Kenneth D. Phillips

Counteracting muscle wasting in HIV-infected individuals

HIV‐infected persons often experience a loss of lean tissue mass, which includes decreases in skeletal muscle mass. This HIV‐associated wasting is significant because it has been associated with accelerated disease progression and increased morbidity. Signalling related to several circulating molecules, including tumour necrosis factor (TNF)‐α, growth hormone, insulin‐like growth factor (IGF)‐1 and testosterone, has been associated with the aetiology of muscle wasting. Additionally, nutritional status related to malnutrition and specific dietary deficiencies may be involved. In an attempt to counter muscle wasting in HIV‐infected persons, treatments have been suggested that target these mechanisms. Nutritional supplementation, cytokine reduction, hormone therapy and resistance exercise training are potential treatments for this condition. Resistance exercise training, which is more easily accessible to this population than other treatments, holds promise in counteracting the process of HIV wasting, as it has been successfully used to increase lean tissue mass in healthy and clinical populations. This review will explore the HIV/AIDS muscle‐wasting syndrome, its aetiology, and the treatments used to counteract wasting.

Sleep Disturbance and Depression as Barriers to Adherence

This study examined the relationships among subjective sleep disturbance, depressive symptoms, and adherence to medications among HIV-infected women. HIV-infected women ( N = 173) were recruited through community AIDS service organizations throughout South Carolina. Participants completed the Pittsburgh Sleep Quality Index (PSQI), the Centers for Epidemiological Studies Depression Scale (CES-D), and a modified version of the Adults AIDS Clinical Trials Group Adherence Baseline Questionnaire. Women who reported greater sleep disturbance also reported a higher level of depressive symptoms and reported poor adherence to their medication regimen. Depression helped to explain the relationship between sleep quality and adherence. Results indicate that assessment and management of sleep disturbance and depressive symptoms in women with HIV disease is important to promote medication adherence.

Creativity in older adults : a plethora of possibilities

Aging continues to be an important topic of study. For many older adults, the elder years can be a challenging, if not difficult, time. Creativity interventions have been shown to positively affect mental and physiological health indicators. The process of creating and ones attitude toward life may be more important than the actual product or tangible outcome. While many activities are those typically thought of as creative, such as painting, there are also a number of useful interventions that are not traditionally identified as creative ones, but that are, in fact, creative activities. This paper describes recent work with creativity in older adults, including research and clinical projects, and earlier works that could be refined as creative interventions. Recommendations for further investigation of creativity also are presented.

Physiological and Psychological Correlates of Fatigue in HIV Disease

Fatigue is a frequent symptom reported by persons living with HIV disease and one that affects all aspects of quality of life. To improve quality of care of persons with HIV disease, it is important to address all factors that contribute to fatigue. The purpose of this study was to determine the associations of physiological, psychological, and sociological factors with fatigue in an HIV-infected population. With Piper’s integrated fatigue model guiding selection, factors examined in this study were hemoglobin, hematocrit, CD4+ cell count, HIV-RNA viral load, total sleep time, sleep quality, daytime sleepiness, HIV-related symptoms, anxiety, depression, and perceived stress. The sample (N = 79) for this descriptive correlational study was recruited from a primary health care association in South Carolina and consisted of 42 (53.2%) HIV-infected women and 37 (46.8%) HIV-infected men between the ages of 24 and 63 years (x = 39.9, s = 7.9). Of the participants, 70 (90%) were African American, 5 (6%) were Caucasian, and 3 (4%) were Hispanic. Using Pearson’s r, significant relationships were observed between fatigue and sleep quality, daytime sleepiness, HIV-related symptoms, state anxiety, trait anxiety, depression, and perceived stress. Sleep quality (F5,65 = 12.02, P = 0.0009), state anxiety (F5,65 = 8.28, P = 0.0054), HIV-related symptoms (F5,65 = 4.87, P = 0.0308), and depression (F5,65 = 7.31, P = 0.0087) retained significance in a 3-step, backward stepwise elimination model and accounted for 67% of the variance in fatigue. These findings underscore the need for addressing psychosocial stressors and sleep quality in developing effective care for HIV-infected individuals who experience fatigue.

Effect of acupuncture administered in a group setting on pain and subjective peripheral neuropathy in persons with human immunodeficiency virus disease.

OBJECTIVES The present study was performed to determine the effect of 5 weeks of acupuncture treatment in a group setting on pain and symptoms of peripheral neuropathy in human immunodeficiency virus (HIV)infected individuals. DESIGN Twenty-one (21) subjects completed the study that consisted of a pretreatment and post-treatment case series design. The subjects completed the Pain Rating Scale and the Subjective Peripheral Neuropathy Screen (SPNS) before and after 5 weeks of acupuncture. The acupuncture treatments occurred two evenings per week. Each of the 10 sessions consisted of participants receiving 10-15 needle insertions in acupoints that addressed the individuals changing pattern of pain, sleep problems, or other health issues. The treatment utilized only main or common points located below the elbows and knees, and on the head, neck, and ears. Only reactive points were used in the acupuncture treatments. Needles were left in situ for 30-45 minutes. RESULTS Comparison of the pretreatment and post-treatment Pain Rating Scale results indicated a significant reduction in present pain (p = 0.0002), least and most pain in the last 24 hours (p < 0.0001 and p = 0.0004, respectively) and the total pain summary score (p < 0.0001). Symptoms reported in the SPNS were reduced during the 5 weeks of acupuncture. Scores for pain/aching/burning, pins and needles, and numbness in the hands and feet were reduced (all significant at less than p = 0.0065), as well as the total summary score (p = 0.0001). CONCLUSION The results of this study indicate that subjective pain and symptoms of peripheral neuropathy were reduced during the period of individual acupuncture therapy delivered in a group setting. While the study design did not allow for control of nonspecific placebo factors, the data support the hypothesis that acupuncture in a group setting can reduce pain and neuropathic symptoms in HIV-infected individuals.

Moderate intensity exercise training reverses functional aerobic impairment in HIV-infected individuals

Abstract HIV infection and HIV drug therapies result in physical and psychological challenges to those living with HIV. These conditions contribute to decreased functional aerobic capacity (FAC). The aim of this study was to determine the effects of a combined moderate-intensity aerobic and resistance exercise intervention on the FAC of HIV-infected individuals. Forty HIV-infected individuals were randomized to an exercise group (EX) who completed six weeks of moderate-intensity exercise training, or to a control group (CON) that did not receive the exercise intervention. Twice weekly, the EX group completed 30 minutes of moderate-intensity aerobic training followed by moderate-intensity resistance training. Prior to, and following, the intervention the FAC for each subject was determined by graded exercise treadmill stress test (GXT). At baseline testing, the mean FAC as determined by treadmill time-based estimation of maximal oxygen consumption was 25% below age-predicted values, a level of reduction indicating the presence of functional aerobic impairment (FAI). Following the intervention, the EX had a significant increase in time to fatigue and estimated VO2 max (p<.001). Further, FAI was eliminated (1% above age predicted values) during the exercise training. The EX group also experienced decreased heart rates during Stages 1 (p=.02), 2 (p=.01), 4 (p=.05) and 6 (p=.02) of the GXT. The CON had no significant changes during the intervention period. These data indicate that six weeks of combined moderate-intensity aerobic and resistance training can improve FAC and eliminate FAI in those with HIV. Results suggest that the functional limitations common in HIV-infected individuals are due in part to detraining that is reversible through moderate exercise adherence.

Physical Activity and Immunity in HIV-Infected Individuals

The purpose of this study was to determine what relationship exists among physical activity levels and viral load and CD4+ cell count in HIV-infected individuals. Increased viral load is associated with disease progression and symptom severity. A convenience sample of 66 male and female subjects between the ages of 18 and 64 years of age (mean 39±8) was recruited from a hospital-based HIV/AIDS clinic. Components of PA were assessed for three continuous days using a mini-motion logger wrist actigraph. These components included mean PA level, and PA index and acceleration index. Pearsons correlational analysis was used to test the strength of association between PA components and viral load or CD4+ cell count. A significant inverse relationship was found between mean PA level and viral load (p=0.047). An inverse relationship was also observed between PA index and viral load (p=0.0061). Neither mean PA nor PA index scores correlated with CD4+ cell counts. Acceleration index, a measure of PA intensity, showed no correlation to viral load or CD4+ cell counts. These findings suggest that increasing levels of physical activity might have beneficial effects on viral load in HIV-infected individuals.

Perceived stress in HIV-infected individuals: Physiological and psychological correlates

Abstract The purpose of this study was to determine the correlation of perceived stress with selected physiological and psychological factors in an HIV-infected, predominantly African American population and to assess the multivariable effects on perceived stress. The variables that correlated significantly with perceived stress were entered into a backward stepwise regression model. Pearsons r analysis showed significant correlations between perceived stress and state and trait anxiety, depression, HIV-related symptoms, sleep quality, daytime sleepiness and fatigue. State and trait anxiety, depression and fatigue retained significance (p<0.1) in the final regression model. These factors explained approximately 80% of the variance in perceived stress. The significant interactions of multiple physiological and psychological correlates suggest that perceived stress is a complex outcome with a multifactorial etiology. Further, the model suggests that psychological factors may contribute to perceived stress in this population more than physiological factors such as HIV-related symptomatology or stage of disease.

Effects of Individualized Acupuncture on Sleep Quality in HIV Disease

Although it may begin at any point, sleep disturbance often appears early in HIV disease and contributes to decreased quality of life during the course of the illness. Relatively few studies have explored the complex nature of poor sleep quality in HIV disease or tested interventions to improve sleep quality. The purpose of this study was threefold: explore the nature of sleep quality in HIV disease, test the relationship between pain and sleep quality, and test the effectiveness of acupuncture delivered in a group setting for improving sleep quality in those who are HIV infected. A pretest, posttest, preexperimental design was used to test the effects of acupuncture on sleep quality. Participating in the study were 21 HIV-infected men and women between the ages of 29 and 50 years who reported sleep disturbance three or more times per week and who scored greater than 5 on the Pittsburgh Sleep Quality Index. The Wrist Actigraph was used to measure sleep activity, and the Current Sleep Quality Index was used to measure sleep quality for 2 nights before and after a 5-week acupuncture intervention (10 treatments). Acupuncture was individualized to address insomnia and other symptoms reported by the participants. Sleep activity and sleep quality significantly improved following 5 weeks of individualized acupuncture delivered in a group setting.

Physiological and Psychological Correlates of Sleep in HIV Infection

Insomnia, a common problem associated with HIV disease, is most likely caused by a multitude of factors. This study investigated the correlations between a selected group of physiological and psychological factors and sleep quality in an HIV-infected population. A convenience sample of 79 ethnically diverse HIV-positive adults, ages 24 to 63, completed a number of questionnaires and released their laboratory records for CD4+ cell count and viral load information. Variables significantly related to sleep quality were HIV-related symptoms, total pain, fatigue, depression, state anxiety, and the number of adults in the household. Findings support the need for health care providers to consider factors that contribute to impaired sleep when developing effective care for HIV-infected individuals with sleep disturbance.