Antiretroviral medications have enabled people living with HIV to live normal lifespans but about half of those with HIV meet diagnostic criteria for HIV-associated neurocognitive disorder (HAND). People diagnosed with HAND show deficits in attention, memory, verbal fluency, and visuospatial ability and are susceptible to depression, lower quality of life, and poorer medication compliance. Existing treatments for HAND include computerized cognitive training and interventions to increase levels of physical activity.
Mindfulness training might also be a promising intervention because of its established beneficial effects on depression and quality of life for patients with a variety of chronic illnesses, as well as its potential benefit for executive cognitive function. Moskowitz et al. [AIDS and Behavior] tested the ability of Mindfulness-Based Stress Reduction (MBSR) to alleviate distress and neurocognitive symptoms and improve quality of life in older patients diagnosed with HAND.
The researchers randomly assigned 180 patients (mean age=65 years; 80% male; 73% white; average HIV duration=30 years) aged 55 years and over who were currently on antiretroviral medication, had undetectable serum HIV levels, and were diagnosed with HAND to either MBSR or a waitlist control.
Recruitment efforts targeted participants from the San Francisco Bay Area using various methods, such as community outreach talks, recommendations from healthcare providers, advertising on buses and in newspapers, and direct outreach facilitated by the UCSF Electronic Health Record Recruitment Service. The MBSR intervention followed the standard 8-week group-based protocol.
Participants were assessed at baseline, post-intervention, and one-month follow-up using self-report measures of anxiety, depression, quality of life, and activities of daily living. The activities of daily living measures assessed participants’ basic abilities to shop, cook, do laundry, bathe, clean house, and take their medications, They were also assessed at all three time points on neurocognitive measures of information processing speed (a symbol-digit test), working memory (a letter number sequencing task), and vigilance (a continuous performance task).
The trial results showed that the MBSR group had a significant decrease in depressive symptoms at post-intervention compared to the control group, but this difference was no longer significant at one month follow-up. The MBSR group showed a significant improvement in quality of life compared to the control group at one month follow-up.
No significant group differences were observed in terms of anxiety, neurocognitive scores, or activities of daily living at either immediate post-intervention or one-month follow-up assessment.
The trial findings suggest that MBSR can reduce depressive symptoms and improve quality of life for older patients with HIV-associated neurocognitive disorder in the shorter term but does not improve anxiety, neurocognitive symptoms, or activities of daily living. The study is limited by reliance on a waitlist control and lack of long-term follow-up.
Reference:
Moskowitz, J. T., Sharma, B., Javandel, S., Moran, P., Paul, R., De Gruttola, V., Tomov, D., Azmy, H., Sandoval, R., Hillis, M., Chen, K. P., Tsuei, T., Addington, E. L., Cummings, P. D., Hellmuth, J., Allen, I. E., Ances, B. M., Valcour, V., & Milanini, B. (2024). Mindfulness-Based Stress Reduction for Symptom Management in Older Individuals with HIV-Associated Neurocognitive Disorder. AIDS and Behavior.
Link to study
