A randomized trial of the efficacy of group therapy in changing viral load and CD4 counts in individuals living with HIV infection

Supportive-expressive and coping group teletherapies for HIV-infected older adults: a randomized clinical trial

This clinical trial tested whether telephone-administered supportive-expressive group therapy or coping effectiveness training reduce depressive symptoms in HIV-infected older adults. Participants from 24 states (N = 361) completed the Geriatric Depression Scale at pre-intervention, post-intervention, and 4- and 8-month follow-up and were randomized to one of three study arms: (1) 12 weekly sessions of telephone-administered, supportive-expressive group therapy (tele-SEGT; n = 122); (2) 12 weekly sessions of telephone-administered, coping effectiveness training (tele-CET; n = 118); or (3) a standard of care (SOC) control group (n = 121). Tele-SEGT participants reported fewer depressive symptoms than SOC controls at post-intervention (MSEGT = 11.9, MSOC = 14.3) and 4- (MSEGT = 12.5, MSOC = 14.4) and 8-month follow-up (MSEGT = 12.7, MSOC = 14.5) and fewer depressive symptoms than tele-CET participants at post-intervention (MSEGT = 12.4, MCET = 13.6) and 8-month follow-up (MSEGT = 12.7, MCET = 14.1). Tele-CET participants reported no statistically significant differences from SOC controls in GDS values at any assessment period. Tele-SEGT constitutes an efficacious treatment to reduce depressive symptoms in HIV-infected older adults.

Non-conventional practices and immune functioning among individuals receiving conventional care for HIV

OBJECTIVE

to examine the relationships among non-conventional practices, adherence and immune functioning in individuals with HIV.

METHODS

92 participants completed an interview on non-conventional practices (complementary and alternative medicines (CAM), psychosocial therapies, and religious practice). They also completed the Psychiatric Symptom Index and the AIDS Clinical Trials Group Adherence Follow-up Questionnaire. Medical chart reviews determined CD4 count and viral load.

RESULTS

Hierarchical logistic regressions revealed religious practice was associated with adherence and CAM was associated with viral load.

CONCLUSION

Participation in non-conventional practices in HIV populations may lead to positive health and health behaviors. Clinical implications are discussed.

Art groups for marginalized women with breast cancer

Professionally led support groups can significantly reduce distress, trauma symptoms, and pain for women with breast cancer. Despite the known benefits, women with breast cancer from marginalized groups tend not to participate in support groups. It is important to address barriers that prevent their participation and to identify types of support groups that appeal to as wide a range of women as possible. For this study, we interviewed women with breast cancer from marginalized groups in the San Francisco Bay Area (United States). We asked them about social, cultural, and psychological barriers that prevent participation in support groups, and about the potential of art groups to overcome these barriers. Our qualitative analysis of the interviews yielded findings that suggest a model for a type of support group that could make the benefits of support groups available to more women with breast cancer.

A needs assessment of clients with HIV in a home-based care program in Guyana

OBJECTIVE

To assess the needs of clients in a home-based care (HBC) program aimed at improving the quality of lives of people living with HIV in Region 4 of Guyana (Demerara-Mahaica region) following their involvement with the HBC program, volunteers, and nurse providers.

DESIGN AND SAMPLE

A cross-sectional analysis of a needs assessment conducted through a verbally administered questionnaire. We collected a cross-sectional sample of 84 HBC clients living with HIV from Region 4 in Guyana.

MEASURES

Respondents were administered a questionnaire that asked questions regarding the demographics; services received; quality of service delivery; and mental health and substance abuse.

RESULTS

The services most commonly received by respondents included nutritional assessment and counseling, HIV prevention education, emotional support, hygiene education, support for antiretroviral adherence, and support for HIV disclosure. Respondents reported further need of referrals to income-generation opportunities, food and nutritional supplement support, and support for children. Forty-two percent of the respondents screened positive for probable depression, and 37% of respondents screened positive for being at risk for a drinking problem.

CONCLUSIONS

While a substantial portion of needs were addressed by the HBC program, outstanding needs included linking people living with HIV to income-generation opportunities, food support, mental health, and services for children. We suggest that mental health and substance use services be factored into HIV programming and that referral systems be strengthened to ensure access to support services for people living with HIV.

Treatment considerations for psychiatric syndromes associated with HIV infection

Psychiatric syndromes associated with HIV disease were recognized early in the AIDS epidemic. Public education, new technologies and antiretroviral therapies have resulted in earlier recognition and therapautic interventions of HIV infection, improving the physical health for individuals living with HIV. While HIV-associated psychiatric symptoms have been recognized for more than 20 years, our understanding of the mechanisms underlying psychiatric symptoms among HIV-infected individuals and treatments for these symptoms have not kept pace with advances in HIV therapies. In this article, we discuss current knowledge of the psychiatric symptoms occurring with HIV disease, specifically mood, anxiety and psychotic disorders, evidence-based treatments and treatment considerations, new strategies for the treatments of psychiatric symptoms in HIV disease are also discussed.

Health-related quality of life in bereaved HIV-positive adults: relationships between HIV symptoms, grief, social support, and Axis II indication

OBJECTIVE

This study evaluated a model of the impact of borderline and antisocial personality disorder indications on HIV symptoms and health-related quality of life (HRQoL) in AIDS-bereaved adults, accounting for grief severity, social support, and years since HIV diagnosis.

DESIGN

Structural equation modeling was used to test the proposed model in a sample of 268 HIV-seropositive adults enrolled in an intervention for coping with AIDS-related bereavement.

MAIN OUTCOME MEASURES

Functional assessment of HIV infection, HIV symptoms.

RESULTS

The proposed model demonstrated excellent fit with study data and all hypothesized paths were supported. Personality disorder indication was directly related to HIV symptoms and HRQoL and indirectly related through both social support and grief severity. Social support was negatively related to HIV symptoms and positively related to HRQoL, while grief severity was positively related to HIV symptoms and negatively related to HRQoL. Finally, HIV symptoms had a direct negative relationship with HRQoL.

CONCLUSION

Personality disorders have a direct negative effect on HIV symptoms and HRQoL and indirect effects through grief severity and social support.

Factors associated with psychotherapy longevity among HIV-positive patients

Mental health concerns are salient to many HIV-positive individuals, yet, there are also numerous challenges with regard to access and retention in care. The present study sought to investigate factors that are associated with longevity in outpatient psychological care for HIV-positive patients. We aimed to better understand what factors (e.g., race, gender, age, history of mental health service utilization) are associated with the length of participation in psychotherapy in our clinic. This is an archival study consisting of chart review of our clinical documentation related to the psychological services provided in our clinic from January 2005 through December 2007. Eligible charts included all HIV-positive individuals seeking psychotherapy in the Department of Psychiatry and Health Behavior at the Medical College of Georgia (n = 87 records; 33.3% female; 52.9% ethnic minority, 57% sexual minority, middle-aged (42.0 years +/- 9.6 years). Results indicated that the presence of cohabitating social support distinguished between those who continued or terminated after the intake session, with social support being associated with continuation after intake. Furthermore, shorter distance from clinic, history of previous psychotherapy, concurrent pharmacotherapy, comorbid personality disorder diagnosis, and having an ethnic minority provider were associated with greater longevity in treatment. As a result of modest sample size relative to the number of predictor variables, analyses utilized multiple bivariate analyses and thus, results must be considered preliminary and should be replicated in a larger investigation. However, treatment providers may utilize these initial findings to improve retention in care and to improve the quality of mental health care provided to HIV-positive outpatients.

Spiritual Striving, Acceptance Coping, and Depressive Symptoms among Adults Living with HIV/AIDS

We prospectively examined the effects of spiritual striving, social support, and acceptance coping on changes in depressive symptoms among adults living with HIV/AIDS. Participants were 180 culturally diverse adults with HIV/AIDS. Participants completed measures of spiritual striving, social support, coping styles, and depressive symptoms at baseline, three-month follow-up, and six-month follow-up. A path model showed that spiritual striving had direct and indirect inverse effects on changes in depressive symptoms. The relationship between spiritual striving and depressive symptoms was partially mediated by acceptance coping, but not by social support. Results suggest that people living with HIV/AIDS who strive for spiritual growth in the context of their illness experience less negative affect.

Effects of time-limited dynamic psychotherapy on distress among HIV-seropositive men who have sex with men

The current study seeks to examine changes in distress associated with receiving time-limited dynamic psychotherapy (TLDP) among men who have sex with men (MSM) who are also living with HIV and AIDS. Participants included 79 HIV-seropositive MSM who were seeking psychotherapy at a community mental health clinic between January 2000 and June 2005. Participants' had a mean age of 42 and were predominantly European American (77%), although Latinos (13%), African Americans (5%), and Asian Americans (4%) were also included. Each participant completed a pretest on a self-report measure of subjective distress, the Outcome Questionnaire 45.2 (OQ-45.2), received 20 sessions of TLDP over the course of 20 weeks, and then completed a posttest on the OQ-45.2 to examine changes associated with TLDP. Participants' self-reported distress showed statistically significant decreases after 20 sessions of TLDP. Furthermore, the overall effects were strong, suggesting that decreases in distress were clinically meaningful as well as statistically significant. These results are particularly significant in light of the AIDS Health Project's (AHP's) policy of assigning higher functioning clients to TLDP therapists at intake, indicating that the participants in this study began treatment with lower pretest scores than mental health clients in the general population. These results suggest that HIV-seropositive MSM who receive TLDP may experience significantly decreased distress. Future research using a randomized study design is needed to compare such benefits to those of more standard psychological interventions for this population. Strengths and limitations of the study are discussed in detail.

Effects of cognitive behavioral stress management on HIV-1 RNA, CD4 cell counts and psychosocial parameters of HIV-infected persons

OBJECTIVE

To determine the effects of cognitive-behavioral stress management (CBSM) training on clinical and psychosocial markers in HIV-infected persons.

METHODS

A randomized controlled trial in four HIV outpatient clinics of 104 HIV-infected persons taking combination antiretroviral therapy (cART), measuring HIV-1 surrogate markers, adherence to therapy and well-being 12 months after 12 group sessions of 2 h CBSM training.

RESULTS

Intent-to-treat analyses showed no effects on HIV-1 surrogate markers in the CBSM group compared with the control group: HIV-1 RNA < 50 copies/ml in 81.1% [95% confidence interval (CI), 68.0-90.6] and 74.5% (95% CI, 60.4-85.7), respectively (P = 0.34), and mean CD4 cell change from baseline of 53.0 cells/microl (95% CI, 4.1-101.8) and 15.5 cells/microl (95% CI, -34.3 to 65.4), respectively (P = 0.29). Self-reported adherence to therapy did not differ between groups at baseline (P = 0.53) or at 12 month's post-intervention (P = 0.47). Significant benefits of CBSM over no intervention were observed in mean change of quality of life scores: physical health 2.9 (95% CI, 0.7-5.1) and -0.2 (95% CI, -2.1 to 1.8), respectively (P = 0.05); mental health 4.8 (95% CI, 1.8-7.3) and -0.5 (95% CI, -3.3 to 2.2) (P = 0.02); anxiety -2.1 (95% CI, -3.6 to -1.0) and 0.3 (95% CI, -0.7 to 1.4), respectively (P = 0.002); and depression -2.1 (95% CI, -3.2 to -0.9) and 0.02 (95% CI, -1.0 to 1.1), respectively (P = 0.001). Alleviation of depression and anxiety symptoms were most pronounced among participants with high psychological distress at baseline.

CONCLUSION

CBSM training of HIV-infected persons taking on cART does not improve clinical outcome but has lasting effects on quality of life and psychological well-being.