Grief Therapy May Offer Tool to Fight HIV Infection

When HIV-positive gay men who have lost a partner or friend to AIDS receive grief therapy, the therapy, not surprisingly, benefits them psychologically. But could such therapy also counter the HIV virus in their bodies?

The idea sounds implausible, but there is mounting evidence that it is not. The evidence comes from Karl Goodkin, M.D., a professor of psychiatry at the University of Miami School of Medicine, and his colleagues. Goodkin is also a member of APA’s Commission on AIDS.

Several years ago, Goodkin and his coworkers undertook a study of 74 HIV-positive gay men who had lost a friend or partner to AIDS within the previous six months. One-half of these men received a 90-minute group grief therapy session weekly for 10 weeks, and the other half did not. The number of CD4 cells—the cells that help indicate the extent to which the HIV virus has compromised the person’s immune system—were measured in each subject both at the start of the study and at the end, and then compared.

The level of CD4 cells remained stable in those subjects who had gotten grief therapy but declined in the subjects who had not, the researchers reported in the May 1998 issue of Clinical and Diagnostic Laboratory Immunology.

Goodkin and his colleagues then launched another study. This time they focused on 36 HIV-positive gay men who had lost a partner or friend to AIDS within the previous six months, half of whom had received group grief therapy weekly for 10 weeks. The researchers then examined blood samples taken from each man before the start of the study and at the end to see how much HIV virus the samples contained since viral load, not CD4 cells, is the best lab predictor of long-term outcome with HIV. The investigators then compared the amount of HIV virus each man had at the start of the study with the amount he had at the end of the study, and then they compared viral-load changes in the grief therapy group with viral-load changes in the control group.

As the researchers report in the January/February Journal of Human Virology, the amounts of HIV virus in those men who received grief therapy tended to be about the same at the end of the study as at the beginning, whereas the amounts in those men who did not receive grief therapy tended to increase, suggesting that grief therapy appeared to contain HIV infection. And when viral-load changes in the grief therapy group were compared with those in the control group, a statistically significant effect of grief therapy on viral load was found, even when stage of disease and antiviral-medicine use were taken into consideration. (However, only 10 of the 36 subjects—28 percent—were using such medications, Goodkin pointed out in an interview.)

In any event, he and his colleagues recommend that a similar study with a larger number of subjects on antiviral drugs now be conducted, so that the apparently positive effect of grief therapy on the HIV virus can be more carefully evaluated apart from any antiviral-medicine effects on the virus.

Gail Ironson, M.D., Ph.D., a psychiatrist and psychologist with the University of Miami, has been researching the effects of religion on HIV-positive men (Psychiatric News, May 5, 2000). She is also familiar with this most recent investigation by Goodkin and his colleagues. It is the first randomized controlled clinical trial “to show an impact of stress management on the HIV virus, so I think it is a very important study,” she told Psychiatric News.

The study, “A Bereavement Support Group Intervention Affects Plasma Burden of Human Immunodeficiency Virus Type 1,” can be accessed on the Web at www.humanvirology.com. ▪