Positive Living with HIV (POLH) study cohort produces wealth of findings on the struggles of HIV-positive individuals in the Kathmandu Valley, Nepal

January 22, 2015

In February 2010, Associate Professor of Community Health Education Krishna Poudel and Kalpana Poudel-Tandukar, an adjunct faculty member in the UMass Amherst School of Public Health and Health Sciences, set out to recruit a group of HIV-positive individuals living in the Kathmandu Valley, Nepal with the aim of improving the health status of HIV-positive individuals. The pair planned to address multiple risk behaviors and co-morbidities first bymeasuring the prevalence of risk behaviors and co-infections and examining their associations with mental health, disease progression, and mortality, and then by designing and testing culturally appropriate behavior change interventions. At the time, they were both living and working in Tokyo and envisioning the first steps in the creation of a longitudinal study they called the “Positive Living with HIV” (POLH) study. Soon, that study would pay off with a wealth of research findings.

Poudel drew on his years of experience of conducting research studies among HIV-positive individuals and other populations in the Kathmandu Valley region, to garner the cooperation and support of five non-governmental organizations (NGOs) working with an HIV-positive population: Shakti Milan Samaj, Sneha Samaj, SPARSHA Nepal, Srijansil Mahila Samuha, and Youth Vision. Together with the help of the five collaborating NGOs, the researchers recruited a cohort of 322 HIV-positive individuals.

The cohort study is now producing a wealth of findings with the potential for improving the health outcomes of HIV-positive individuals. A large variety of behavioral, health, and biologic information collected both at baseline and in follow-up surveys is allowing the team for multiple lines of research in a variety of important issues: depression and family support; the effectiveness of intervention studies; dietary or serum micronutrients and disease progression; dietary or serum micronutrients and mental health; as well as co-infection rates of sexually transmitted infections and Hepatitis C among the HIV-infected population. Together Poudel, Poudel-Tandukar, and their colleagues, along with graduate students under their supervision, have accounted for nine papers and abstracts published in peer-reviewed journals, and another twenty presentations at major conferences around the world.

Now, their latest research study, led by Kalpana Poudel-Tandukar and titled “C-reactive protein and depression in persons with Human Immunodeficiency Virus infection: The Positive Living with HIV (POLH) Study,” appears in the November 2014 issue of Brain, Behavior, and Immunity.

The researchers set out to determine what role chronic inflammation had, if any, in rates of depression among participants in the POLH study. Depression has a high rate of co-morbidity among people living with HIV/AIDS, and treating one often means treating the other.

The researchers used a latex agglutination turbidimetric method to measure serum C-reactive protein (CRP) concentrations and the Beck Depression Inventory (BDI)-I to measure depression. Using both multiple linear regression analysis and multiple logistic regression analysis, with adjustment for potential socio-demographic, cardiovascular, life-style, and HIV-related clinical and treatment confounding factors, they assessed the relationship between CRP concentrations and depression symptoms.

The results indicated a clear correlation between the two, showing 2.3-fold higher odds of depression symptoms overall among participants, and most strikingly among men, who reported 3.6-fold higher odds of depression if co-presenting with high rates of inflammation.

These findings are important, note the authors, in that they may lead to potential new intervention strategies to improve the mental health of HIV-positive people, and thereby, their quality of life.

Drs. Poudel and Poudel-Tandukar and their colleagues are hard at work on additional studies examining the POLH study population. They report that six additional studies are in submission or under preparation.

Note: For more information on the POLH study, contact Krishna Poudel at krishna@schoolph.umass.edu.