Interventions for Symptom Management in Older Patients with HAND

Investigator: Victor Valcour, MD, PhD
Sponsor: NIH National Institute of Nursing Research

Location(s): United States


The proposed work will address symptom management for patients over age 60 who are living with HIV- infection, are on combination antiretroviral therapy (cART) with suppressed viral loads, and yet continue to experience behavioral and cognitive symptoms of HIV-associated neurocognitive disorders (HAND). It is increasingly relevant that HAND persists despite cART, impacting between 30-50% of elders living with HIV. Treatment trials for adjuvant therapies in such a setting have failed, including strategies aimed at increasing central nervous system penetration effectiveness (CPE) of cART. Patients suffer symptoms that are pervasive in their impact on everyday functioning and quality of life; yet these patients are currently left with a dearth of treatment options. In this applicaton, we propose that cognitive impairment in elders living with HIV is a geriatric syndrome - a clinical condition that does not fit discreetly into a disease category because it is driven by more than one disease process and occurs with greater frequency in old age. In response to PA-13-210, we propose a randomized controlled evaluation of Mindfulness Based Stress Reduction (MBSR) to target attention, stress, anxiety, and depressive symptoms among patients over age 60 who have HAND and have maximized treatment options. We will employ intrinsic connectivity network (ICN) analyses of resting state functional magnetic resonance imaging to demonstrate increased strength of brain networks corresponding to improved symptoms. We will quantify social networks and perceived strength of social networks to determine if they moderate our main findings. Together this work employs geriatric, neuroscience and complementary medicine disciplines to reduce the symptom burden in aging HIV-infected patients.