| Background. Stress may hasten HIV disease progression by compromising immune response and increasing viral replication. Conversely, efforts to reduce stress may buffer the physiological effects of stress on HIV disease progression. Purpose. This study determined the effects of a structured, eight-week, mindfulness-based stress reduction (MBSR) program on perceived stress, mood, stress hormone secretion, immune function, and functional health outcomes in HIV-infected subjects. Conceptual framework. A synthesized framework of psychoneuroimmunology and a transactional model of stress guided the study. Design. A quasi-experimental, repeated measures, control group design was utilized. Subjects were nonrandomly assigned to intervention (N = 24) or control group (N = 10) and data was collected at baseline, four weeks, eight weeks, and three months postintervention (only baseline and eight weeks for control). Data Analysis. Paired t-tests between baseline scores and scores from subsequent time points and repeated measures ANOVAs were used to determine within group changes. Independent t-tests (calculated on change scores from baseline to eight weeks) were used to determine between group differences. Pearson correlation coefficients were calculated between change scores for psychological, endocrine, and immune measures to determine the associations among these variables. Results. At eight-weeks, the MBSR group showed significant increases in total functional health score, natural killer (NK) cell activity, NK cell number, and a significant decrease in fatigue. In addition, RANTES levels significantly increased while levels of SDF-1 remained stable. At three months postintervention, significant increases in NK cell number and function were maintained, and significant decreases in tension, depression, anger, confusion, and total mood disturbance emerged. Control subjects showed no changes in any dependent variables. Serum cortisol and DHEAS did not significantly change in either group. Within MBSR group changes over time (ANOVA) were found for perceived stress, tension, depression, anger, confusion, fatigue, and NK cell number. Between group differences in change scores were found for NK cell activity and number. No significant associations were found among change scores for dependent variables. Conclusion. These results provide empirical evidence that MBSR may assist in slowing HIV disease progression and may be considered an effective adjunctive therapy in the comprehensive management of HIV disease. |
