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Differences found in sleep cycles of HIV patients (6/22/98)

In a recent study by researchers at The University of Texas Health Science Center at San Antonio, a difference was found in the body temperature's circadian rhythm between healthy individuals and those who are HIV positive.

"Although we don't yet understand the cause, we found the body temperature discrepancy during a pilot study," says Donna H. Taliaferro, PhD, assistant professor in the School of Nursing at the Health Science Center and clinical associate at University Hospital.

Dr. Taliaferro initially worked with Barbara Holtzclaw, PhD, research director at the School of Nursing. "We were studying fever management in HIV patients," says Dr. Taliaferro. "During Dr. Holtzclaw's study, I became interested in circadian patterns (the body's biological clock that regulates our sleep-wake cycle) of temperature. We found HIV patients had hectic fevers that occurred as much as seven times in a 24-hour period. From the normal circadian pattern that is known, I speculated that HIV patients had changes in this natural pattern and I became curious about the biorhythms related to sleep and stress in those patients.

"Cortisol, produced by the adrenal gland, is the hormone that causes the fight or fight syndrome," Dr. Taliaferro says, "and indicates the level of stress in your body. Melatonin, produced by the pituitary gland, is a hormone that reflects changes in sleep patterns.

"In my second pilot study, I measured melatonin and cortisol levels in both HIV and healthy subjects. I found changes but the patient sample was small, so I decided to do a larger study," she explains. "Before going forward, though, I needed to know the base hormone levels in our patient population.

"I have been funded for a study to measure the variables with a larger number of subjects. I will measure body temperatures as well as melatonin and cortisol levels in both healthy subjects and those with HIV, to determine circadian rhythms," she continues.

Some HIV patients take 40 or more pills per day, according to Dr. Taliaferro. "Some patients take their first drugs at 5 am and don't finish until midnight. There are medications that must be taken with meals, and some are taken without; some prescriptions are taken two hours prior to eating, some two hours afterward and some during meals.

"What this means is that the patient's entire sleep-wake cycle is disrupted," Dr. Taliaferro says, "so I suspect their circadian rhythms are off balance, partially due to the drugs and partially due to constant disruption of rest periods. I'm hoping, in the next study, to clearly identify the circadian rhythm in the HIV population. We can then look at interventions and possibly find measures to help these patients."

It's very difficult to comply with the extensive drug regimen, the researcher explains. It's necessary to keep the disease under control but many patients find compliance impossible - some because they simply can't swallow that many pills and some because they've developed a toxicity to the drugs.

"The ones who work don't want their co-workers to know they are HIV positive," she says, "and many don't have time to be treated with so many medications."

Dr. Taliaferro is encouraged because with the advent of protease inhibitors, great strides have been made in the treatment of AIDS patients. "When we were doing the fever study 18 months ago the participating patients were very sick; today most AIDS patients are up and walking. Many patients request passes to leave the facility during the day; some even go shopping.

"One thing that hasn't changed is the number of patients diagnosed," Dr. Taliaferro says. "Sadly, we still have many new cases per month, with a large number of young adults and teenagers.

"The things that are going on among today's teen population are frightening," she says. "Our children need AIDS education as early as elementary school. Some high school students still don't understand that the HIV virus is spread by body fluids and can be a death sentence.

"The problem is, they think they are immune; kids think nothing can happen to them. We need to aggressively educate our children. They need to be aware of the consequences of their actions," Dr. Taliferro says. "We need to teach our children to respect their bodies, and how to say no.

"Kids also need parents who present a united front," she concludes. "Young men need a strong male influence, but both boys and girls need constant parental guidance. This is important for our children's future, and for the future of our country."

Contact: Jan Elkins, (210) 567-2570