A bereavement support group intervention is longitudinally associated with salutary effects on the CD4 cell count and number of physician visits

Abstract

A randomized, controlled, clinical trial was conducted to examine the impact of a semistructured, 10-week, once weekly, 90-min/session bereavement support group intervention on immunological, neuroendocrine, and clinical health status in human immunodeficiency virus type 1-seropositive (HIV-1+) and HIV-1-seronegative (HIV-1-) homosexual men, compared to a standard of care control condition. A total of 119 homosexual men (74 HIV-1+ and 45 HIV-1-) were assessed at baseline, 10 weeks, and 6 months follow-up. At the 6-month follow-up assessment, the intervention groups exhibited significant beneficial effects compared to controls on changes in CD4 cell, total T-lymphocyte, and total lymphocyte counts, when baseline levels, antiretroviral medication use, CDC stage of disease, and other potentially confounding factors were accounted for. There was no statistically significant effect on the CD4/CD8 ratio or on the CD8 cell count. The effect on CD4 cell count was associated with group attendance and with changes in plasma cortisol level. Plasma cortisol levels decreased significantly among intervention subjects, compared to controls. A significantly reduced number of health care visits over the 6-month follow-up period among the intervention subjects supported the clinical relevance of the immunological changes observed for both HIV-1+ and HIV-1- individuals. These results indicate that behavioral interventions may have salutary immunological and clinical health effects following bereavement among HIV-1-infected individuals. The effect in HIV-1- individuals suggests that this bereavement support group intervention might have similar salutary effects in the general population. Potential effects of such interventions on clinical HIV disease progression are of interest and should be studied.

FIG. 1

CD4 cell count, plasma cortisol level, and health care utilization change in HIV-1⁺ and HIV-1⁻ individuals. (A and B) Regarding the CD4 cell count outcome, among HIV-1⁻ intervention subjects (A), the mean CD4 cell count increased progressively, whereas for HIV-1⁻ control subjects there was a progressive decrease. For HIV-1⁺ subjects (B), the mean CD4 cell count was higher at baseline (statistically controlled herein) among control subjects than among their intervention counterparts. However, the change in CD4 cell count reflected a decrease overall among control subjects, whereas for HIV-1⁺ intervention subjects the CD4 cell count remained stable. (C and D) Regarding plasma cortisol level, among HIV-1⁺ intervention subjects (D) mean plasma cortisol level stabilized initially postintervention and then decreased at 6 months, while the mean of HIV-1⁺ control subjects increased at T2 and again, though less substantially, at 6 months. In HIV-1⁻ intervention subjects (C), unlike their HIV-1⁺ counterparts, mean plasma cortisol levels initially decreased postintervention, a change that was essentially maintained at 6 months. The HIV-1⁻ control subjects showed a pattern similar to their HIV-1⁺ counterparts, with an increase in the mean at T2 and again, though less substantially, at T3. (E and F) Regarding the clinical outcome on health care visit utilization, among HIV-1⁺ control subjects (F) mean health care visit utilization increased, whereas for HIV-1⁺ intervention subjects there was a smaller, progressive increment. Among HIV-1⁻ subjects (E), a similar pattern of change in the mean number of health care visits was observed. For all panels, standard errors are shown by vertical bars.