Psychosocial Group Intervention and the Rate of Decline of Immunological Parameters in Asymptomatic HIV-lnfected Homosexual Men

Abstract

The aim of the study was to determine changes in the rate of decline of immunological parameters after psychosocial group intervention. Subjects were 26 asymptomatic HIV-infected homosexual men who participated in a cognitive-behavioral group therapy (CBT; n = 14), or an experiential group therapy program (ET; n = 12), both of 15 weeks duration. The outcome measures were changes in the decline of CD4 cell counts, and T cell proliferative responses to anti-CD 3 monoclonal antibodies from preintervention to 24 months postintervention. No differences in the rate of decline of CD4 cells or T cell responses between the CBT and ET condition were found, and there were no significant changes in CD4 cell count from pre-to postintervention. However, those subjects who showed larger decreases in distress showed a smaller decline in CD4 cell counts. While the rate of decline in T cell responses was significantly less after both interventions, a similar positive change in T cell responses was found in a comparison group of 149 HIV-infected men with similar demographic, psychosocial and immunological characteristics who did not participate in one of the interventions. We conclude that the psychosocial intervention programs tested here did not cause changes in CD4 cell decline or T cell responses and that decreases in distress were related to increases in CD4 cell counts.

Cognitive–Behavioral Stress Management Interventions for Persons Living with HIV: A Review and Critique of the Literature

“…However, most programs used multiple sessions (range=6-20 sessions; mode= 10 sessions) that were between an hour and two and a half hours in length (mode= 2-h session). Three interventions also supplemented multiple sessions with an additional daylong retreat [25,29,30,32,33]. Only one treatment incorporated booster sessions after the intervention was completed [29,30].…”

“…Additionally, the majority of HIV-infected individuals included in the reviewed interventions were Caucasian. While most studies were conducted in the USA, three interventions were conducted with international patient samples [32,33,35,38].…”

“…However, only 38% of studies examined changes in coping approaches as core study outcomes [27,28,[31][32][33][40][41][42][43]. In addition, there was little consistency in the way in which coping was measured across studies.…”

“…Indeed, three different coping measures were used (i.e., COPE, Ways of Coping Checklist, Jalowiec Coping Scale), with each study assessing a unique set of coping dimensions. For example, in one study, only changes in the active coping and seeking emotional support dimensions of the situational COPE were reported [32,33], whereas another stress management program reported change across 13 different coping domains of the situational COPE [40]. The variability in coping assessment approaches resulted in more than 20 different coping dimensions being measured across these eight studies.…”

Stress management interventions for HIV+ adults: A meta-analysis of randomized controlled trials, 1989 to 2006.

“…As Ironson and colleagues (2002) note in their review, stress management interventions tend to improve psychosocial outcomes but the effects on immune functioning have been inconsistent. For example, some investigators have found improvements in immunological markers such as CD4+ counts for intervention but not control participants (Antoni et al, 1991) whereas other investigators have found similar increases in CD4+ counts for both the intervention and control groups (Mulder et al, 1995). In addition, the association between stressful life events and CD4+ counts among people with HIV tends to be delayed.…”