The HIV epidemic is at a point where the short-term gains of highly active ART have been realized in first world countries. By 2015 half of the people living with HIV infection in the U.S. are estimated be over the age of 50, and this cohort of patients with well-controlled plasma viremia is aging at a more rapid pace than their non-HIV peers. Long-term chronic inflammation plays a critical role in premature aging in HIV-infected adults. Markers associated with chronic inflammation, including IL-6, CRP, sCD14 and d-dimer, have not only been shown to be present at higher levels in HIV-infected adults, but are also correlated to a wide variety of morbidities and mortality. The goal of this project is to determine the impact of an effective mind-body intervention, Mindfulness-Based Stress Reduction (MBSR), on reducing biological markers associated with chronic inflammation in HIV-infected adults with an undetectable HIV viral load. In order to achieve this goal, a pilot RCT with 120 subjects over 50 years old who are on ART will be conducted with the following specific aims: 1) to assess the effect of MBSR on biomarkers of chronic inflammation (IL-6, CRP, sCD14, d-dimer), and, 2) to explore whether changes in psychological well-being (anxiety, depression, fatigue, cognitive functioning) mediate the impact of MBSR on chronic inflammation. Subjects will be randomized to participation in an 8- week group MBSR course as the study intervention or to the Health Enhancement Program (HEP) as the attention control arm. Three time points will be measured: baseline, 8 weeks (immediately after completion of MBSR intervention), and 6-months post MBSR course. Mixed linear and structural equation model will be used to test the study hypotheses. The proposed study is innovative in that it is the first to explore the impact of a complementary mind-body intervention on chronic inflammation in HIV-infected adults. Given that the consequences of early aging in this cohort will be a burden on the health care system as well as a medical, social and psychological load on those living with HIV, the study has the potential to have a major public health impact.
Chronic inflammation plays a critical role in premature aging in HIV-infected adults and there are currently no interventions available to reduce it. Strategies are needed to address that patients with well-controlled HIV are aging at a more rapid pace than their non-HIV peers. This study will test whether a mindfulness-based behavioral intervention can decrease chronic inflammation in this growing population of HIV-infected adults 50 years of age and older.
