HIV-Positive? Start Meditating

Researchers at UCLA recently announced the results of a study of mindfulness medication among people with HIV. This isn’t the first team to look at the use of stress-reducing psychological and spiritual practices among people with HIV/AIDs. But it is the first team to look at the right outcome measure.

Studies of the impact of alternative and complementary therapies in immune-mediated diseases (chronic inflammatory processes, cancer, and HIV/AIDS) typically use mortality as the outcome of interest. You can make a good argument that this is fitting: avoiding death is, of course, the most ultimately meaningful outcome. However, using mortality as the outcome in studies of chronic, debilitating diseases is like saying that the best way to gauge the effectiveness of changing the oil in your car every 2,500 miles is whether or not it stops running in the next year or two. I don’t mean to trivialize the practice of mindfulness or being HIV-positive or having any other disease with this automotive analogy. I’m just trying to make a point about how loose the association often is between intervention and outcome in mortality studies — even though most try, with varying degrees of success, to control for some other factors that can influence mortality: age, comorbid conditions, stress levels, the use of antiretroviral therapy.

But, until now, no study has focused solely on clinically meaningful intermediate outcomes.

The UCLA researchers measured the impact of  mindfulness-based stress reduction (MBSR) on CD4 T lymphocyte levels. These cells are the ones that the human immunodeficiency virus slowly eradicates.

The researchers took a small population of ethnically diverse and stressed HIV-positive people and, by random selection, separated them into two groups. The control group went to a one day seminar on MBSR. The other group augmented the one-day session with weekly two-hour training sessions and daily home practice.

People who participated in the eight-week program showed no decline in CD4 T cells. In contrast, T cell levels in members of the control group continued to decline over the course of the study. The researchers controlled for key factors, such as whether the participants were also taking antiretroviral medications.

Other than the small population size (48), the study design sidesteps the criticisms that are often leveled at CAM (complementary and alternative medicine) related research: no random selection, no control group. In fact, the use of one day of MBSR as the control criterion (as opposed to no MBSR at all) is brilliant, because the study suggests a dose-response effect. As the lead author, David Creswell, noted in a UCLA press release,

The more mindfulness meditation classes people attended, the higher the CD4 T cells at the study’s conclusion.

Reference

CRESWELL, J., MYERS, H., COLE, S., IRWIN, M. (2008). Mindfulness meditation training effects on CD4+ T lymphocytes in HIV-1 infected adults: A small randomized controlled trial. Brain, Behavior, and Immunity DOI: 10.1016/j.bbi.2008.07.004