Randomized controlled trial of mindfulness-based stress reduction delivered to human immunodeficiency virus-positive patients in Iran: effects on CD4⁺ T lymphocyte count and medical and psychological symptoms

Abstract

Objective: To evaluate the immediate and long-term effectiveness of mindfulness-based stress reduction (MBSR) on biological and symptomatological markers of health among human immunodeficiency virus-positive (HIV+) patients in Tehran, Iran.

Methods: Using a randomized controlled trial design, data from 173 HIV+ patients (CD4 count > 250) not yet receiving antiretroviral therapy, who participated in either an 8-week MBSR (n = 87) or a brief education and support condition (n = 86) at the Imam Khomeini Hospital, were analyzed. Assessments included CD4 count, Symptom Checklist-90-Revised (SCL-90R), and Medical Symptom Checklist (MSCL) at baseline, immediate post-treatment, and at the 3-, 6-, 9-, and 12-month follow-up periods.

Results: The treatment-adherent sample had a mean (standard deviation) age of 35.1 (6.5) years and 69% were male. Linear mixed-model estimates indicated that, in the MBSR condition, the mean CD4 count increased from baseline up to 9 months after treatment and then returned to baseline level at 12 months. Improvements in mean SCL-90R (up to 6 months) and MSCL (up to 12 months) scores were observed for the MBSR condition, whereas education and support condition scores remained the same over time; however, only MSCL improvements significantly differed between groups and these changes lasted up to the final assessment.

Conclusions: Findings suggest that among treatment-adherent Iranian HIV+ patients not yet receiving antiretroviral drug treatment, MBSR seems to have the strongest potential to improve self-reported medical symptoms.

Trial registration: Iranian Registry of Clinical Trials: IRCT201106084076N2.

Figure 1

Flow of participants through study Notes. ^aexcluded due to post-traumatic stress disorder (n=9), active substance addiction (n=14), comorbid post-traumatic stress disorder and active substance addiction (n=6), lack of time (n=9), and CD4 < 250 (n=11);^bmissed >2 treatment sessions due to lack of time (n=25), and family commitments (n=8); ^cmissed single treatment session due to lack of time (n=27), family commitments (n=7), and illness (n=5)

Figure 2

Estimated marginal means(SE) for CD4+ count across time by treatment condition Notes. SE = standard error; Time 0 = baseline, 2 = immediate posttest, 3 = 3 months post-intervention, 6 = 6 months post-intervention, 9 = 9 months post-intervention, 12 = 12 months

Figure 3

Estimated marginal means(SE) for SCL scores across time by treatment condition. Notes. SE = standard error; Time 0 = baseline, 2 = immediate posttest, 3 = 3 months post-intervention, 6 = 6 months post-intervention, 9 = 9 months post-intervention, 12 = 12 months

Figure 4

Estimated marginal means(SE) for MSCL scores across time by treatment condition Notes. SE = standard error; Time 0 = baseline, 2 = immediate posttest, 3 = 3 months post-intervention, 6 = 6 months post-intervention, 9 = 9 months post-intervention, 12 = 12 months