Infection with HIV is a chronic condition, requiring daily medication to suppress viral replication. Maintaining and adhering to antiretroviral therapy (ART) is extremely important in obtaining the best outcomes for person’s living with HIV (PLWH). Today, those living with HIV who adhere to a daily medication regimen have close to a normal life expectancy. However, knowing what affects medication adherence has the potential to improve outcomes. CU Anschutz Nursing faculty and students are recognized for their work in HIV research, and have recently published studies addressing a variety of issues affecting this population including fatigue, exercise and mental health. The following are highlights of recent work.

Published Articles and Studies

Nursing Considerations for Patients with HIV in Critical Care Settings

AACN Advanced Critical Care Volume 31, Number 3, pp. 308-317 © 2020 AACN

Lucy Graham, PhD, MPH, RN; Mary Beth Flynn Makic, PhD, RN, CCNS, FAAN, FNAP, FCNS

Maintaining Antiretroviral Therapy (ART) during critical care admissions is essential as it suppresses the virus and is critical for successful management of HIV infection. Unfortunately, many antiretroviral regimens result in drug interactions and adverse drug incidents. Stopping ART can have significant consequences, including future resistance to HIV treatment. By recognizing the difficulties of managing HIV along with additional comorbidities, critical care nurses can provide safe, unbiased and compassionate care that promotes health for HIV patients.

Body Composition Changes in Response to Moderate- or High-Intensity Exercise Among Older Adults With and Without HIV Infection

Journal of Acquired Immune Deficiency Syndrome, Nov. 2020

Catherine Jankowski, Samantha Mawhinney, Melissa P. Wilson, Thomas B. Campbell, Wendy M. Kohrt, Robert S. Shwartz, Todd T. Brown, Kristine M. Erlandson

People with HIV are at an increased risk for obesity and muscle loss, despite effective antiretroviral therapy. Exercise reduced total and visceral fat in older PWH and controls. Minimal gains in lean mass suggest that greater emphasis on resistance exercise may be needed to more effectively increase muscle in PWH.

The Impact of Moderate or High-Intensity Combined Exercise on Systemic Inflammation among Older Persons with and without HIV

Journal of Infectious Diseases, August 11, 2020

Kristine M. Erlandson, Melissa P. Wilson, Samantha Mawhinney, e. Rapaport, J Liu, CC Wilson, JT Rahkola, EN Janoff, TT Brown, TB Campbell, CM Jankowski

Exercise did not exacerbate inflammation and greater intensity and adherence to exercise improves physical function and may be associated with more beneficial changes in inflammation.

Physical Activity and Exercise to Improve Cardiovascular Health for Adults Living with HIV

Progress in Cardiovascular Diseases, 2020

C Ozemek, Kristine Erlandson, Catherine Jankowski

Although ART has contributed to a drastic increase in life expectancy for people living with HIV, the side effects of years of ART may contribute to the development of cardiovascular disease (CVD), which is significantly increased in this population and ultimately a major cause of mortality. Higher-intensity exercise appears to result in even greater health benefits without exacerbation of underlying immune dysfunction. Mounting evidence supports the positive effects combined aerobic and strength exercise.

Sensor and Survey Measures Associated With Daily Fatigue in HIV

Journal of Association of Nurses in AIDS Care, 2019

Makic, Mary Beth PhD, RN, CNS; Danielle Gilbert, BA; Catherine Jankowski, PhD; Blaine Reeder, PhD; Nasser Al-Salmi, RN, CNS; Whitney Starr, NP; Paul F. Cook, PhD*

Fatigue is the most common symptom of people living with HIV and remains a significant concern despite viral suppression. Studies show that fatigue reduces treatment adherence and in turn efficacy of ART, while increasing the risk of HIV transmission. Causes of fatigue may have many causes. This study used daily smartphone surveys and Fitbit data to characterize fatigue experiences and self-management behaviors. Research that clarifies the co-occurrence of fatigue with other symptoms, and the situations in which fatigue symptoms are most likely to occur can help patients and clinicians discover new options for symptom management. PLWH reported new insights into fatigue from self-monitoring, an interest in reducing fatigue, and a willingness to use self-monitoring technology. Thus presenting potential opportunities for PLWH to improve sleep, activity, or stress management to alleviate fatigue.

Comorbid Mental Health Disorders in Persons Living with HIV: Adherence to Antiretrovial Therapy

Archives of Psychiatric Nursing, 33(4), 364-370. August, 2019

Anna Smith, BS Honors student, Paul F. Cook, PhD

This study looked at factors that hinder and help promote good medication adherence among people who have both HIV and a mental health or substance use disorders. It found that PLWH who had reliable housing were over six times more adherent than those with unreliable housing.

Current Funded Study

High Intensity Exercise to Attenuate Limitations and Train Habits (HEALTH) in Older Adults with HIV, R01, National Institute on Aging

Principal Investigators: Kristine Erlandson, MD, A. Webel
Co-Investigator: Catherine M. Jankowski, PhD

The global aim of this study is to determine whether high-intensity interval training can overcome physical function and mitochondrial impairments in people aging with HIV infection to a greater extent than continuous moderate-intensity exercise and whether biobehavioral coaching promotes long-term adherence to physical activity.

Get to know Paul Cook, PhD, Associate Professor

Dr. Cook studies problems in health behavior change, such as medication adherence, self-management of chronic diseases, and preventing inappropriate opioid use. He brings to his research his background in clinical psychology and training as a psychotherapist. In 2012, he received an R21 grant from the National Institute of Nursing Research (NINR) that led to four papers on people with HIV – their everyday experiences and medication adherence.  Published from 2015-2018, the papers also incorporated Two Minds Theory (TMT​: http://2mindstheory.org) addressing human behavior and the reasons why people don’t do what’s good for them. In 2018, Cook published an elaboration of TMT that explains health behaviors based on an interaction between two separate mental health systems – intuitive and narrative. The intuitive system​ is deeply involved in the action of people's day-by-day lives, reacting to events and actually generat​ing behavior in the moment. The narrative system works more like a sports commentator, providing commentary about people's actions and intentions but not directly influencing the action on the field.  ​Although the intuitive system has a more direct effect on behavior, it's also harder to modify because it usually operates outside people's conscious awareness. Cook’s ​latest research therefore harnesses technology like sensors and in-the-moment text messages to bridge the gap between the two systems, helping people to change their behavior to improve their health.

	Featured Experts
Catherine Jankowski, PhD Professor	Paul Cook, PhD Professor	Mary Beth Makic, PhD, RN, CCNS, CCRN, FAAN, FNAP, FCNS Professor