies on fibroids, progestins produced significant reductions in pain, however, statistically significant differences compared to comparator interventions were not demonstrated. The most frequently cited adverse effect of progestins was spotting/irregular bleeding whilst those receiving comparator interventions most often reported hot flushes; cited in 12 and seven studies respectively. Five studies assessed the impact of progestins and comparators on BMD. Three studies found progestins significantly reduced BMD, however, in these instances reductions were significantly lower than those produced by comparator interventions and in two studies were not statistically significant after 12 months of follow-up.ConclusionOur review demonstrates the potential scope for the use of progestins as analgesics in the management of pain associated with endometriosis. Further research will need to be conducted to identify their efficacy in the management of pain associated with fibroids and PMS.

Objective Heart failure is a major public health problem worldwide nowadays. However, the morbidity, mortality, and awareness of heart failure are not satisfied as well as the status of current treatments. According to the standard treatment for chronic heart failure (CHFST), Fuzi (the seminal root of Aconitum carmichaelii Debx.) formulae are widely used as a complementary treatment for heart failure in clinical practice for a long time. We are aiming to assess the efficacy and safety of Fuzi formulae (FZF) on the treatment of heart failure according to high-quality randomized controlled trials (RCTs). Methods RCTs in PubMed, Cochrane Library, China National Knowledge Infrastructure (CNKI), Chinese Scientific Journals Database (VIP), and Wanfang Database were searched from their inception until June 2019. In addition, the U.S. National Library of Medicine (clinicaltrials.gov) and the Chinese Clinical Trial Registry (http://www.chictr.org.cn) were also searched. We included RCTs that test the efficacy and safety of FZF for the treatment of heart failure, compared with placebo, CHFST, or placebo plus CHFST. The methodological quality of included studies were evaluated by the Cochrane Collaboration's tool for assessing risk of bias. RCTs with Cochrane risk of bias (RoB) score ≥4 were included in the analysis. The meta-analysis was conducted through RevMan 5.2 software. The GRADE approach was used to assess the quality of the evidence. Results Twelve RCTs with 1490 participants were identified. The studies investigated the efficacy and safety of FZF, such as FZF plus the CHFST vs placebo plus CHFST (n = 4), FZF plus CHFST vs CHFST (n = 6), FZF plus digoxin tablets (DT) plus CHFST vs placebo plus DT plus CHFST (n = 1), and FZF plus placebo plus CHFST vs placebo plus DT plus CHFST (n = 1). Meta-analysis indicated that FZF have additional benefits based on the CHFST in reducing plasma NT-proBNP level, MLHFQ scores, Lee's heart failure scores (LHFs), and composite cardiac events (CCEs). Meanwhile, it also improved the efficacy on TCM symptoms (TCMs), NYHA functional classification (NYHAfc), 6MWD, and LVEF. Adverse events were reported in 6 out of 12 studies without significant statistical difference. However, after assessing the strength of evidence, it was found that only the quality of evidence for CCEs was high, and the others were either moderate or low or very low. So we could not draw confirmative conclusions on its additional benefits except CCEs. Further clinical trials should be well designed to avoid the issues that were identified in this study. Conclusion The efficacy and additional benefits of FZF for CCEs were certain according to the high-quality evidence assessed through GRADE. However, the efficacy and additional benefits for the other outcomes were uncertain judging from current studies. In addition, the safety assessment has a great room for improvement. Thus, further research studies are needed to find more convincing proofs.

Complex regional pain syndrome (CRPS) is a debilitating chronic pain condition that may develop after fractures, surgery, or soft tissue trauma. It is characterized by pain disproportionate to the initial injury, often accompanied by sensory, motor, autonomic, and trophic changes. Despite extensive research, pathophysiology remains unclear, and treatment approaches are varied, with inconsistent supporting evidence. Given its complexity and the potential for chronic disability, identifying effective therapies remains a clinical priority.This review systematically evaluated the analgesic efficacy of pharmacological and non-pharmacological therapies for CRPS, based on randomized controlled trials (RCTs) published between 2003 and 2025. The protocol was developed previously and registered in PROSPERO (CRD420251026503).A structured literature search using a PICO (Population, Intervention, Comparator, Outcome) framework was conducted across MEDLINE, PubMed, and the Cochrane Library. Search terms included “Complex Regional Pain Syndrome,” its earlier term “Reflex Sympathetic Dystrophy,” and intervention-specific keywords. Included were English-language RCTs in adults with clinically diagnosed CRPS (type I or II), assessing pain reduction as the primary outcome and function, quality of life, and pain medication use as secondary outcomes. Two reviewers independently screened and extracted studies. Risk of bias was assessed using the Cochrane Risk of Bias (ROB) 2. Publication bias was evaluated using funnel plots of standard errors and effect sizes.In total, 45 RCTs met the inclusion criteria and included 2,125 patients. Among pharmacological interventions, bisphosphonates showed consistent and significant pain reduction over six months. Intravenous ketamine demonstrated strong short-term analgesia, though findings were limited by small samples, variable protocols, and lack of long-term data. Combinations of local anesthetics and other medications (e.g., lidocaine with citalopram or parecoxib) were especially effective in acute CRPS. Steroid treatments (oral or regional) offered short-term pain relief and functional improvement, particularly in early or post-stroke CRPS.Non-pharmacological therapies also showed promise in reducing CRPS pain. Mirror therapy (MT) and graded motor imagery (GMI) consistently improved pain and motor function, especially when applied early. Pain exposure physical therapy (PEPT) improved range of motion but had a limited impact on overall functional outcomes. Neuromodulation methods, including spinal cord stimulation (SCS), dorsal root ganglion (DRG) stimulation, and transcutaneous electrical nerve stimulation (TENS), provided durable pain relief in select patients but were technically complex and associated with complications, particularly with SCS.In conclusion, CRPS remains a complex and difficult-to-treat condition, with substantial variability in treatment response. RCT evidence supports the use of bisphosphonates, ketamine, and early use of mirror or motor imagery therapies. Neuromodulation via electrical stimulation may benefit select cases but carries procedural risks. Physiotherapeutic strategies offer low-cost, low-risk benefits, especially when started early or combined with pharmacotherapy. However, many studies were limited by small size, short follow-up, or methodological flaws. There is an urgent need for large, high-quality, and mechanistically informed RCTs to guide long-term CRPS management.

Micronutrient deficiencies are common and frequently co-occurring among people living with HIV (PLHIV) globally, with consequences for their health and clinical outcomes. Previous reviews of the influence of micronutrient supplementation on HIV outcomes were conducted in the pre-highly active antiretroviral therapy (pre-HAART) era or included both HAART-naive and HAART-experienced individuals; thus, the evidence in the context of HAART is inconclusive. A systematic review and meta-analysis was conducted to evaluate the effect of micronutrient supplementation on important clinical outcomes among PLHIV on HAART. Original research articles published up to August 2022 in the following medical literature databases were identified and examined: PubMed/Medline, Embase, Web of Science, and Google Scholar. Randomized controlled trials (RCTs) and pre-post intervention studies that evaluated the relationship of micronutrient supplementation and HIV-related outcomes were included. A total of 32 studies investigating the effect of micronutrient supplementation on HIV outcomes in PLHIV on HAART were included. The main outcomes of interest were disease progression, CD4 lymphocyte count, viral load, weight, body mass index (BMI), hemoglobin, and anemia. The Cochrane Risk of Bias (RoB) 2 and ROBINS-I tools were used to assess the risk of bias in included studies, and GRADE was used to assess the certainty of the evidence. Vitamin D supplementation increased serum 25-hydroxyvitamin D concentration by 23.2 nmol/L (95% CI: 11.8 to 34.6; 6 RCTs, 567 participants; low-certainty evidence), but had little to no effect on CD4 lymphocyte counts (mean difference [MD]: 60 cells/µL; 95% CI: -35 to 155; 4 RCTs, 127 participants; low-certainty evidence). The effect of vitamin D on CD4 lymphocyte counts was greater among those with baseline CD4 count <350 cells/µL compared with counterparts with higher CD4 lymphocyte counts. Evidence from single RCTs suggests a beneficial effect of vitamin D on the incidence of sputum-smear-positive tuberculosis (hazard ratio = 0.54; 95% CI: 0.31, 0.92; 4000 participants; low-certainty evidence), and vitamin E (MD = 0.2 g/dL; 95% CI: 0.1, 0.3; 18 participants; moderate-certainty evidence) and selenium (MD = 0.30 g/dL; 95% CI: 0.29, 0.31; 97 participants; high-certainty evidence) on hemoglobin, and selenium on BMI (MD: -0.5; 95% CI: -0.51, -0.49; high-certainty evidence). Zinc supplementation had little to no effect on CD4 lymphocyte count overall, but for every 10-µg/dL higher serum zinc concentration, the predicted change in CD4 lymphocyte count from meta-regression was lower by 28 cells/µL (95% CI: -54, -3; 5 RCTs). Moderate- or high-certainty evidence indicates that there is probably no effect of zinc supplementation on log10 viral load, vitamin D on BMI and lumbar spine bone mineral density, and multiple micronutrient (MMN) supplementation on hemoglobin. The evidence is very uncertain about the effect of zinc supplementation on hemoglobin concentration and BMI, vitamin D supplementation on lumbar spine bone mineral density, vitamin E on CD4 lymphocyte count, and MMN supplementation on CD4 lymphocyte count. Zinc and vitamin D supplementation may promote immune recovery in a substantial proportion of PLHIV on HAART, and selenium and vitamin E supplementation may prevent anemia.