Control groups in randomized trials rarely get big play.
But the control group in a large trial aimed at HIV prevention appears to show that an eight-week program of health promotion increases healthy behavior, according to Willo Pequegnat, PhD, of the National Institute of Mental Health in Bethesda, Md., and colleagues.
The trial, first reported last year, showed that an eight-week education program reduced HIV transmission between members of African-American serodiscordant couples (in which one person is HIV-positive and the other is not).
That reduction was compared with a control group — similar couples who took part in a program aimed at improving health-related behaviors, including taking more exercise, eating better, and getting screened for some cancers.
That program — compared with the HIV intervention — also worked, Pequegnat and colleagues reported in the April 25 issue of Archives of Internal Medicine.
The issue of healthy lifestyles is important, the authors noted, because the success of HIV medications means more and more people are living long enough to develop chronic disease.
The issue is “particularly worrisome for the 48% of people living with HIV in 2007 who were African-American,” they noted.
For this analysis, the researchers looked at the efficacy of the program aimed at the 275 couples in the control group — a structured series of two-hour sessions designed to improve rates of physical activity, consumption of fruits and vegetables, fat consumption, use of breast and prostate cancer screening, and decreased alcohol use.
Compared with participants in the 260-couple HIV intervention arm, they found: Participants in the health promotion arm were more likely to report consuming five or more servings of fruits and vegetables a day. The rate ratio was 1.38 with a 95% confidence interval from 1.18 to 1.62. They were also more likely to follow physical activity guidelines. The rate ratio was 1.39 with a 95% confidence interval from 1.22 to 1.59. They ate fatty food less often. The rate ratio was 0.87 with a 95% confidence interval from 0.51 to 1.23. More men received prostate cancer screening and more women received a mammogram. The rate ratios were 1.51 and 1.26, respectively, with 95% confidence intervals from 1.21 to 1.88 and from 1.06 to 1.50. Alcohol use did not differ significantly.
The authors cautioned that the primary goal of the study was to examine HIV prevention, so that the current analysis had a limited number of outcomes that could be assessed.
As well, they noted, the outcomes were based on self-report, which can be subject to bias.
Nonetheless, the study results were impressive, according to Mitchell Katz, MD, from the Los Angeles Department of Health Services, who argued in an accompanying editorial that primary care is becoming the order of the day for HIV patients.
“Owing to the advances in HIV treatment,” he wrote, “our patients are no longer dying: They are aging!” and therefore need less specialized care and more primary care.
But, Katz noted, prevention is a central part of primary care, so that the intervention described by Pequegnat and colleagues is especially interesting.
He cautioned that serodiscordant couples are a highly specialized population, but added, “there is no reason to believe that (the) intervention would not work among other HIV-infected persons.”
The study should encourage other group health promotion classes, he wrote, “because, as I often tell my HIV-infected patients with diabetes, liver disease or uncontrolled hypertension, ‘It’s not HIV that’s going to kill you.’”
The study was supported by the National Institute of Mental Health.
The authors reported no conflicts.
Katz reported no financial disclosures.