The proposed work will address symptom management for patients over age 60 who are living with HIV- infection, are on combination antiretroviral therapy (cART) with suppressed viral loads, and yet continue to experience behavioral and cognitive symptoms of HIV-associated neurocognitive disorders (HAND). It is increasingly relevant that HAND persists despite cART, impacting between 30-50% of elders living with HIV. Treatment trials for adjuvant therapies in such a setting have failed, including strategies aimed at increasing central nervous system penetration effectiveness (CPE) of cART. Patients suffer symptoms that are pervasive in their impact on everyday functioning and quality of life;yet these patients are currently left with a dearth of treatment options. In this applicaton, we propose that cognitive impairment in elders living with HIV is a geriatric syndrome - a clinical condition that does not fit discreetly into a disease category because it is driven by more than one disease process and occurs with greater frequency in old age. In response to PA-13-210, we propose a randomized controlled evaluation of Mindfulness Based Stress Reduction (MBSR) to target attention, stress, anxiety, and depressive symptoms among patients over age 60 who have HAND and have maximized treatment options. We will employ intrinsic connectivity network (ICN) analyses of resting state functional magnetic resonance imaging to demonstrate increased strength of brain networks corresponding to improved symptoms. We will quantify social networks and perceived strength of social networks to determine if they moderate our main findings. Together this work employs geriatric, neuroscience and complementary medicine disciplines to reduce the symptom burden in aging HIV-infected patients.

Public Health Relevance

Despite treatment with combination antiretroviral medications, people living with HIV continue suffer HIV- associated neurocognitive disorder (HAND) leading to cognitive and behavioral symptoms. This study will investigate Mindfulness Based Stress Reduction to decrease the symptom burden in older patients suffering from HAND.

Agency
National Institute of Health (NIH)
Institute
National Institute of Nursing Research (NINR)
Type
Research Project (R01)
Project #
1R01NR015223-01A1
Application #
8859890
Study Section
Behavioral and Social Consequences of HIV/AIDS Study Section (BSCH)
Program Officer
Hardy, Lynda R
Project Start
2014-09-26
Project End
2019-06-30
Budget Start
2014-09-26
Budget End
2015-06-30
Support Year
1
Fiscal Year
2014
Total Cost
$759,023
Indirect Cost
$263,516
Name
University of California San Francisco
Department
Neurology
Type
Schools of Medicine
DUNS #
094878337
City
San Francisco
State
CA
Country
United States
Zip Code
94143