Foley Jacklyn D, Bernier Lauren B, Ngo Long, Batchelder Abigail W, O'Cleirigh Conall, Lydston Melissa, Yeh Gloria
Behavioral Medicine Program, Massachusetts General Hospital, Boston, Massachusetts.
Harvard Medical School, Boston, Massachusetts.
J Acquir Immune Defic Syndr. 2024 Aug;96(4):399-409. doi: 10.1097/qai.0000000000003441.
People with HIV (PWH) are disproportionately affected by cardiovascular disease (CVD). Psycho-behavioral therapies are capable of targeting the pathophysiology underlying HIV-CVD comorbidity. This study synthesized findings from randomized controlled trials (RCTs) of psycho-behavioral therapies for reducing CVD risk among PWH following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria were: (1) utilized an RCT design, (2) evaluated a cognitive-behavioral or mindfulness-based therapy, (3) sampled adults (age ≥18 years) with HIV, (4) measured a behavioral (e.g., diet) or biological (e.g., immune functioning) CVD risk factor, and (5) published in an English-language peer-reviewed journal. Electronic searches were conducted in six databases (e.g., MEDLINE) using controlled vocabulary and free-text synonyms for HIV, psycho-behavioral therapy, and CVD risk. Data were independently extracted with consensus reached. Outcomes were immune activation, tobacco-smoking, stress, inflammation, and physical activity from 33 studies. There were stronger effects for psycho-behavioral interventions compared to controls on CD4 (Hedge's g=0.262, 95% Confidence Interval [CI]=0.127, 0.396) and tobacco-smoking abstinence (Hedge's g=0.537, 95% CI=0.215, 0.86). There were no differences or insufficient data for stress, inflammation, or physical activity. No eligible studies examined psycho-behavioral interventions on blood pressure, lipids, or weight in PWH. There is increasing importance to further invest in broader CVD risk reduction effort for PWH that include psycho-behavioral intervention strategies.
感染艾滋病毒的人（PWH）受心血管疾病（CVD）的影响尤为严重。心理行为疗法能够针对艾滋病毒与心血管疾病合并症的病理生理学。本研究根据系统评价和荟萃分析的首选报告项目指南，综合了心理行为疗法随机对照试验（RCT）的结果，以降低PWH患心血管疾病的风险。纳入标准为：（1）采用随机对照试验设计；（2）评估基于认知行为或正念的疗法；（3）对年龄≥18岁的成年艾滋病毒感染者进行抽样；（4）测量行为（如饮食）或生物（如免疫功能）心血管疾病风险因素；（5）发表于英文同行评审期刊。使用艾滋病毒、心理行为疗法和心血管疾病风险的控制词汇和自由文本同义词，在六个数据库（如MEDLINE）中进行电子检索。数据由专人独立提取，并达成共识。33项研究的结果包括免疫激活、吸烟、压力、炎症和身体活动。与对照组相比，心理行为干预对CD4（Hedge's g=0.262，95%置信区间[CI]=0.127，0.396）和戒烟（Hedge's g=0.537，95%CI=0.215，0.86）的影响更强。压力、炎症或身体活动方面没有差异或数据不足。没有符合条件的研究考察心理行为干预对PWH血压、血脂或体重的影响。进一步投资于包括心理行为干预策略在内的更广泛的降低PWH心血管疾病风险的努力变得越来越重要。
