The Effect of a Mind-Body Intervention on Mental Health and Coping Self-Efficacy in HIV-Infected Individuals: A Feasibility Study.

OBJECTIVES: Human immunodeficiency virus (HIV) infection is a stressful disease, and depression is the most common form of psychologic distress experienced by those infected. The aim of this study was to further develop and validate a mind-body intervention to improve coping self-efficacy strategies and increase mental health. DESIGN: Feasibility study, a randomized trial. Participants were assigned into two blocks (female/male) and simple randomization in a 1:1 ratio was performed within each block to one of two arms (1) intervention group, (2) control group who received usual care. Setting/Location and Subjects: The authors enrolled 30 HIV-infected individuals (10 women and 20 men) who had psychologic challenges and were motivated for working with personal development at the Department of Infectious Diseases at Aarhus University Hospital, Denmark. INTERVENTION: The intervention was a group intervention facilitated by an educated coach. The framework was a 3-day residential course plus two single-day/8-h follow-up events. The intervention was based primarily on a Native American philosophy of life and its understanding of how changes affect human beings and create imbalance. OUTCOME MEASURES: Primary outcomes were change in risk of depression and level of coping self-efficacy. Secondary outcomes were change in levels of stress and personal growth. RESULTS: Significant improvement between the intervention group and control group was seen in risk of depression and personal growth mean values from baseline to 6-month follow-up. Significant improvements were shown within the intervention group in mean values of risk of depression, coping self-efficacy, stress, and personal growth. There were no significant improvements within the control group. CONCLUSIONS: The authors suggest that interventions designed to increase resilience through enhancing coping self-efficacy be used in conjunction with HIV medication to make this approach and especially the "whole-person" commitment a fully integrated aspect of HIV care.

Reproductive patterns and fertility wishes among HIV-infected patients: survey from six outpatient clinics in Denmark.

OBJECTIVES: Reproductive patterns among HIV patients in Denmark have not previously been described. We aimed to uncover the fertility wishes among Danish HIV-infected persons. METHODS: A cross-sectional questionnaire survey was done at six outpatient HIV clinics in Denmark. A total of 409 (56%) HIV patients returned the questionnaire; 323 had completed the questionnaire, although they had not all responded to all of the questions. RESULTS: Among HIV-infected individuals, 49% (137/280) had their own biological children. Fifteen percent (43/280) desired (additional) children and 15% (43/280) were undecided. Female gender, birth outside Europe, young age, completed high school education, heterosexuality, present partner, and non-disclosure were associated with a desire for children in the univariate analysis. In the multivariate analysis only young age, heterosexual orientation, and non-disclosure were significant. Thirty-seven percent (93/250) felt that HIV infection was a hindrance to having more children. The most common reasons indicated were fear of HIV transmission to the child (24%, 59/244) and to the partner (16%, 40/244). CONCLUSIONS: Many HIV-infected patients have children and a substantial proportion of HIV-infected patients desire (additional) children, although there is a high degree of fear of HIV transmission to their partner or child. This highlights the need for care providers to improve the services provided to HIV-infected patients who desire to have children.

Changes in depression in a cohort of Danish HIV-positive individuals: time for routine screening.

BACKGROUND: The aim of this study was to follow a cohort of HIV-positive individuals for 3 years in order to assess changes in depression, adherence, unsafe sex and emotional strains from living with HIV. METHODS: Participants were assessed for depression, adherence, emotional strain and unsafe sex via a questionnaire. The Beck Depression Inventory II (BDI) was used to assess the prevalence and severity of depressive symptoms. Patients with a BDI score of 20 or above (moderate to major depression) were offered a clinical evaluation by a consultant psychiatrist. RESULTS: In 2005, 205 HIV-positive individuals participated in the study. Symptoms of depression (BDI >14) were observed in 77 (38%) and major depression (BDI ≥20) in 53 (26%) individuals. In 2008, 148 participants were retested (72% of original sample). Depression (BDI >14) was observed in 38 (26%) and symptoms of major depression (BDI ≥20) in 24 (16%) individuals. Patients at risk of moderate to major depression were more likely to be non-adherent to medications, to practice unsafe sex and to suffer from emotional strains compared with patients not at risk of depression, both at baseline (2005) and follow-up (2008). CONCLUSION: This study demonstrated a decline in depression scores over time and an association between the risk of depression and low medication adherence, stress and unsafe sex. We recommend routine screening for depression to be conducted regularly to provide full evaluations and relevant psychiatric treatment.

HIV late presenters in Denmark: need for increased diagnostic awareness among general practitioners.

INTRODUCTION: The study objective was to describe demographic and clinical characteristics among HIV late presenters in a Danish university hospital. MATERIAL AND METHODS: Patients > 15 years of age were enrolled in this retrospective study. Data from the medical patient records were analyzed in accordance with the CD4 count at the time of HIV diagnosis. RESULTS: Among 194 HIV patients (138 men and 56 women), 63 (33%) were diagnosed with a CD4 count below 200 cells/microlitre (late presenters). Heterosexuals constituted a larger proportion of patients in the late presenter group than did homosexual men (MSM) (p = 0.02), whereas a higher proportion of MSM than heterosexuals were diagnosed with HIV during primary infection (p < 0.01). Half of the late presenters had consulted a general practitioner three to 12 months prior to their HIV diagnosis. HIV antibody testing had not been performed although complaints consistent with possible underlying immune deficiency had been reported. Twenty per cent of the late presenters had a persistently low CD4 count below 200 cells/microlitre at follow-up despite having received HAART therapy for more than two years. CONCLUSION: One third of the HIV patients in this study were diagnosed as late presenters, and this group featured a higher proportion of heterosexuals than of MSM. The HIV antibody test should be performed more consistently on solid clinical ground by general practitioners.

[Assisted reproduction for HIV discordant couples]. / Assisteret reproduktion ved HIV-infektion.

INTRODUCTION: In Denmark assisted reproductive treatment to HIV discordant couples is offered in order to minimize risk of horizontal transmission of virus. MATERIAL AND METHODS: The outcome of 24 HIV-seropositive couples referred with a wish for parenthood to Aarhus University Hospital, Skejby, between September 1999 and December 2007 was reviewed on the basis of prospectively collected data. A total of 18 couples were offered treatment. RESULTS: In all, eight couples achieved 17 pregnancies, six by home-insemination, ten by homologous intrauterine insemination, and one spontaneously. Neither horizontal nor vertical infection occurred. CONCLUSION: Our study confirms that insemination is a good first-choice treatment in respect to chance of pregnancy and risk for virus transmission in HIV-seropositive couples in cases without indication for IVF.