Miami Research: Counseling Weakens HIV
By Christine Morris
Originally published in The Miami Herald, March 3, 2001
Intensive grief therapy significantly reduced the amount of the AIDS virus in gay men who had lost a partner or close friend to the disease, researchers at the University of Miami have found.
The study is the first to show that behavioral intervention can actually affect the HIV viral load, the most important measure of the severity of the disease.
Dr. Karl Goodkin, the UM psychiatrist who directed the study, found that men who attended 10 specially designed group counseling sessions were markedly healthier, as measured by the number of copies of AIDS virus RNA in their blood.
"I'm extremely excited,'' said Dr. Alberto Avendaño, director of HIV services in UM's Department of Family Medicine. "From now on every single doctor treating HIV—and many other serious diseases—should think hard about helping patients with their mental health so the outcome of the treatment will be better.
"It's not enough just to give people pills,'' he said.
For John Walker, who cared for his partner during the final excruciating years of his life, the bereavement group was a welcome opportunity to share a horrific experience.
"When my friend died, I went through hell,'' said Walker, 48, who works in information systems at the UM/Sylvester Comprehensive Cancer Center. "He got every disease HIV throws at you.''
Few people in the counseling groups, recruited between 1992 and 1995, were taking the drug combinations that have made many AIDS patients' viral loads undetectable in recent years. The drugs were too new, the patients too jaded.
"At that time, we all thought we were dying,'' said Walker, who had just begun a drug cocktail and has since returned to good health. "I didn't see anybody in that group who didn't want to die. They had seen how the disease progressed, and they knew they would go through the same thing.
"I probably would have been dead if I hadn't done that study.''
GRIEF LINK
Research at UM and elsewhere has shown a link between grief and impaired functioning of the immune system. "When you are depressed, when you are having trouble, your immune system goes down,'' Avendaño said.
In fact, earlier UM studies of the HIV patients had shown that those who participated in the special grief therapy retained vital disease-fighting cells. They also made fewer visits to the doctor.
The counseling sessions, which covered 10 different topics, encouraged crying and venting, figuring out how to face the future, and learning ways to deal with stress in general. Researchers have learned that stress can exacerbate many illnesses, including high blood pressure, diabetes, asthma, migraine headaches and some cancers.
The stress of caring for their dying partners and friends had drained the study participants. "I lost a lot of friends,'' Walker said.
ADDED THERAPY
Goodkin said the study results, published in the latest Journal of Human Virology, suggest that group therapy would be a valuable addition to the antiretroviral therapy that has been so successful at controlling the disease in recent years. Although loss clearly affects HIV-positive patients' health, Goodkin said, few doctors ask if they have experienced a loss. "Why aren't we paying more attention to death and dying?'' he asked.
The original studies involved 119 men who had lost a partner or close friend within the past six months. They were divided into two groups: one receiving the intensive therapy, and one getting help in a community program.
MEASURING CELLS
With funding from the National Institute of Mental Health—a branch of the National Institutes of Health—the researchers measured the number of CD4 cells in the participants' blood before the sessions, immediately after they ended, and six months later.
At the time, infection-fighting CD4 cells were the primary indicator of the progression of the disease.
The study found that among men with the AIDS virus, CD4 counts remained stable for those in intensive therapy. Those who did not get the UM counseling showed a continued decline in CD4 levels.
The researchers also created a stockpile of all the blood samples.
When viral load became the most important measure of HIV infection, Goodkin wanted to find out if the therapy could affect the virus itself as well as the health of the patient's immune system.
Thirty-six participants were randomly selected from the study group, and the viral load of their blood samples was tested.
Controlling for other factors that can affect the level of the virus—including medications and the stage of the disease—the researchers found significant decreases.
The changes were high enough to reflect a marked improvement in the patients' well-being.
Not to mention, of course, a dramatic improvement in psychological outlook. "People who were ready to talk were able to help others,'' said Goodkin, who is now studying whether intensive therapy can similarly help women who have lost spouses, friends or children to AIDS. "You have your own peers experiencing the same stress helping you overcome it.''
