Healthy Behaviors for Insomnia Prevention in People with HIV and Ongoing Pain (the HIP HOP study)

Washington University, Saint Louis MO

Investigators

Abstract

PROJECT SUMMARY Advancements in antiretroviral therapies have helped people with HIV (PWH) achieve longer life expectancies. Unfortunately, PWH still experience earlier onset and increased rates of aging-associated comorbidities. Sleep disorders and chronic pain are underappreciated age-associated comorbidities that PWH report being especially detrimental to their quality of life. Our recent work demonstrated that insomnia is significantly associated with enhanced experimental pain sensitivity, greater severity of bodily pain, and poor quality of life in PWH. Insomnia severity was also associated with a faster pace of biological aging in PWH as demonstrated by the DunedinPACE DNA methylation biomarker. Chronological aging simply reflects the rate of time passed since birth and is the same for all people. Biological aging reflects the decline in physiologic function resulting from the deterioration of molecular and cellular functions, which can vary widely across people. PWH often experience a faster pace of biological aging that exceeds chronological aging, which may help explain the excess burden of age-associated health comorbidities in this highly affected population. We recently published the results of a pilot study demonstrating that a non-pharmacologic intervention for sleep known as Brief Behavioral Treatment for Insomnia (BBTI) delivered via telephone was not only feasible to implement but also reduced insomnia and pain severity in PWH. These preliminary findings await confirmation via an adequately resourced and powered clinical trial. Therefore, we propose a clinical trial titled, “Healthy Behaviors for Insomnia Prevention in People with HIV and Ongoing Pain (the HIP HOP study)”, to be conducted in PWH with comorbid insomnia and chronic pain. This study will test whether a four-week course of telephone-based BBTI can significantly 1) improve sleep quality, 2) decrease experimental pain sensitivity and clinical pain severity, 3) improve quality of life, and 4) slow the pace of biological aging by assessing these variables at baseline, upon treatment completion, and at 3 months follow-up. There is often substantial variability in treatment responses for clinical trials with a behavioral intervention, like BBTI. Social impacts on health may help explain this variability. Neighborhood social environments (disorder, safety, and social cohesion) and sleep environments (noise, light, and comfort) may influence how PWH respond to BBTI. Relatedly, neighborhood disorder is associated with poorer sleep quality, greater bodily pain severity, poor quality of life, and a faster pace of biological aging in PWH. The HIP HOP study will also determine whether social environmental factors assessed at baseline influence how PWH respond to BBTI. Brief Mindfulness Training (BMT) will be included as an active control condition against which to compare the effects of BBTI. This study is significant because results will help solidify telephone-based BBTI as an efficacious and scalable sleep intervention for PWH while also elucidating whether pain improves, and the pace of biological aging slows.