Implications of HIV treatment advances for behavioral research on AIDS: Protease inhibitors and new challenges in HIV secondary prevention.

Protease inhibitor combination therapies can reduce HIV viral load, improve immune system functioning, and decrease mortality from AIDS. These medical developments raise a host of critical new issues for behavioral research on HIV/AIDS. This article reviews developments in HIV combination therapy regimens and behavioral factors involved in these regimens and focuses on four key behavioral research areas: (a) the development of interventions to promote treatment adherence, (b) psychological coping with HIV/AIDS in the context of new treatments for the disease, (c) the possible influence of treatment on continued risk behavior, and (d) behavioral research in HIV prevention and care policy areas. Advances in HIV medical care have created important new opportunities for health psychologists to contribute to the well-being of persons with HIV/AIDS. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The radiology of the thoracic manifestations of AIDS

The thoracic manifestations of AIDS have undergone a gradual metamorphosis, partly due to more awareness about the disease leading to earlier diagnoses and partly due to the fact that research has produced more effective prophylaxis as well as treatment for these patients. Many patients now demonstrate partial or complete clinical response which prolongs the length and quality of life of individuals positive for the Human Immunodeficiency Virus (HIV+). Also, with the large number of infected individuals coming to medical attention, and the years of experience in diagnosing and treating these AIDS patients, we now recognize not only the usual but also less usual manifestations of thoracic illnesses in AIDS, including infections, non-infectious diseases such as HIV associated Lymphocytic Interstitial Pneumonia and the neoplasms associated with AIDS. A section will be devoted to HIV infection in children. We will finish the article with a discussion of the current role of Nuclear Medicine in the diagnosis of HIV associated thoracic diseases. These topics are the subject of this article.     

Identifying effective psychological treatments for insomnia: A meta-analysis.

Insomnia is a debilitating and widespread complaint. Concern over the iatrogenic effects of pharmacological therapies has led to the development of several psychological treatments for insomnia. To clarify the effects of these treatments, 66 outcome studies representing 139 treatment groups were included in a meta-analysis. The results indicated that psychological treatments produce considerable enhancement of both sleep patterns and the subjective experience of sleep. In terms of enhancing sleep onset, active treatments were all superior to placebo therapies but did not differ greatly in efficacy. Greater therapeutic gains were available for participants who were clinically referred and who were not regular users of sedative hypnotics. Future research directions are suggested. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Frequency and correlates of posttraumatic-stress-disorder-like symptoms after treatment for breast cancer.

Diagnosis of life-threatening illness now meets Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) criteria for traumatic stressor exposure for posttraumatic stress disorder (PTSD). Quality of life (QOL) and PTSD-like symptoms were assessed in 55 women posttreatment for breast cancer. PTSD symptom measures included the PTSD Checklist—Civilian Version (PCL-C) and the Impact of Events Scale. QOL was assessed using the 20-item Medical Outcomes Study Questionnaire. PTSD symptomatology was negatively related to QOL, income, and age. Time since treatment, type of cytotoxic treatment, and stage of disease were unrelated to PTSD symptoms. With suggested criteria for the PCL-C, 5% to 10% of the sample would likely meet DSM-IV PTSD criteria. Findings suggest that in survivors of breast cancer, these symptoms might be fairly common, may exceed the base rate of these symptoms in the general population, are associated with reports of poorer QOL, and, therefore, warrant further research and clinical attention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Protease inhibitor combination therapies and perceptions of gay men regarding AIDS severity and the need to maintain safer sex

BACKGROUND: Advances in the treatment of HIV disease with protease inhibitor combination therapies have been widely documented in the media. OBJECTIVES: To investigate perceptions concerning the severity of HIV/AIDS and the need to maintain safer sex practices in the light of recent HIV treatment advances. METHODS: A survey eliciting demographic characteristics, HIV serostatus and treatment information, and HIV/AIDS severity and safer sex perceptions was administered to a community sample of 379 homo-/bisexual men who reported awareness of combination therapy regimens. RESULTS: Ten per cent of all respondents agreed or strongly agreed with the statement that 'AIDS is now very nearly cured' and 13% felt that the threat of AIDS is less serious than in the past. HIV-positive men were more likely to perceive AIDS as a less serious threat or as very nearly cured. Overall, 8% of men in the sample indicated that they practice safer sex less often since new AIDS treatments came along; 18% of HIV-positive men on combination therapy regimens said they practice safer sex less frequently since treatments have advanced. Regardless of serostatus, nearly 20% of men indicated they would stop practicing safer sex if an AIDS cure was announced. CONCLUSION: It is essential to integrate behavior change counseling into HIV treatment programs and to temper optimism concerning treatment advances with recognition that the threat of HIV/AIDS remains great.     

Protease inhibitors and the new AIDS combination therapies: Implications for psychological services.

Practicing psychologists face many challenges in caring for people living with HIV infection, including keeping abreast of new treatments and their impact on the psyche. Highly active antiretroviral therapies, which include protease inhibitors, demand particularly strict adherence to cumbersome treatment regimens, potentially interact with psychotropic medications, are not universally accessible, and may lower vigilance against AIDS. The promises of new treatments are also not always realized, and treatment failures pose significant psychological ramifications. In keeping pace with the ever-changing AIDS epidemic, psychologists and counselors should be aware of the promises and the realities of advances in medical treatments for HIV infection. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

United Kingdom Cancer Research Campaign approach to quality-of-life research in cancer clinical trials

Clinical trials of new anticancer therapies form an important part of the research activity of the Cancer Research Campaign (United Kingdom), and quality-of-life (QOL) end points are being increasingly used in the evaluation of new treatment approaches. The Campaign has a unique policy of supporting a broad range of scientific and clinical research, including psychosocial studies, and thus QOL research is generated in a variety of clinical settings. The focus of interest for the Cancer Research Campaign lies in QOL design and assessment rather than the routine application of QOL protocols. Clinical investigators are free to adopt in individual approach, but the Campaign operates a strict peer-review system in protocol assessment. Some standardization of approach is being achieved through consensus of opinion and wide collaboration, both nationally and internationally.     

Physical activity and quality of life in multiple sclerosis: Possible roles of social support, self-efficacy, and functional limitations.

Objective: Quality of life (QOL) is compromised among individuals with multiple sclerosis (MS). Physical activity has been positively associated with QOL, but little is known about the factors that explain and/or confound the relationship in those with MS. On the basis of a social-cognitive perspective and previous research, the authors tested the hypothesis that physical activity would be indirectly associated with QOL through a mediated pathway that included self-efficacy and functional limitations, after controlling for perceived social support. Participants: Participants were 196 individuals with a definite diagnosis of MS living in the Midwest region of the United States who completed a battery of questionnaires and wore a pedometer and accelerometer for a 7-day period. Results: Covariance modeling analyses indicated that physical activity was indirectly associated with QOL through a pathway that included self-efficacy and functional limitations, and the pattern of relationships was independent of the perception of social support. Conclusions: The findings support physical activity as a possible modifiable behavior for mitigating reductions of QOL in those with MS and suggest that a social-cognitive model aids in the understanding of physical activity's relationships with QOL. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Quality of life after radical prostatectomy

In the past, radical prostatectomy commonly led to urinary incontinence and erectile dysfunction. In the last decade, new operative techniques have greatly reduced the complication rate and the operation has gained increasing popularity as treatment of choice for localized prostate cancer. Success or failure of radical prostatectomy has been reported not only in terms of disease-free survival, but in terms of patient attitudes to treatment and side effects. As physicians, we must remember that in presenting treatment options to patients it is important to emphasize both the quality and quantity of life that may result. With richer information on QOL in addition to duration of survival, patients will be able to make more informed decisions. Therefore, the QOL study will contribute patient self-report data to current treatment decision models that rely solely on physician estimates of patients' QOL and side effects following radical prostatectomy. We herein report the results of our recent QOL survey in men treated with radical prostatectomy, and briefly discuss QOL methodology.     

Longitudinal association between frequency of substance use and quality of life among adolescents receiving a brief outpatient intervention.

Recognition of the broad consequences of adolescent substance abuse has led to increased emphasis on balancing traditional measures of treatment effectiveness, such as frequency of substance use, with measures of patient functioning and quality of life (QOL). This study evaluated the longitudinal association between frequency of use and QOL among adolescent substance abusers receiving a brief outpatient intervention. Participants were 106 adolescents, aged 13 to 21 years, who met criteria for substance abuse or dependence and completed 4 assessments over a 12 month period. Results of a parallel-process latent growth curve model indicated a moderate longitudinal association, such that reduced frequency of use was associated with QOL improvement. Elaboration of the temporal ordering of this association via a cross-lagged panel model revealed that frequency of substance use predicted subsequent QOL, but that QOL did not predict subsequent frequency of use. Implications pertaining to the assessment of comprehensive outcomes and the setting of treatment expectations are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Introduction to the featured section: Pain—from mechanisms to management.

Over the past 30 years, health psychologists have been at the forefront of pain research. Behavioral and psychological research has not only led to new insights into the nature of the pain experience, it has also led to the development of new behavioral and psychological pain management protocols. Although many individuals who have chronic pain respond well to behavioral or cognitive-behavioral treatment protocols, there are individuals who show little or no response to these treatment regimens. Tailoring treatment plans for refractory pain sufferers requires that we go beyond simple, minor adjustments to our standard treatment protocols. Rather, we need to more carefully assess the fundamental mechanisms that underpin the pain experience of treatment-resistant patients and develop new treatment approaches that effectively address these mechanisms. What mechanisms are responsible for flares in pain or pain episodes? Are there specific underlying mechanisms that can explain the persistence of pain? Finally, are there mechanisms that can explain why some people who use specific coping strategies report reduced pain, while others do not? The three articles that are included in this featured section are important because they provide some indications of how we might begin to address some of these questions. All three studies address pain mechanisms, although each does so from a different perspective. For health psychologists working in the pain research area, the challenge for the future is to translate an enlightened understanding of pain mechanisms into new and more effective treatments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Critical values: ASCP practice parameter. American Society of Clinical Pathologists

During the past year progress has been made in our understanding of the pathogenesis of the dementia associated with the acquired immunodeficiency syndrome. As many as one-third of acquired immunodeficiency syndrome patients eventually develop this condition, and at present it remains only poorly or transiently treated by existing antiretroviral therapies which do not penetrate well into the central nervous system. The past year has witnessed further characterization of microglial/macrophage neurotoxins, increasing evidence for neuronal death by apoptosis, and a more quantitative search for viral products, surrogate markers, or magnetic resonance spectroscopic parameters of brain or cerebrospinal fluid, or both. An increased understanding that the mediation of neuronal injury is not by direct infection of neurons, but rather via a complex network of cytokines, excitotoxins, and free radical mechanisms triggered by human immunodeficiency virus-infected or immune-stimulated brain macrophages and astrocytes has led to the development of therapies that are administered adjunctively with antiretroviral drugs. Some of these potential new treatments have now entered clinical trials.     

Epilepsy in older adults: causes, consequences and treatment

OBJECTIVES: Seizures and epilepsy are common problems in older adults. Although, the highest incidence of seizures and epilepsy occurs in individuals more than 65 years of age, the magnitude of this public health problem, and its consequences on the quality of life of older adults, are not appreciated. Moreover, there is no consensus on the most appropriate way to diagnose or manage epilepsy in this population. This report reviews the current literature on all aspects of epilepsy in older people. DESIGN/METHODS: The medical literature was reviewed for all articles pertaining to pathophysiology, diagnosis, and treatment of epilepsy in older people. RESULTS: Epidemiology, etiology, diagnosis, use of diagnostic tests including EEG and imaging, new medical and surgical treatments, and psychosocial issues as they relate to older epilepsy patient are discussed. Several questions that merit future systematic investigation are presented. CONCLUSION: Seizures and epilepsy in older people are much more common than is generally known. There are unique issues related to this population with regard to diagnosis and treatment. Several new medical and surgical therapies are now available for all epilepsy patients, some of which may be helpful for the older epilepsy patient.     

Illness intrusiveness and quality of life in end-stage renal disease: Comparison and stability across treatment modalities.

Examined the impact of illness intrusiveness (ILI) on quality of life (QOL) in 99 patients with end-stage renal disease. Ss were interviewed twice, 6 wks apart, to determine differences in perceived ILI across treatment modalities, life domains, and time. Life domains were affected differentially across treatments. Perceived ILI correlated significantly with treatment time requirements, uremic symptoms, intercurrent nonrenal illnesses, fatigue, and difficulties in daily activities. Significant QOL differences emerged across treatment modalities for satisfaction/happiness and pessimism/illness related concerns but not for depression/distress. Perceived ILI correlated significantly with each of these QOL measures. Findings substantiate the construct of ILI as a mediator of the psychosocial impact of chronic, life-threatening illness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

AIDS treatment advances and behavioral prevention setbacks: Preliminary assessment of reduced perceived threat of HIV–AIDS.

Recent advances in AIDS treatment have brought renewed optimism for prolonging the lives of those infected with HIV. This article examined beliefs about how new treatments may reduce HIV transmission risk among 298 HIV-negative gay and bisexual men attending a gay pride festival. Results from an anonymous survey showed that men who practiced unprotected anal intercourse as the receptive partner (UAR intercourse) were younger, less well educated, and more likely to believe that it is safe to have UAR intercourse with an HIV-positive man who has an undetectable viral load and that new treatments for HIV relieve their worries about unsafe sex. As HIV treatments continue to advance, new challenges for HIV prevention will likely emerge. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Quality of life: A review of theory and practice implications for individuals with long-term mental illness.

Reviews quality of life (QOL) models and findings applied to individuals with long-term mental illness as an illustration of approaches to QOL methodologies and models. Gap-discrepancy theories are discussed, and life satisfaction and adaptive functioning models of QOL and measurement instruments related to these models are described. QOL represents a viable means of investigating the subjective well-being of individuals with chronic mental illness. Despite psychiatric symptomatology, measuring QOL or subjective well-being represents a viable means of measuring client change or program outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Exercise therapy for patients with psychiatric disorders: Research and clinical implications.

There is now considerable evidence that regular exercise is (a) a viable, cost-effective, but underused treatment for mild to moderate depression that compares favorably to individual psychotherapy, group psychotherapy, and cognitive therapy, and (b) a necessary ingredient in effective behavioral treatments that reduce self-reported pain in individuals with chronic pain. Preliminary evidence also suggests that regular exercise deserves further attention as (a) a singular treatment for some anxiety disorders, for individuals suffering from body image disturbance, and for the reduction of problem behavior of developmentally disabled persons, and (b) an adjunct in treatment programs for schizophrenia, conversion disorder, and alcohol dependence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Chemokine receptors--future therapeutic targets for HIV?

To date, triple drug therapies for HIV have resulted in spectacular reductions in the number of virus particles and often remarkable recovery from disease in infected people. There is still, however, a great need for improved therapies. A battery of drugs aimed at different stages in the life cycle of HIV will enable switching of treatments if resistant viruses emerge or if patients are unable to tolerate particular therapies. Intense efforts are now underway to produce drugs that target chemokine receptors used by HIV to gain entry into cells. HIV needs two receptors on the host cell surface for efficient attachment and infection. HIV first interacts with CD4 but requires a coreceptor to penetrate the cell membrane. The first coreceptor, identified in 1996, is a member of the family of chemokine receptors, members of the G-protein coupled 7TM superfamily, which are involved in the trafficking of leukocytes in immune surveillance and inflammation. Such a therapeutic approach would differ from those used successfully to date, which focus largely on proteins coded by the HIV virus itself, and which are required for the replicative cycle of the virus. Many small, orally bioavailable molecules that block various 7TM receptors are used to treat a panoply of diseases including ulcers, allergies, migraines, and schizophrenia. These molecules are the cornerstone of the pharmaceutical industry's contribution to the fight against so many diseases, and it is hoped that a small molecule inhibitor of coreceptors can be developed that will become an invaluable drug in the fight against AIDS.     

A new assessment of quality of life (QOL) for cancer patients

A new assessment of quality of life (QOL) was made for cancer patients. The QOL assessment consists of 12 items: pain; nausea; constipation; general fatigue; sleep; eating; activity; a daily life pattern; conversation; treatment acceptability; satisfaction at the present status and family exhaustion. Ranges of scores are one (best) to five (worst). For visual expression of QOL, the author made an original method called "QOL diagram", drawn with a circle which has 12 diverging lines marked five points indicating the score for each item. QOL changes after cancer pain control with either oral or intravenous morphine were examined in 22 adult cancer patients by the QOL assessment. Laxatives and anti-nausea drugs were mostly prescribed at the same time in order to avoid side effects of morphine. QOL was evaluated and recorded by the author through an individual interview with each patient. It was observed that the psychological factors were improved along with pain relief. Although items such as general fatigue, nausea, constipation, sleep and eating did not change considerably at first, they improved well with time in the oral morphine group. On the other hand, there was no marked time-dependent change in the intravenous morphine group. Items such as activity, a daily life pattern and conversation were rather negative than positive. These items seem to be more important to improve QOL of the cancer patients, in particular, whose general status is relatively good. In conclusion, the QOL diagram helped us to follow subtle changes of status and needs of cancer patients. And it enables us to easily assess risks and benefits of the treatment plans including palliative care and home supportive programs. It is designed for both patients and medical staffs to use easily and repeatedly. However, the further evaluation and refinement will be needed to verify validity and reliability of the QOL diagram before a routine clinical application.