Massage treatment in HIV-1 infected Dominican children: A preliminary report on the efficacy of massage therapy to preserve the immune system in children without antiretroviral medication

Objectives: More than 1.4 million children are living with HIV and global access to antiretrovirals is not yet readily available. Massage therapy, which has been shown to improve immune function in HIV+ adults and adolescents, may provide an important complementary treatment to boost immune status in young children living with HIV disease, especially those without access to antiretroviral medications. No studies have been conducted, however, that specifically target massage therapy to enhance immune function in HIV+ children. Design: Clinical trial with eligible, consented HIV+ children randomized to receive either massage therapy or a friendly visit (controls). Settings/Location: CENISMI/Robert Reid Cabral Hospital, Santo Domingo, Dominican Republic. Subjects: HIV+ children ages 2-8 years. Intervention: Massage therapy sessions (20 minutes, twice weekly, for 12 weeks), conducted by trained nurses, following a structured protocol of moderate pressure stroking and kneading of muscles, using a nonscented oil. The friendly visit control group, (reading, talking, playing quiet games), met with the nurse twice weekly for 12 weeks. Outcome Measures: At the initial evaluation, and following the 12-week intervention, blood was drawn to determine absolute helper (CD4/T4) and suppressor (CD8/T8) counts. Results: Children in the control arm had a greater relative risk of CD4 count decline (>20%) than massagetreated children (RR = 5.7, p = 0.03). Lymphocyte loss was also more extensive in the controls (p < 0.02), and more of the control group than the massage group lost >50 CD8 lymphocytes (p = 0.03). Conclusions: The efficacy of massage therapy in maintaining immunocompetence may offer a viable alternative to the thousands of children worldwide without antiretroviral access.