Stress treatment may raise benefits of HIV therapy

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A form of psychotherapy called cognitive behavioral stress management may enhance the effectiveness of anti-HIV drug therapy, Florida-based researchers report in the journal Psychosomatic Medicine.

“Managing complex HIV regimens...can be facilitated by helping patients better manage stress,” Dr. Michael H. Antoni from University of Miami, Coral Gables told Reuters Health. “Beyond maintaining solid adherence to the medication regimen, our work indicates that reducing patients’ distress levels… had an impact on decreasing HIV (levels), above and beyond the excellent adherence that they were achieving by meeting with a pharmacist.”

Antoni and colleagues compared the combination of cognitive behavioral stress management (CBSM) and medication adherence training (MAT) to MAT alone in a cohort of HIV-positive men who have sex with men. The CBSM intervention consisted of 10 weekly sessions including relaxation training and the MAT approach comprised 3 educational sessions conducted by a pharmacist.

Men receiving CBSM had significantly reduced HIV levels through the 15-month study, the authors report, whereas comparison subjects displayed no change in levels. By contrast, CBSM seemed to have no effect on the low levels of immune T cells seen with HIV infection.

Men in CBSM reported significant reductions in depressed mood at the end of the intervention, the researchers note, whereas comparison subjects reported marginally significant increases in depressed mood.

Improvements in depression scores were associated with declines in HIV levels, the report indicates, but medication adherence was unrelated to changes in HIV levels during the course of the study.

Given these findings, Antoni concluded that “health psychologists working with pharmacists may provide a potent one-two punch in optimizing both quality of life outcomes and the effectiveness of the medication regimen.”

Doctors, he added, “Might benefit from attending to their patients’ distress levels and ability to adhere to the medication regimen--both seem to matter.”

SOURCE: Psychosomatic Medicine, January/February 2006.

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