CTNPT 029: Psychosocial intervention for older HIV+ adults with HAND

About The Study

CNTPT 029 tested the feasibility and acceptability of cognitive remediation group therapy in older adults living with HIV who have been diagnosed with HIV-associated neurocognitive disorder (HAND). The cognitive remediation therapy included tablet-based cognitive training and mindfulness-based stress reduction sessions.

About The Disease

Approximately half of the aging HIV-positive population will be affected by HAND, making cognitive impairment related to HIV a significant comorbidity in this population. With the development, access to, and early initiation of modern antiretroviral therapy (ART), HAND is less severe and less common than it once was. However, people who were treated with old therapies, ones that were less effective and with higher rates of toxicity compared to current regimens, or who experienced AIDS defining illnesses, may be affected by HAND more frequently and more severely. Issues with cognition, memory, processing new information, problem solving, and decision making are all potential symptoms.

Psychosocial interventions have been used to decrease stress and depression and improve coping and quality of life in the general aging population experiencing cognitive impairment and depression. These techniques, which can vary widely, have not been fully tested in people aging with HAND.

Study Approach

CNTPT 029 enrolled 12 people at St. Michael’s Hospital in Toronto. Study participants were randomized to either receive cognitive remediation group therapy (CRGT) or standard HIV group therapy (control group). Both group therapies consisted of a series of weekly 3-hour sessions led by a certified social worker and a peer. The CRGT group spent one hour per session on brain training exercises (PositScience Software) and the remaining two hours on mindfulness-based stress reduction (meditation, breathing exercises, etc.). The control group focused on general health and wellbeing for people aging with HIV. The study investigators aimed to determine the usefulness of the structure of the sessions and the feasibility and acceptability of performing a study of this kind.

Results

Participants in the CRGT group had statistically significant improvements in stress and mindfulness use compared to the control group. They also continued to use brain training and mindfulness at 3-month follow-up. Overall, the results of this pilot study show that group therapy may be feasible and acceptable to people aging with HIV and cognitive challenges. The results also suggest that combining mindfulness and brain training activities may be preferential to standard group therapy sessions. CTNPT 029 is the first pilot study of group therapy for people living with HAND and provides the necessary data for a larger trial to more definitively determine the effectiveness of CRGT.