title: Randomized clinical trial of cognitive behavioral stress management on human immunodeficiency virus viral load in gay men treated with highly active antiretroviral therapy.
abstract: OBJECTIVE
  Human Immunodeficiency Virus (HIV)-positive individuals treated with highly active antiretroviral therapy (HAART) may experience psychological burdens and negative mood states, which could impair their ability to derive maximum benefits from their medical treatment. We tested whether a cognitive behavioral stress management (CBSM) intervention in combination with antiretroviral medication adherence training (MAT) from a clinical pharmacist influences HIV viral load more than MAT alone.
  
  
  METHODS
  HIV-positive men who have sex with men were randomized to either a 10-week CBSM + MAT intervention (n = 76) or a MAT-Only condition (n = 54). Data were collected at baseline immediately following the 10-week intervention period, at 9 months postrandomization, and at 15 months postrandomization.
  
  
  RESULTS
  We found no differences in HIV viral load among the 130 men randomized. However, in the 101 men with detectable viral load at baseline, those randomized to CBSM + MAT (n = 61) displayed reductions of 0.56 log10 units in HIV viral load over a 15-month period after controlling for medication adherence. Men in the MAT-Only condition (n = 40) showed no change. Decreases in depressed mood during the intervention period explained the effect of CBSM + MAT on HIV viral load reduction over the 15 months.
  
  
  CONCLUSIONS
  A time-limited CBSM + MAT intervention that modulates depressed mood may enhance the effects of HAART on suppression of HIV viral load in HIV+ men with detectable plasma levels.
authors.affiliation: Department of Psychology, University of Miami, Coral Gables, FL, USA. Mantoni@miami.edu
authors.forename: Michael H
authors.initials: MH
authors.lastname: Antoni
authors.forename: Adam W
authors.initials: AW
authors.lastname: Carrico
authors.forename: Ron E
authors.initials: RE
authors.lastname: Durán
authors.forename: Susan
authors.initials: S
authors.lastname: Spitzer
authors.forename: Frank
authors.initials: F
authors.lastname: Penedo
authors.forename: Gail
authors.initials: G
authors.lastname: Ironson
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Fletcher
authors.forename: Nancy
authors.initials: N
authors.lastname: Klimas
authors.forename: Neil
authors.initials: N
authors.lastname: Schneiderman
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D015928:Cognitive Behavioral Therapy; D003863:Depression / Q000150:complications / Q000628:therapy; D006678:HIV / Q000302:isolation & purification; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000523:psychology / Q000628:therapy*; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D013315:Stress, Psychological / Q000150:complications / Q000628:therapy; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents