Effects of Mindfulness Training on Chronic Inflammation in HIV-Infected Adults

正念训练对艾滋病毒感染者成人慢性炎症的影响

• 批准号: 9186982
• 负责人: PETER BARBOSA
• 金额: $ 20.34万
• 依托单位: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-12-01 至 2017-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9186982
• 关键词: Address; Adult; Age; Age-Years; Aging; Anxiety; Area; Behavior Therapy; Biological; Biological Markers; Categories; Chronic; Clinical; Complementary Medicine; Control Groups; Country; Data; Disease; Disease Progression; Effectiveness; Emotions; Epidemic; Equation; Event; Fatigue; Fibrin fragment D; Funding; Gap Junctions; Goals; HIV; HIV Infections; HIV Seropositivity; Health; Healthcare Systems; Highly Active Antiretroviral Therapy; Individual; Inflammation; Inflammatory; Interleukin-6; Intervention; Intervention Studies; Life; Light; Link; Measures; Mediating; Medical; Medicine; Mental Depression; Mind-Body Intervention; Modeling; Morbidity - disease rate; Natural Immunity; Outcome; Patients; Pharmaceutical Preparations; Pilot Projects; Plasma; Play; Polypharmacy; Population; Premature aging syndrome; Psychoneuroimmunology; Psychosocial Stress; Public Health; Randomized; Research; Role; Stress; System; Target Populations; Testing; Time; Training; United States; Viral Load result; Viremia; antiretroviral therapy; arm; attentional control; base; chronic pain; clinical care; cognitive function; cohort; design; inflammatory marker; innovation; microbial; mindfulness; mindfulness meditation; mindfulness-based stress reduction; mortality; novel; patient population; peer; programs; psychologic; psychosocial; public health relevance; social

 DESCRIPTION (provided by applicant): 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.

 描述（由申请人提供）：艾滋病毒流行病正处于第一世界国家实现高度活跃的ART短期收益的阶段。据估计，到2015年，美国一半的艾滋病毒感染者年龄超过50岁，而这群血浆病毒血症控制良好的患者的衰老速度比非艾滋病毒感染者更快。长期慢性炎症在HIV感染成人的过早衰老中起着关键作用。与慢性炎症相关的标志物，包括IL-6、CRP、sCD 14和d-二聚体，不仅在艾滋病毒感染的成年人中含量较高，而且还与多种发病率和死亡率相关。这个项目的目标是确定 一种有效的身心干预，基于正念的压力减轻（MBSR），对减少与HIV病毒载量不可检测的HIV感染成年人慢性炎症相关的生物标志物的影响。为了实现这一目标，将对120名50岁以上接受ART的受试者进行试点随机对照试验，具体目标如下：1）评估MBSR对慢性炎症生物标志物的影响（IL-6、CRP、sCD 14、d-二聚体），和，2）探索心理健康是否发生变化（焦虑、抑郁、疲劳、认知功能）介导正念减压疗法对慢性炎症的影响。受试者将被随机分为两组，一组参加为期8周的小组MBSR课程，作为研究干预，另一组参加健康促进计划（HEP），作为注意力控制组，测量三个时间点：基线、8周（MBSR干预完成后立即）和MBSR课程后6个月。将使用混合线性和结构方程模型来检验研究假设。这项拟议的研究是创新的，因为它是第一次探讨的影响， 对HIV感染成年人慢性炎症的补充身心干预。鉴于这一队列中过早老龄化的后果将对卫生保健系统造成负担，并对艾滋病毒感染者造成医疗、社会和心理负担，该研究有可能对公共卫生产生重大影响。