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TREATMENT AND PREVENTIVE INTERVENTIONS |
From the Department of Psychiatry (A.W.C.), University of California, San Francisco, San Francisco, California, and the Departments of Psychology and Psychiatry (M.H.A.), University of Miami, Miami, Florida.
Address correspondence and reprint requests to Adam W. Carrico, Health Psychology Program, University of California, San Francisco, 3333 California St., Suite 465, Box 0848, San Francisco, CA 94143-0848. E-mail: adam.carrico{at}ucsf.edu
We reviewed randomized controlled trials (RCTs) that examined the effects of psychological interventions on HIV disease markers including neuroendocrine hormone regulation and immune status. Utilizing both PubMed and PsycINFO, we searched for RCTs published over the past 20 years (1987–2007). Of the 31 RCTs identified, 14 tested effects of psychological interventions on neuroendocrine regulation or immune status. Despite the fact that there are significant methodological limitations of RCTs that have been conducted to date, psychological interventions for HIV-positive persons have been shown to be efficacious in improving psychological adjustment compared with wait-list or treatment as usual control conditions. However, there is little support for differential efficacy of group-based interventions that have been tested to date, even in comparison with semistructured social support groups. Irrespective of the treatment modality, it seems that interventions that are successful in improving psychological adjustment are more likely to have salutary effects on neuroendocrine regulation and immune status. Psychological interventions represent a viable adjuvant treatment that can assist patients with improving psychological adjustment and potentially enhancing immune status. To inform the development of innovative treatments with potentially superior efficacy, deconstruction trials are necessary to examine the effects of distinct components of multimodal psychological interventions compared with nonspecific social support effects. Effectiveness trials of promising psychological interventions with more representative samples of HIV-positive persons are also needed to provide more definitive information on the clinical utility and potential cost-effectiveness of treatments that have been developed to date.
Key Words: AIDS • psychological • psychoneuroimmunology • interventions • HIV • randomized controlled trials
Abbreviations: AIDS = acquired immune deficiency syndrome; CBSM = cognitive-behavioral stress management; CD8+ = cytotoxic-suppressor; DHEA-S = dehydroepiandrosterone-sulfate; EBV = Epstein-Barr virus; HSV-2 = herpes simplex virus type 2; HAART = highly active antiretroviral therapy; IgG = immunoglobulin G; MAT = medication adherence training; NK = natural killer; NKCC = natural killer cell cytotoxicity; NE = norepinephrine; PHA = phytohemagglutinin; RCTs = randomized controlled trials; CD4:CD8 = ratio of T helper to cytotoxic-suppressor cells; SET = supportive/expressive therapy; CD4+ = T helper.
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