Pilot Randomized Controlled Trial of Acceptance-Based Behavior Therapy to Promote HIV Acceptance, HIV Disclosure, and Retention in Medical Care.

HIV patients who are not retained in medical care risk viral resistance, disease progression to AIDS, and mortality. Numerous interventions have been tested to improve retention, but they are limited by their resource-intensive approaches and lack of focus on new patients, who are at highest risk for drop-out. Data show that acceptance and disclosure of HIV status might impact retention, yet these variables have not been targeted in previous interventions. In this pilot randomized controlled trial, we assessed feasibility, acceptability, and preliminary efficacy of a brief, 2-session acceptance based behavior therapy (ABBT), relative to treatment-as-usual (TAU), in 34 new-to-care HIV patients. ABBT attendance was high and patient feedback was positive. Relative to TAU, ABBT had significant positive effects on retention, as well as putative mechanisms of action, including experiential avoidance of HIV, willingness to make and actual disclosures of HIV status, and perceived social support. Further testing of ABBT is warranted. Trial registered at clinicaltrials.gov; Clinical Trial #NCT02004457.

Association of caregiver health beliefs and parenting stress with medication adherence in preschoolers with asthma.

OBJECTIVE: This study examined the associations of parenting stress and caregiver negative health beliefs with medication adherence in a sample of preschool-aged children with asthma. METHODS: Participants included 43 caregivers and their child with asthma, aged 2-5 years, who were prescribed a preventative or controller medication. Assessment included parent report of parenting stress associated with parental characteristics and difficult child behavior, health-related beliefs, and adherence to inhaled corticosteroids (ICS). Pharmacy refill records were reviewed to measure medication adherence objectively. Statistical analyses included paired samples t-test and Pearson's correlation coefficients. RESULTS: Parent-report and objective measures of adherence to ICS were significantly different, with parents reporting significantly higher rates of medication adherence (p < 0.001). Also, increased caregiver negative health beliefs, but not parenting stress, were significantly and negatively associated with an objective measure of ICS adherence (p < 0.01). CONCLUSIONS: Because the findings for parenting stress are not consistent with that of the literature on school-aged children with asthma, our results may suggest that preschool children are a unique developmental group. A review of endorsed health beliefs also highlights strengths and concerns for caregivers of these very young children. Overall, our study findings underscore the importance of caregivers' health-related beliefs in promoting adherence to ICS in young children with asthma.

Chronic alcohol increases CD8+ T-cell immunosenescence in simian immunodeficiency virus-infected rhesus macaques.

Activated CD8+ T-cells correlate with viral load and may foretell antiretroviral therapy (ART) failure. HIV infection has been suggested to accelerate immunosenescence through chronic persistent inflammation. Alcohol-use disorders (AUD) are prevalent in persons living with HIV/AIDS (PLWHA). We tested the hypothesis that hazardous alcohol consumption accelerates immune activation and immunosenescence. Immune activation and immunosenescence were examined in CD8+ T lymphocytes (CD3+CD4-CD8+) isolated from intestinal biopsies, axillary lymph nodes, and peripheral blood mononuclear cells (PBMCs) of chronic binge alcohol (CBA)-consuming simian immunodeficiency virus (SIV)-infected male rhesus macaques with and without antiretroviral therapy (ART; CBA/ART+, CBA/ART-) and in PBMCs isolated from a cohort of PLWHA. Polychromatic flow cytometry was used to phenotype cells isolated from intestinal biopsies, lymph nodes, and peripheral blood from rhesus macaques and PLWHA. The Alcohol Use Disorders Identification Test (AUDIT) identified hazardous alcohol drinking in PLWHA. Viral load was determined by RT-qPCR and telomere length was measured using qPCR. PBMC CD8+ T-cell activation (CD38+HLA-DR+) and immunosenescence (CD28-) were increased over baseline levels (857% ± 334, p < 0.05; 398% ± 80, p < 0.05, respectively) only in CBA animals not receiving ART. Viral load correlated with CD8+ T-cell immunosenescence in macaque PBMCs (r(s) = 0.49, p = 0.02). Activated immunosenescent T-cell (CD8+CD38+CD28-) frequencies in PBMCs from PLWHA significantly correlated with AUDIT scores (r(s) = 0.75, p = 0.001), while no correlation was observed with CD4+ T-cell and AUDIT scores (r(s) = -0.24, p = 0.38). Activated immunosenescent T-cells had shorter telomeres than CD8+ T-cells (CD8+CD28+) from PLWHA. Our results suggest that CBA and AUD augment immune activation and immunosenescence in SIV-infected macaques and PLWHA.