Division of Clinical Care and Research

Lydia R. Temoshok, Ph.D.
Director of Behavioral Medicine Program, Institute of Human Virology, UMBI
Professor of Medicine, University of Maryland School of Medicine, Baltimore
Adjunct Professor, Department of Psychology and Behavioral Sciences, University of Maryland Baltimore County
temoshok@umbi.umd.edu

Psychoneuroimmunologic factors and mechanisms in HIV progression

• Currently funded by NIH grant (10-04 to 10-09, PI: Temoshok), Elucidating the biopsychosocial mediators of HIV progression.
• The study's aims are to: (1) extend our group's previously observed relationships between HIV progression and lower production of specific ß-chemokines that bind to the CCR5 HIV co-receptor, and between HIV progression and dysfunctional psychological
  (Type C) and physiological (heart rate/ blood pressure reactivity and recovery) coping with stress; (2) test within a single 48-month longitudinal study the core hypothesis that lower ß-chemokine production (specifically MIP-1a/ ß) mediates the relationship between Type C coping and HIV progression; and (3) test the secondary hypothesis that dysregulated cardiovascular reactivity may mediate or moderate the relationships between Type C coping, immune dysfunction, and disease progression.
• Status: Preliminary analyses on baseline data for N = 100 (ultimate N = 200) demonstrated strong support for hypothesized relationships between higher Type C coping and lower production of HIV-inhibiting ß-chemokines, and between dysregulated cardiovascular stress reactivity/ recovery (i.e., higher reactivity and slower recovery) and lower ß-chemokine production.

HIV secondary prevention: assessment of transmission risk and preventive interventions

• Currently funded by CDC/DHMH grant (10-04 to 10-09, PI: Temoshok), Integrating HIV prevention in primary care settings serving HIV positive individuals, and subcontract to conduct the same clinical study in the HIV/AIDS Program, Prince George's County Health Department.
• The project's aims are to: (1) extend our group's previously documented findings in the same outpatient primary care clinic (N = 131) of clinically significant levels (~ 35%) of inconsistent condom use, and non-disclosure of HIV status to partners; (2) extend our group's previous study of psychosocial and sociodemographic predictors of transmission risk behaviors using the same Transmission Risk Assessment (TRA) and Non-adherence Risk Assessment we have developed and/or adapted from our previous large-scale surveys, and validated in this inner-city, largely African American population; (3) develop an evidence- based prevention intervention that can be individually tailored, based on the risk factors identified by the TRA; (4) implement this intervention in primary care settings using highly experienced behavioral medicine specialists, and (5) evaluate the efficacy of this intervention in reducing transmission risk-relevant behaviors, including reducing nonadherence to HIV medications (which increases the likelihood of transmission because of higher viral loads, as well as the probability of transmitting drug-resistant viral strains).
• Status: We have developed an innovative intervention, consisting of 8 prevention modules (education on HIV infection, transmission, and treatment; partner /family disclosure; sexual negotiation skills; behavioral skills training; coping with stress; domestic and sexual violence; medication adherence; community support of positive behavioral norms), and produced an intervention manual which includes additional handouts and materials. We have implemented and integrated the project in two sites (Baltimore and Prince George's County), conducting risk assessments, and individualized one-on-one as well as group-level interventions to patients referred by their medical providers to the project.

Adherence to HIV medications: Predictive factors

• Currently funded by a grant from Bristol-Myers-Squibb (1-05 to 1-07, PI: Temoshok), Patient coping styles, adherence, and medical outcomes.
• The project's aims are to: (1) extend our group's previous findings in outpatient samples (N = 131; N = 70) using the Non-adherence Risk Assessment (which we developed and validated in this inner-city largely African American population), of significant risk factors for poorer adherence to HIV medications, including severity of life stressors, depressive symptoms, social instability, heroin or cocaine use, and mistrusting/ lacking confidence in one's doctor or medical care provider (we previously found but are not testing in this study the significant relationship between poorer adherence and feeling unforgiven by important others regarding HIV/AIDS); (2) evaluate adherence in 100 outpatients and 300 inpatients, about whom little has been reported in the literature, drawn from the same disadvantaged inner-city community; (3) evaluate the relationship between adherence to HIV medical regimens at baseline and adherence/ medical status 6 months later and four different styles of coping with HIV and its medical treatment (thriving, silent coping, emotionally despairing, and alienated avoiding), originally assessed in a questionnaire developed by BMS, and additionally assessed in this study using Temoshok's Vignette Similarity Rating Method, adapted to assess these coping styles.
• Status: Findings presented in March, 2006 (157 inpatients, 99 outpatients) indicated that HIV-positive inpatients are at uniquely high risk for non-adherence to anti-retroviral therapy (ART). Compared to outpatients, inpatients missed almost 4 times as many doses of ART in the previous week, had significantly lower CD4+ counts at baseline, reported more psychiatric symptoms, greater social instability, more severe life stressors, poorer neurocognitive functioning (brief screening test), and more use of heroin or cocaine (in the 30 days prior to baseline). Inpatients were also significantly less likely to be engaged in healthcare and to report having a regular HIV doctor. Among the 75 patients who completed 6-month follow-up, former inpatients were significantly less likely to have been on ART during the follow-up period, despite their initially more progressed HIV status.

Clinical Trials