Effects of two cognitive-behavioral interventions on immunity and symptoms in persons with HIV

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Abstract
Investigations in both healthy and clinical populations support the effectiveness of cognitive-behavioral interventions for immune enhancement and symptom reduction. However, there is a paucity of research examining these interventions in human immunodeficiency virus (HIV) positive populations, and existing studies lack precision in design. In this study, HIV seropositive subjects, blocked by illness stage, were randomized to a guided imagery (N=23) or progressive muscle relaxation (PMR) (N=22) treatment, or a control group (N = 24). The six-week treatments were delivered via audiotape following brief face-to-face instruction, and effects on fatigue, depression, and three measures of cellular immunity were examined. Pre and posttreatment measures included the Center for Epidemiologic Studies Depression Scale (CES-D), Sleep and Rest subscale of the Sickness Impact Profile (SIP), CD4+ and CD16+ lymphocyte numbers, and CD4+:CD8 + T lymphocyte ratio. Data were analyzed using a hierarchical multiple regression model, holding pretreatment effects constant while assessing the contribution of each treatment to the dependent variables. The guided imagery group had a significant decrease in depression and fatigue, while the PMR group demonstrated an increased CD4+ T lymphocyte count and a reduction in depression. Findings supported the effectiveness of both interventions for symptom alleviation, and of PMR for immune enhancement in persons with HIV, and suggest a differential effect for the two treatments in this population.