Berger Simona, Schad Tanja, von Wyl Viktor, Ehlert Ulrike, Zellweger Claudine, Furrer Hansjakob, Regli Daniel, Vernazza Pietro, Ledergerber Bruno, Battegay Manuel, Weber Rainer, Gaab Jens
Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Zurich, Switzerland.
AIDS. 2008 Mar 30;22(6):767-75. doi: 10.1097/QAD.0b013e3282f511dc.
To determine the effects of cognitive-behavioral stress management (CBSM) training on clinical and psychosocial markers in HIV-infected persons.
A randomized controlled trial in four HIV outpatient clinics of 104 HIV-infected persons taking combination antiretroviral therapy (cART), measuring HIV-1 surrogate markers, adherence to therapy and well-being 12 months after 12 group sessions of 2 h CBSM training.
Intent-to-treat analyses showed no effects on HIV-1 surrogate markers in the CBSM group compared with the control group: HIV-1 RNA < 50 copies/ml in 81.1% [95% confidence interval (CI), 68.0-90.6] and 74.5% (95% CI, 60.4-85.7), respectively (P = 0.34), and mean CD4 cell change from baseline of 53.0 cells/microl (95% CI, 4.1-101.8) and 15.5 cells/microl (95% CI, -34.3 to 65.4), respectively (P = 0.29). Self-reported adherence to therapy did not differ between groups at baseline (P = 0.53) or at 12 month's post-intervention (P = 0.47). Significant benefits of CBSM over no intervention were observed in mean change of quality of life scores: physical health 2.9 (95% CI, 0.7-5.1) and -0.2 (95% CI, -2.1 to 1.8), respectively (P = 0.05); mental health 4.8 (95% CI, 1.8-7.3) and -0.5 (95% CI, -3.3 to 2.2) (P = 0.02); anxiety -2.1 (95% CI, -3.6 to -1.0) and 0.3 (95% CI, -0.7 to 1.4), respectively (P = 0.002); and depression -2.1 (95% CI, -3.2 to -0.9) and 0.02 (95% CI, -1.0 to 1.1), respectively (P = 0.001). Alleviation of depression and anxiety symptoms were most pronounced among participants with high psychological distress at baseline.
CBSM training of HIV-infected persons taking on cART does not improve clinical outcome but has lasting effects on quality of life and psychological well-being.
确定认知行为压力管理（CBSM）训练对HIV感染者临床及社会心理指标的影响。
在4家HIV门诊对104例接受联合抗逆转录病毒治疗（cART）的HIV感染者进行随机对照试验，在为期12个月、每次2小时的12次CBSM训练课程结束12个月后，测量HIV-1替代指标、治疗依从性和幸福感。
意向性分析显示，与对照组相比，CBSM组在HIV-1替代指标方面无显著影响：HIV-1 RNA<50拷贝/ml的比例分别为81.1%[95%置信区间（CI），68.0 - 90.6]和74.5%（95%CI，60.4 - 85.7）（P = 0.34），CD4细胞从基线的平均变化分别为53.0个细胞/微升（95%CI，4.1 - 101.8）和15.5个细胞/微升（95%CI，-34.3至65.4）（P = 0.29）。自我报告的治疗依从性在基线时两组无差异（P = 0.53），干预后12个月时也无差异（P = 0.47）。与无干预相比，CBSM在生活质量评分的平均变化方面有显著益处：身体健康方面分别为2.9（95%CI，0.7 - 5.1）和-0.2（95%CI，-2.1至1.8）（P = 0.05）；心理健康方面为4.8（95%CI，1.8 - 7.3）和-0.5（95%CI, -3.3至2.2）（P = 0.02）；焦虑方面分别为-2.1（95%CI，-3.6至-1.0）和0.3（95%CI，-0.7至1.4）（P = 0.002）；抑郁方面分别为-2.1（95%CI，-3.2至-0.9）和0.02（95%CI，-1.0至1.1）（P = 0.001）。在基线时心理困扰程度高的参与者中，抑郁和焦虑症状的缓解最为明显。
对接受cART的HIV感染者进行CBSM训练并不能改善临床结局，但对生活质量和心理健康有持久影响。
