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

 描述(申请人提供)：艾滋病毒的流行已经在第一世界国家实现了高度活跃的抗逆转录病毒疗法的短期收益。到2015年，美国估计有一半的艾滋病毒感染者年龄在50岁以上，这群血浆病毒血症得到很好控制的患者正在以比非艾滋病毒感染者更快的速度老龄化。长期的慢性炎症在感染艾滋病毒的成年人过早衰老中起着关键作用。与慢性炎症相关的标记物，包括IL-6、CRP、sCD14和d-二聚体，不仅在感染艾滋病毒的成年人中存在较高水平，而且与各种疾病和死亡率有关。这个项目的目标是确定 一种有效的心身干预--基于正念的压力减轻(MBSR)对减少艾滋病毒感染成人中与慢性炎症相关的生物标志物的影响，这些成年人的艾滋病毒病毒载量无法检测到。为了实现这一目标，将对120名50岁以上接受抗逆转录病毒治疗的受试者进行一项试验性随机对照试验，具体目的如下：1)评估MBSR对慢性炎症生物标记物(IL-6、CRP、sCD14、d-dimer)的影响；2)探索MBSR在心理健康(焦虑、抑郁、疲劳、认知功能)方面的变化是否中介MBSR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。将测量三个时间点：基线、8周(MBSR干预完成后立即)和MBSR疗程后6个月。将使用混合的线性和结构方程模型来检验研究假设。这项拟议的研究具有创新性，因为它是第一次探讨 对感染艾滋病毒的成年人慢性炎症的补充心理-身体干预。鉴于这一人群中过早老龄化的后果将是医疗保健系统的负担，以及艾滋病毒携带者的医疗、社会和心理负担，这项研究可能会对公共卫生产生重大影响。

 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.