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Psychosomatic Medicine 68:143-151 (2006)
© 2006 American Psychosomatic Society

ORIGINAL ARTICLES

Randomized Clinical Trial of Cognitive Behavioral Stress Management on Human Immunodeficiency Virus Viral Load in Gay Men Treated With Highly Active Antiretroviral Therapy

Michael H. Antoni, PhD, Adam W. Carrico, MS, Ron E. Durán, PhD, Susan Spitzer, PhD, Frank Penedo, PhD, Gail Ironson, MD, PhD, Mary Ann Fletcher, PhD, Nancy Klimas, MD and Neil Schneiderman, PhD

From the Department of Psychology (M.H.A., A.W.C., R.E.D., S.S., F.P., G.I., N.S.), Department of Psychiatry (M.H.A., G.I., N.S.), and Department of Medicine (M.A.F., N.K., N.S.), University of Miami, Coral Gables, FL.

Address correspondence and reprint requests to Michael H. Antoni, PhD, Department of Psychology, 5665 Ponce De Leon Blvd, Coral Gables, FL 33146. E-mail: Mantoni{at}miami.edu

Objective: Human Immunodeficiency Virus (HIV)–positive individuals treated with highly active antiretroviral therapy (HAART) may experience psychological burdens and negative mood states, which could impair their ability to derive maximum benefits from their medical treatment. We tested whether a cognitive behavioral stress management (CBSM) intervention in combination with antiretroviral medication adherence training (MAT) from a clinical pharmacist influences HIV viral load more than MAT alone.

Methods: HIV-positive men who have sex with men were randomized to either a 10-week CBSM + MAT intervention (n = 76) or a MAT-Only condition (n = 54). Data were collected at baseline immediately following the 10-week intervention period, at 9 months postrandomization, and at 15 months postrandomization.

Results: We found no differences in HIV viral load among the 130 men randomized. However, in the 101 men with detectable viral load at baseline, those randomized to CBSM + MAT (n = 61) displayed reductions of 0.56 log10 units in HIV viral load over a 15-month period after controlling for medication adherence. Men in the MAT-Only condition (n = 40) showed no change. Decreases in depressed mood during the intervention period explained the effect of CBSM + MAT on HIV viral load reduction over the 15 months.

Conclusions: A time-limited CBSM + MAT intervention that modulates depressed mood may enhance the effects of HAART on suppression of HIV viral load in HIV+ men with detectable plasma levels.

Key Words: depression • HIV/AIDS • HIV viral load • intervention

Abbreviations: AIDS = acquired immunodeficiency syndrome; ACTG = Adherence to Combination Therapy Guide; BDI = Beck Depression Inventory; CBSM = cognitive behavioral stress management; CET = coping effectiveness training; EDTA = ethylenediaminetetraacetic acid; HAART = highly active antiretroviral therapy; HIV = human immunodeficiency virus; MAT = medication adherence training; MEMS = medication event monitoring system; POMS = Profile of Mood States.




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