Cognitive Therapy Gives Boost to 50-Year-Olds With Long-Term HIV

Small sample but very hopeful

Subject: NATAP/Aging Wk: Cognitive therapy in Aging Patients >50

Cognitive Therapy Gives Boost to 50-Year-Olds With Long-Term HIV 

2nd International Workshop on HIV and Aging, October 27-28, 2011, Baltimore, Maryland

Mark Mascolini

Mindfulness-based cognitive therapy proved popular and effective in improving quality of life in a randomized trial involving 40 men and women around 50 years old in Barcelona [1]. Whether positive effects of this intensive therapeutic course last more than a few months in people with HIV remains to be seen.

Anxiety and depression rates are high among people with HIV and may increase as HIV-positive people age. Mindfulness-based cognitive therapy--designed for people with depression--combines cognitive therapy with meditation and other practices aimed at cultivating mindfulness. Psychologists variously define mindfulness as focusing complete attention on the present moment or staying aware of thoughts, feelings, and sensations in the present moment--instead of mulling past or future concerns [2].

Carmina Fumaz and colleagues at Badalona's Germans Trias i Pujol University Hospital planned this randomized trial of 20 men and 20 women with HIV infection for at least 15 years and with quality-of-life deficits marked by scores at or above 65 on the Nottingham Health Profile. The researchers excluded people with bipolar disorder, a documented psychotic episode or epileptic episode, or ongoing psychotherapy. They randomized 10 men and 10 women to a control arm involving only assessment and 10 men and 10 women to mindfulness-based cognitive therapy. Fumaz and colleagues evaluated study participants 3 and 6 months after the intervention.

Cognitive therapy involved eight 3-hour weekly classes, a day-long retreat, and an hour or more of "homework" 6 days a week. The goal of these exercises was to encourage people "to appreciate the present moment instead of focusing on worries about [the] future or past."

Everyone invited to participate agreed to join the study. Median age stood at 50 years (interquartile range [IQR] 46 to 52), median HIV duration at 20 years (IQR 16 to 24), and median time on antiretroviral therapy at 16 years (IQR 12 to 18). Median current CD4 count was 527 (IQR 364 to 633), 39 people (98%) had a viral load below 25 copies, and 17 (43%) had a stable partner. These numbers did not differ significantly between the intervention group and the control group. Nor did measures of energy, pain, emotional reactions, sleep, social isolation, and physical mobility on the Nottingham Health Profile. Only 1 person (in the cognitive therapy group) dropped out.

At post-treatment evaluations, all of the just-noted psychosocial variables improved significantly in the intervention group compared with the control group. All 20 people in the cognitive therapy group had a poor energy score before treatment and none did afterwards. Among seven aspects of daily living, four improved significantly in the intervention group compared with the control group: work, relationships at home, interests and hobbies, and ability to take holidays. The positive impact of cognitive therapy did not differ by gender. 

Fumaz and colleagues concluded that mindfulness therapy may be a useful strategy in aging people with HIV infection.

At the Aging Workshop, David Clifford (Washington University, St. Louis) noted that this intervention requires a big time commitment and wondered whether recruitment favored selection of people attuned to this type of therapy. Notably, half of the study participants were retired.

Fumaz agreed that this strategy takes time (she did not discuss cost) but said their center now has a waiting list of people who want to try it. Health workers in the hospital are also eager to sign up for mindfulness-based cognitive therapy. Fumaz noted that 200 hospitals in the United States have mindfulness-based cognitive therapy programs. 

The researchers plan to monitor study participants to see if the reported benefits persist longer than 1 year. Three-year follow-up of 18 of 22 US patients in a trial of mindfulness-based meditation for anxiety disorders found sustained good responses on Hamilton and Beck Anxiety and Depression scores, the Hamilton pain score, the Mobility Index-Accompanied test, and the Fear Survey [3].

References
1. Fumaz CR, Gonzalez-Garcia M, Munoz-Moreno JA, et al. Improvement of quality of life after the application of mindfulness-based cognitive therapy in subjects aging with HIV infection. 2nd International Workshop on HIV and Aging. October 27-28, 2011. Baltimore, Maryland. Abstract: O_09.
2. Baer RA. Mindfulness training as a clinical intervention: a conceptual and empirical review. Clin Psychol Sci Prac. 2003;10:125-143. http://www.wisebrain.org/papers/MindfulnessPsyTx.pdf.
3. Miller JJ, Fletcher K, Kabat-Zinn J. Three-year follow-up and clinical implications of a mindfulness meditation-based stress reduction intervention in the treatment of anxiety disorders. Gen Hosp Psychiatry. 1995;17:192-200. http://www.ncbi.nlm.nih.gov/pubmed/7649463.

Updates From the 1st International Workshop on HIV & Aging- By Nelson Vergel

Here is an update I just wrote for thebody.com on the recent Aging and HIV Conference



http://www.thebody.com/content/art59048.html

Nelson's Lecture on Activism Needs Related to Metabolic Disorders and Aging with HIV

www.hivresearchcatalyst.org/files/user_1/SYT1Vergel.ppt

Doctors Seek Way to Treat Muscle Loss

Nandrolone can do this easily, as long as doctors have a very close monitoring on hematocrit since older men tend to have more problems with polycythemia

http://www.nytimes.com/2010/08/31/health/research/31muscle.html?adxnnl=1&adxnnlx=1283259693-/5OVKCtiMHD2uTxULb30yQ

Strive To Thrive While Growing Older With HIV

By Dennis McMillan Published: February 11, 2010

Nelson Vergel. Photo by Rink. Positive Force will present “Survivor Health Wisdom: Strive to Thrive While Growing Older with HIV” on Wednesday, Feb. 17, 6:30-9:30 p.m. at the San Francisco LGBT Community Center, 1800 Market and Octavia Streets. Join Nelson Vergel, author of Built to Survive, for the latest information on lipoatrophy, combating premature aging, and much more. A light dinner will be provided. To take advantage of the fact that Vergel will be in the Bay Area for a conference, Positive Force scheduled this event on the third Wednesday of the month. Twice annually, Positive Force produces a community health forum on a hot button issue. “Survivor Health Wisdom...” is a Positive Force community health forum.In this instance, they decided to do a forum on HIV and aging. The face of HIV changes with each passing day. For example, thanks to treatment advances, many people living with HIV today are living longer lives. Along with longer lives come the usual health concerns: increased risks for heart disease, non-HIV related cancers, bone loss, decreased mental function, etc. However, a plethora of recent research has clearly demonstrated that people living with HIV are suffering from accelerated aging; sometimes their minds and bodies manifest problems decades earlier than their HIV-negative counterparts. Consequentially, researchers, medical providers, treatment advocates, and HIV-positive people alike are trying to figure out how to conquer this new phase of living with HIV. Many community forums on HIV and aging involve doctors and other socio-medical professionals speaking clinically, and providing the same information, from the same point of view, time and time again. Positive Force decided to move in a different direction. They invited Vergel, a man who has lived with HIV for more than two decades and who is an internationally renowned treatment advocate, to discuss HIV and aging concerns from a peer perspective. Vergel has traveled the world talking about living and thriving with HIV; has written books on the topic; and has been featured in numerous publications for his expertise and perspective. Participants who attend the forum will benefit from Vergel’s unique perspective, presentation style, and lots of information. He will present the latest treatment information, both clinical and practical, for a range of subjects, including but not limited to lipodystrophy/ lipoatrophy, accelerated aging of both mind and body, and sexual health. Forum attendees will walk away with a better handle on how to deal with problems they may already be facing and how to prevent new problems associated with HIV and aging. Vergel is a 27-year HIV survivor, Venezuelan, retired chemical engineer, lecturer and author of Built to Survive, founder of the Body Positive Wellness Clinic in Houston, and treatment activist involved in research advocacy. Bay Times interviewed him recently. “I am the founder of pozhealth at yahoogroups.com, the largest online health discussion group, and serve as an expert at thebody.com, the HIV web site with the largest reach in HIV related health issues,” he said. “I have provided over 600 lectures since 1994 in English and Spanish. I am a member of the DHHS HIV Treatment Guidelines Panel. I have presented in many conferences about issues related to living with HIV.” What is different about what he does is his being able to lecture in layman terms by blending the latest research data with a patient perspective. He spoke of the hot topics in HIV in the next five years. “The search for a cure using stem cell and immune based therapy research will become more important as well as how to deal with long term effects of HIV medications on aging, frailty, cognitive function, bone density, frailty, body changes, and others,” said Vergel. “Combating stigma and dealing with challenges in funding will be essential to controlling the spread of this epidemic.” Vergel provides a unique angle to patients. He speaks in their language about the latest research findings on facial lipoatrophy options, cardiovascular health, sexual dysfunction, hormonal balance, exercise and nutrition, latest HIV medications for those with limited treatment options, side effect management, and many other issues that are important to patients.

Lecture: Survivor Health Wisdom: Strive To Thrive While Growing Older With HIV

STOP AIDS Project's Positive Force Presents "Survivor Health Wisdom: Strive To Thrive While Growing Older With HIV" on Wed, February 17 6:30-9:30 pm at the LGBT Community Center in San Francisco.

Join Nelson Vergel, author of Built to Survive, for the latest information on: Lipoatrophy, Combating Premature Aging, and MUCH MORE!!! A light dinner will be provided.

This evening's event is part of Positive Force's ongoing series "Healthy Minds Healthy Bodies" occurring on the third Wed of every month. For more information about Positive Force, this series or to RSVP to this month's event, contact Justin Jones at 575-0150, x 250 or jjones@stopaids.org.

Background:

The face of HIV changes with each passing day. For example, thanks to treatment advances, many people living with HIV today are living longer lives. Along with longer lives comes the usual health concerns: increased risks for heart disease, non-HIV related cancers, bone loss, decreased mental function, etc. However, a plethora of recent research has clearly demonstrated that people living with HIV are suffering from accelerated aging; sometimes their minds and bodies manifest problems decades earlier than their HIV-negative counterparts. Consequentially, researchers, medical providers, treatment advocates, and HIV-positive people alike are trying to figure out how to conquer this new phase of living with HIV.

Many community forums on HIV & Aging involve doctors and other socio-medical professionals speaking clinically, and providing the same information, from the same point of view, time and time again. Positive Force decided to move in a different direction. We invited Nelson Vergel, a man who has lived with HIV for more than two decades and who is an internationally renowned treatment advocate, to discuss HIV & Aging concerns from a peer perspective. Nelson has traveled the world talking about living and thriving with HIV, has written books on the topic, and has been featured in numerous publications for his expertise and perspective.

Participants who attend will benefit from Nelson's unique perspective, presentation style, and gobs of information. Nelson will present the latest treatment information, both clinical and practical, for a range of subjects, including but not limited to lipodystrophy/lipoatrophy, accelerated aging of both mind and body, and sexual health. Forum attendees will walk away with a better handle on how to deal with problems they may already be facing and how to prevent new problems associated with HIV & Aging.