Posted 01.15.2020 | by AMRA

Taken properly, anti-retroviral medications successfully reduce viral loads in people living with HIV infections, helping them to maintain health and reduce disease transmission. Persons with HIV who use methamphetamines often fail to get the full benefit of their anti-retroviral medications. Such stimulant users are more likely to skip medication doses, engage in high-risk sexual behavior, and show signs of hastened AIDS progression.

Carrico et al. [Journal of the International AIDS Society] studied whether an add-on intervention designed to boost positive affect can increase the efficacy of a contingency management program. Contingency management involved offering financial rewards for clean drug tests, and the add-on intervention included elements of mindfulness training.

The researchers randomly assigned 110 HIV+ men who engaged in anal sex with other men and tested positive for methamphetamine use (average age = 43 years; 43% Caucasian) to the add-on intervention called Affect Regulation Treatment to Enhance Methamphetamine Intervention Success (ARTEMIS), or an attention-control condition.

Both groups also participated in a 3- month contingency management program offering financial rewards for maintaining stimulant-free urine samples. The period of active contingency management coincided with participation in the 3 month-ARTEMIS or attention-control group, and financial rewards were not continued after 3 months.

The ARTEMIS intervention consisted of 5 individual 1-hour training sessions delivered over a 3-month period. The program provided training in noticing and savoring positive events, mindfulness, gratitude, altruism, self-compassion, positive reappraisal, and reaching attainable goals. The training included breath-focused and loving-kindness meditations, values clarification, and psychoeducation on stimulant withdrawal. The attention-control condition consisted of 5 individual 1-hour sessions in which participants were administered psychological tests and engaged in neutral writing exercises.

Assessments occurred at baseline, and at 3, 6, 12, and 15 months. They included measures of HIV viral load and CD4+ T-cell (immune cell) counts, urine tests for substance use, and self-reports of stimulant cravings and use and positive affect.

The results showed ARTEMIS participants had significantly lower viral loads at 6 (Cohen’s d= 0.89), 12 (d=0.43), and 15 (d=0.50) months, and were significantly more likely to have all viral loads under 200 viral copies/mL (the level at which HIV infection is undetectable) than were controls.

ARTEMIS participants reported more positive affect at the time of their last ARTEMIS training session (d=0.56) and at 6 (d=0.53) and 12 (d=0.41) months than controls. ARTEMIS participants reported significantly less stimulant use at 3 (d=0.46), 6 (d=0.44), and 12 (d=0.39) months, and fewer and less intense cravings at 3 (d=0.50), 6 (d=0.55), and 12 (d=0.61) months than controls.

ARTEMIS participants were also significantly less likely to have any stimulant-positive urine tests over the course of 15 months, especially at 6 (d=0.32) and 12 (d=0.38) months than controls. There were no significant between-group differences in CD4+ T-cell counts at any time.

The study shows increased positive affect, decreased viral load, and decreased stimulant use in persons living with HIV who participated in contingency management with an add-on program to boost positive affect that included mindfulness skills.

This is the first randomized, controlled study showing persistent (up to 12 months) viral load decreases after active contingency management has ended. ARTEMIS is designed to bolster multiple affect regulation skills, and it is not clear how much the mindfulness practices alone contributed to the observed benefits.

Reference:

Carrico, A. W., Neilands, T. B., Dilworth, S. E., Evans, J. L., Gómez, W., Jain, J. P., . . . Coffin, L. (2019). Randomized controlled trial of a positive affect intervention to reduce HIV viral load among sexual minority men who use methamphetamine. Journal of the International AIDS Society.

[Link to study]