N. Schneiderman

Psychosocial modulation of antibody to Epstein-Barr viral capsid antigen and human herpesvirus type-6 in HIV-1-infected and at-risk gay men.

&NA; We investigated the effects of two behavioral interventions—aerobic exercise and cognitive behavioral stress management (CBSM)—on Epstein‐Barr virus viral capsid antigen (EBV‐VCA) and human herpesvirus type‐6 (HHV‐6) antibody modulation in 65 asymptomatic gay men measured at several time points in the 5 weeks preceding and following notification of their human immunodeficiency virus‐type 1 (HIV‐1) serostatus. After accounting for potential immunomodulatory confounds, we found that HIV‐1 seropositive men had higher EBV‐VCA antibody titers than those diagnosed as seronegative at every time point during the study; however, no significant differences were found with respect to HHV‐6. Among HIV‐1 seropositive and seronegative subjects, respectively, those randomized to either behavioral intervention had significant decreases in both EBV‐VCA and HHV‐6 antibody titers over the course of the intervention as compared with assessment‐only controls (of HIV‐1 seropositive and seronegative status) whose antibody titers did not significantly change and which remained consistently higher than either serostatus‐matched intervention group over subsequent time points, independent of total immunoglobulin G levels and degree of polyclonal B cell activation. In attempting to explain serostatus differences in EBV and HHV‐6 values, it was found that HIV‐1 seropositive men had significantly lower CD4 cells, CD4:CD8 ratio, and blastogenic response to phytohemagglutinin (PHA), as well as significantly higher CD8 cells at baseline. No significant differences were found between the HIV‐1 seropositive and seronegative men with respect to anxiety and depression at baseline. Since the greatest changes in EBV and HHV‐6 occurred between baseline and week 10, we correlated changes in immune (CD4, CD8, CD4:CD8 ratio, PHA stimulation) and distress‐related markers (state depression and anxiety) with EBV and HHV‐6 change scores over this time period. No significant correlations were found between any of these immune‐ or distress‐related variable and the antibody change scores suggesting that the mechanisms by which EBV and HHV‐6 antibodies are being modulated by these interventions possibly involve other, yet to be determined, immune, neuroendocrine, and/or psychologic variables.

Enhancing adherence to combination antiretroviral therapy in non-adherent HIV-positive men

This paper describes a preliminary study aimed at testing the efficacy of a brief medication counselling and behavioural intervention in improving adherence to combination antiretroviral medication therapy and prophylactic treatment among non-adherent men living with HIV. Twenty-one non-adherent HIV-positive men obtaining primary care clinical services at a Veterans Affairs Medical Center were recruited by health care providers. Intervention participants were primarily African-Americans with histories of intravenous drug use. During a period of five months, participants were provided with monthly medication counselling and a weekly medication pill organizer. Participants were compared with 21 non-adherent matched controls receiving standard pharmacy care including review of medications. Intervention and control subjects were compared on several variables: medication refill timeliness, appointment attendance, hospitalizations and opportunistic infections. Medical information was obtained from hospital and pharmacy records at baseline and post-intervention. Pre- to post-intervention rates of adherence to medication refills and clinic appointments increased significantly among intervention participants. Relative to matched controls, intervention participants also significantly increased drop-in visits and showed fewer hospitalizations. Intervention participants also showed significant decreases in the number of opportunistic infections. Results suggest that exposure to medication counselling and behavioural interventions increase adherence, with associated reductions in negative clinical outcomes.

Influencing medication adherence among women with AIDS

This study examined the effects of a ten-session cognitive-behavioural stress management/expressive supportive therapy (CBSM+) intervention on adherence to antiretroviral medication. Although the intervention was not designed to influence adherence, it was theorized that improved coping and social support could enhance adherence. Women with AIDS (N=174) in Miami, New York and New Jersey, USA, were randomized to a group CBSM+ intervention or individual control condition. Participants were African American (55%), Latina (18%) and Caribbean (18%) with drug (55%) and/or alcohol (32%) histories. Participants were assessed on self-reported medication adherence over seven days, HIV-related coping strategies and beliefs regarding HIV medication. Baseline overall self-reported adherence rates were moderate and related to coping strategies and HIV medication beliefs. Low adherent (80%) participants in the intervention condition increased their mean self-reported medication adherence (30.4% increase, t44=3.1, p<0.01), whereas low adherent women in the control condition showed a non-significant trend (19.6% increase, t44=2.0, p>0.05). The intervention did not improve adherence in this population; conditions did not differ significantly on self-reported adherence. Low adhering intervention participants significantly decreased levels of denial-based coping (F1,88=5.97, p<0.05). Results suggest that future interventions should utilize group formats and address adherence using coping and medication-knowledge focused strategies.