CLINICAL OUTCOME CHANGES WITH PSYCHO-SPIRITUAL INTERVENTIONS IN HIV-1 INFECTED PERSONS
LJ Standish, PhD, ND, MS, LAc, A Fitzpatrick, PhD, JG Kim, J Berger, MF, B Brumback, PhD, N Polissar, PhD, C Calabrese, ND, MPH
PURPOSE: To investigate associations between self-reported use of specific psycho-spiritual therapies with subsequent mortality data and one-year change in other clinical markers of health among HIV-1+ participants of the Bastyr University Alternative Medical Care Outcomes in AIDS (AMCOA) study.
METHODS: 905 HIV-1+ persons who completed three questionnaires over one year documenting use of CAM from 1995-98 were analyzed. Self-reported use of spiritual (prayer, meditation, affirmations, visualization, psychic healing, other spiritual activities) and psychological (group and individual therapy, support groups) activities was collected in each questionnaire. Death was ascertained using the National Death Index through 1999. CD4+ count and HIV RNA viral load were collected from laboratory records. Body mass index (BMI), HIV-related conditions and symptoms and progression to AIDS were measured from data collected in questionnaires. Cox proportional hazards regression was used to calculate associations between use of therapies and risk of death. Analyses on one-year change in non-fatal measurements were performed using multiple linear regression adjusted for relevant confounders.
RESULTS: Continuous use of any psychological therapy reported over one-year was associated with reduced risk of death compared to non-users of psychological therapy. (HR: 0.5, 95% CI: 0.3-0.9). No association between use of any spiritual therapy was found in the entire cohort although effect modification by use of highly active antiretroviral therapy (HAART) was found. Non-users of HAART who participated in spiritual activities were found to be at a reduced risk of death than non-users of spiritual activities (HR:0.4, 95% CI:0.2-1.0). Significant increases in BMI were associated with use of psychological therapies but not spiritual therapies. User of spiritual and/or psychological therapies was associated with an increased progression to AIDS. No trends in differences of one-year change in CD4+ count, viral load or HIV-related conditions and symptoms were associated with use of spiritual therapies or psychological interventions.
CONCLUSION: Participation in psycho-spiritual therapies may be related to some beneficial physical outcomes in HIV-1+ individuals, including reduced risk of death. These results should be interpreted cautiously due to sampling biases with this cohort, self selection of therapies and use of multiple testing.
