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Dr.
Gregory Hand, PI
Oral disease resulting from opportunistic infectious agents
is among the earliest clinical manifestations of HIV
infection. These conditions affect the individual’s
quality of life and likely act synergistically in the
progression of the HIV infection. There is a growing
awareness of the value of stress management techniques in
controlling the stress-related exacerbation of HIV
immunosuppression. This immunosuppression appears to be
a primary mechanism for the high incidence of oral disease in
HIV infected subjects. Acupuncture has been shown to
reduce stress hormone levels and stimulate immune function in
animal and human studies. Nursing back rubs reduce
stress, significantly decrease salivary cortisol, and increase
salivary IgA in well elderly individuals. It follows
that acupuncture or nursing back rubs may be useful
therapeutically for reduction of stress, reduction of
HIV-associated immunosuppression, and enhanced oral health.
However, well-controlled studies examining the effects of
these treatments on stress and oral disease in HIV infected
patients have not been performed. We hypothesize that a
5-week regimen of stress-reduction treatments of either
acupuncture or nursing back rub, will significantly reduce the
oral manifestations of HIV including salivary
hypercortisolemia, decreased salivary IgA, and conditions such
as oropharyngeal candidiasis, hairy leukoplakia, aphthous
ulcers, and Herpes Simplex lesions. We further
hpothesize that acupuncture or nursing back rub will improve
mood and reduce self-reported stress levels in HIV+
individuals. The study will include thirty adults of
both genders with documented HIV+ serostatus, a T-cell count
of 500 or less (symptomatic or AIDS), and suffering from oral
manifestations of HIV. South Carolina currently ranks
sixth in the nation in incidence of new HIV cases and the
Columbia area ranks as the metropolitan area with the fourth
highest incidence of new cases (CDC 2000). These
statistics underscore the availability of potential
participants for the proposed study. Following informed
consent, subjects will be randomly assigned (10 per group) to
receive a standard stress-reduction acupuncture treatment
(Group A), a nursing back rub (group B), or participate as a
control with no treatment (Group C). Procedures will
consist of 45-minute treatments, two times per week for 5
weeks. Group C will meet using the same schedule but
will receive acupuncture in clinically non-relevant sites.
Before and following the 5 week treatment period, each subject
will participate in an analysis of mood state (POMS, a 65-item
self-administered measure), an analysis of stress level
(Perceived Stress Scale, a 14-item self-administered
instrument), an oral examination for manifestations commonly
observed with HIV infection, and analysis of salivary cortisol
and IgA levels. During the treatment period, a saliva
sample will be collected immediately before and 15 minutes
following therapy. In addition, each subject will
receive a short mood state analysis (POMS 30-item short form)
immediately following the therapy. Results from this
study should predict future research directions for relatively
inexpensive therapies for reduction of stress-related
conditions associated with HIV.
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