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.


CONCLUSIONS
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.
Berger
Simona
S
Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Zurich, Switzerland.
Schad
Tanja
T
von Wyl
Viktor
V
Ehlert
Ulrike
U
Zellweger
Claudine
C
Furrer
Hansjakob
H
Regli
Daniel
D
Vernazza
Pietro
P
Ledergerber
Bruno
B
Battegay
Manuel
M
Weber
Rainer
R
Gaab
Jens
J
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D001521:Behavior Therapy; D018791:CD4 Lymphocyte Count; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D005260:Female; D015658:HIV Infections / Q000523:psychology* / Q000628:therapy* / Q000821:virology; D015497:HIV-1 / Q000235:genetics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011594:Psychometrics; D012367:RNA, Viral / Q000097:blood; D013315:Stress, Psychological
D019380:Anti-HIV Agents; D012367:RNA, Viral