Fatigue Management in HIV: A Sleep and Circadian Rhythm Pilot Intervention

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DESCRIPTION (provided by applicant): This application is in response to PA-13-211 calling for applications that address symptom management in HIV-infected older adults. This pilot study builds from our prior descriptive research with the HIV-positive population, where we found fatigue, lack of energy, or daytime sleepiness to be their most prevalent symptoms. Fatigue can vary from morning to night or across the social week, and can be measured by severity, frequency, or distress. Fatigue may be related to their chronic disease process, to side effects of drug therapy, or to insufficient sleep. Fatigue limits daytime function and can interfere with adherence to HIV drug therapy. Health-promoting behaviors that strengthen day/night circadian rhythms can improve fatigue without adding another medication to their therapy. In fact, sleep medications have many daytime side effects that include fatigue, inertia, malaise, sleepiness, lack of energy and subsequent insomnia. For this R21, we propose a pilot exploratory study designed as a randomized clinical trial to improve fatigue for adults diagnosed with HIV who are over 50 years of age without adding more medication. The overall aim is to test a brief behavioral intervention, the "Six Strategies for Fatigue" against an attentional control condition, "Dietary Actions to Diminish Fatigue" at 1, 2, and 3 months post- intervention. We will assess feasibility, satisfaction, and attrition issues in 60 participants (Aim 1). The goal is to show moderate to large effect sizes for reducing all dimensions of fatigue (Aim 2). We also expect small to moderate effect sizes and trends for reducing use of sleep medication, improving daytime function, and lowering anxiety and depressive symptoms (secondary aims). Analyses will be by intention-to-treat and we will use Linear Mixed Models to compare the two groups at four time points (baseline, 1, 2, and 3 months). Findings from this pilot study are essential for determining the optimal approach for moving forward to test this behavioral intervention in a larger sample of older HIV-infected adults. If effective, this intervention offers a non-pharmacologic and low-cost option to reduce fatigue as well as other symptoms associated with fatigue such as daytime sleepiness, depression and anxiety. By reducing fatigue in this chronic illness population, daytime function can be improved. This intervention also has high potential for treating fatigue in older adults with other types of complex chronic illness conditions.