Psychoneuroimmunology and human immunodeficiency virus type 1 infection revisited

Psychological Distress, Coping, and Disease Progression in HIV-positive Homosexual Men

The objectives of the study were (1) to examine the role of coping styles in disease progression in models controlling for initial CD4+ cell counts, distress, and health behavior in a sample of HIV- positive homosexual men (n = 65), and (2) to investigate the relationship between coping styles and distress (e.g. depression, anxiety, negative ruminations). A consistent association between planful problem-solving coping and disease progression was demonstrated. Distress was positively correlated with indicators of passive-defensive coping style (e.g. self- controlling, escape-avoidance), and negatively correlated with planful problem-solving and positive reappraisal. The results suggest that coping styles may merit a specific focus in future research of psychological factors in HIV infection, particularly as they may relate both to medical outcome and to the social/emotional aspects of being HIV-infected.

Perceived stress is associated with CD4+ cell decline in men and women living with HIV/AIDS in Spain

This study assessed whether perceived stress as measured by the Perceived Stress Scale (PSS) was associated with a decline in CD4+ cell counts over a six-month period in 59 men and 41 women living with HIV-1. Participants underwent psychological and medical assessment at the study entry (baseline) and again at six months post-baseline. In a hierarchical regression model controlling for sociodemographic (e.g. age, gender, education, income) and disease-related variables (e.g. duration of antiretroviral treatment, antiretroviral treatment and adherence, CD4+ cell count and viral load), perceived stress was associated with the decline in CD4+ cell count over the six-month period. These findings suggest perceived psychosocial stress is associated with CD4+ cell count decline independent of sociodemographic factors and disease status among men and women on antiretroviral medication for HIV/AIDS.

HIV-positive men differ in immunologic but not catecholamine response to an acute psychological stressor

Acute psychological stress in humans induces sudden alterations in catecholamine plasma levels and in the distribution of peripheral blood lymphocytes. The purpose of this study was to investigate whether infection with the human immunodeficiency virus (HIV) had an impact on the psychoneuroimmunologic axis. Twelve asymptomatic HIV-positive homo- or bisexual men (CD4 cell counts>400/mm3) and 13 healthy HIV-negative control subjects were exposed to an acute psychological stressor consisting of a 30 min semi-structured stress interview using emotion- and client-centered conversation techniques surrounded by two relaxation periods. Changes in neuroendocrine and immunological, as well as cardiovascular parameters, were intermittently monitored. Under the influence of the stressor plasma norepinephrine (NE) levels increased significantly in HIV-positive patients (+30.6%; p<0.05) and in HIV-negative individuals (+17.5%; n.s.). These changes were paralleled by significant increases in blood pressure and heart rate. Plasma cortisol decreased continuously from initially high levels during the entire experimental setting in both groups, compatible with an adaption reaction. Concomitantly, WBC and neutrophilic granulocytes increased significantly in HIV-negative subjects, while they were blunted in HIV-positive patients. Interestingly, NK cell increases were significantly higher during the stress experiment in HIV-positive patients than in HIV-negative controls. CD4+ and B cell counts remained unaffected by the stressor. These results suggest that catecholamine secretion induced by an acute psychological stressor is preserved in HIV-infected patients with the responsiveness of WBC and neutrophilic granulocytes being diminished, while NK cells showed an increased response.

Psychoneuroimmunology: psychological influences on immune function and health

This review focuses on human psychoneuroimmunology studies published in the past decade. Issues discussed include the routes through which psychological factors influence immune function, how a stressor's duration may influence the changes observed, individual difference variables, the ability of interventions to modulate immune function, and the health consequences of psychosocially mediated immune dysregulation. The importance of negative affect and supportive personal relationships are highlighted. Recent data suggest that immune dysregulation may be one core mechanism for a spectrum of conditions associated with aging, including cardiovascular disease, osteoporosis, arthritis, Type 2 diabetes, certain cancers, and frailty and functional decline; production of proinflammatory cytokines that influence these and other conditions can be stimulated directly by negative emotions and indirectly by prolonged infection.

Theory-Driven Interventions in Psychoneuroimmunology and HIV-1 Infection

Psychoneuroimmunology (PNI) is a rapidly evolving multidisciplinary field founded on the premise that psychosocial factors, the central nervous system, and the immune system are intimately linked. Following publication of scientific evidence supporting this link, a number of animal and human studies have been published, both inside and outside the area of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome. These studies support the existence of bidirectional feedback mechanisms operating between the brain and the immune system. To date, however, there is no all-encompassing model that predicts individual differences in the relationship among psychosocial factors, immunologic measures, and clinical disease progression in HIV type 1 (HIV-1) infection. This variability in human response has been explained by a number of cofactors (host as well as environmental) that appear to accelerate the course of the disease. Since psychosocial factors are highly amenable to behavioral interventions, several models for intervention research have been proposed to evaluate whether such interventions can enhance immune functioning, thereby curtailing disease progression. Examination of these interventions in the context of PNI and HIV-1 infection, however, is rather limited. Therefore, researchers and clinicians must not only consider conceptualizations and paradigms in this area of research, but also focus on empirically testable, theory-driven models that allow for the unique characteristics of individual patients.

A bereavement support group intervention is longitudinally associated with salutary effects on the CD4 cell count and number of physician visits

A randomized, controlled, clinical trial was conducted to examine the impact of a semistructured, 10-week, once weekly, 90-min/session bereavement support group intervention on immunological, neuroendocrine, and clinical health status in human immunodeficiency virus type 1-seropositive (HIV-1+) and HIV-1-seronegative (HIV-1-) homosexual men, compared to a standard of care control condition. A total of 119 homosexual men (74 HIV-1+ and 45 HIV-1-) were assessed at baseline, 10 weeks, and 6 months follow-up. At the 6-month follow-up assessment, the intervention groups exhibited significant beneficial effects compared to controls on changes in CD4 cell, total T-lymphocyte, and total lymphocyte counts, when baseline levels, antiretroviral medication use, CDC stage of disease, and other potentially confounding factors were accounted for. There was no statistically significant effect on the CD4/CD8 ratio or on the CD8 cell count. The effect on CD4 cell count was associated with group attendance and with changes in plasma cortisol level. Plasma cortisol levels decreased significantly among intervention subjects, compared to controls. A significantly reduced number of health care visits over the 6-month follow-up period among the intervention subjects supported the clinical relevance of the immunological changes observed for both HIV-1+ and HIV-1- individuals. These results indicate that behavioral interventions may have salutary immunological and clinical health effects following bereavement among HIV-1-infected individuals. The effect in HIV-1- individuals suggests that this bereavement support group intervention might have similar salutary effects in the general population. Potential effects of such interventions on clinical HIV disease progression are of interest and should be studied.

"Survivors" and "victims": long-term HIV positive individuals and the ethos of self-empowerment

Recent research on contemporary processes of self-construction has suggested that the concepts of "self", "health", "morality" and "responsibility" have become inextricably interconnected, to the extent that the "pursuit of health has become the pursuit of moral personhood" [R. Crawford (1994) The boundaries of the self and the unhealthy other: reflections on health, culture and AIDS, Social Science & Medicine 38(10), 1347-1365]. What happens then when a person becomes "diseased"? Are they doomed to the stagnant mire of "illness" and "immorality", to the role of undesirable "other"? What if the disease is HIV infection? Is it the case of HIV = AIDS = DEATH = "OTHER" par excellence? This paper addresses these issues by examining the constructions of "self" and "other" used by HIV positive individuals themselves. By reference to a specific group of people living with long-term HIV positive diagnoses, it demonstrates how unhealthy HIV infected "others", as perceived by "healthy" members of society, create their own conceptions of "self" and "other" which microcosmically mirror typical processes of identity construction. The content, function and potential advantages and disadvantages of these processes are highlighted.

Are immunological markers, social and personal resources, or a complaint-free state predictors of progression among HIV-infected patients?

Predictors of disease progression were studied in 89 asymptomatic HIV-infected patients who were prospectively evaluated for psychosocial variables and the development of clinical symptoms over a period of 2 years. The subjects were assessed for symptoms, laboratory measures, demographic variables, social and personal resources, mental status, alcohol, nicotine and drug use, sexual activity and risk behaviour, and sexually transmitted diseases. After 1 year, 17% of the patients had developed HIV-associated symptoms (symptomatic disease or AIDS), and after 2 years, 32% had developed symptoms or had died. In the multivariate analyses, the baseline CD4 count was the only significant predictor of disease progression during both observation periods. Psychosocial measures did not predict the progression of HIV infection.

A Research Derived Bereavement Support Group Technique for the Hiv-1 Infected

A brief, semi-structured, bereavement support group for HIV seropositive and at risk homosexual men suffering a recent loss of a close friend or lover is described. The intervention employed a set of topics to stimulate group discussion. These topics were organized into three phases: making contact, venting of emotion, and “moving on.” Our predictive theoretical model integrating life stressor appraisal, social support availability, and active coping was incorporated. Therapeutic foci are active monitoring of stressor load; accurate stressor appraisal; extending, using and evaluating one's social support network; and selection of adaptive coping strategies. Three vignettes illustrate the integration of the research protocol with clinical issues. Implications for clinical care are discussed.

Bereavement is associated with time-dependent decrements in cellular immune function in asymptomatic human immunodeficiency virus type 1-seropositive homosexual men

Seventy-nine human immunodeficiency virus type 1 (HIV-1)-seropositive homosexual men participating in a longitudinal study of HIV-1 infection were assessed twice, 6 months apart, to investigate associations between bereavement and cellular immune function. Subjects were assessed by using a theory-driven model comprising life stressors, social support and coping style, and control variables. Natural killer cell cytotoxicity was decreased among the bereaved at both times. Lymphocyte proliferative response to phytohemagglutinin was decreased among the bereaved at the second time point but not at the first. These functional immune decrements are associated with increased neuroendocrine responses of the sympathetic adrenomeduallary system as well as the limbic-hypothalamic-pituitary-adrenal axis. Implications for differential neuroendocrine responses over time are discussed. Active coping style was independently and positively related to both immune measures. The results imply that a bereavement support group intervention merits investigation for an effect on immunological measures and clinical progression of HIV-1 infection as well as grief resolution.

Active confrontational coping predicts decreased clinical progression over a one-year period in HIV-infected homosexual men

The association between stressful life events, psychiatric symptoms, coping, and social support and HIV disease progression one year later were studied in 51 HIV-infected asymptomatic and early symptomatic homosexual men. Dependent variables were CD4 counts and clinical progression. No associations between the psychosocial parameters and CD4 counts were found. Active confrontation with HIV infection as a coping strategy was predictive of decreased clinical progression at one year follow-up, after taking into account baseline biomedical and behavioral variables. These results show that active coping strategies may have an effect on disease progression, possibly mediated by greater compliance with medical treatments or by psychoneuroimmunological mechanisms.

Psychoneuroimmunology and health consequences: data and shared mechanisms

There is evidence linking psychosocially mediated immunological alterations with cancer, infectious illness, and HIV progression. The data reviewed suggest that immune modulation by psychosocial stressors and/or interventions may importantly influence health status. The research literature also suggests that the impact of chronic stressors and psychosocial factors on sympathetic nervous system and endocrine function influences the immune system, thereby providing shared mechanisms that may impact on disease susceptibility and progression across a broad spectrum of disorders. A better understanding of individual vulnerability, such as occurs with aging, may help to pinpoint those at greatest risk.

Psychosocial correlates and the effects of behavioral interventions on the course of human immunodeficiency virus infection in homosexual men

The course of infection with the human immunodeficiency virus (HIV) varies widely among individuals. It is hypothesized that some of the variation is due to psychosocial factors, including stressful life events, psychological distress, ways of coping with HIV infection, and the quality of the social network. This article reviews studies investigating the associations between these psychosocial factors and disease progression, and testing the effects of psychosocial interventions on immunological parameters in HIV-infected homosexual men. It is concluded that only a few studies have been done, which have yielded contradictory results so far. The inconsistencies may be partly due to the lack of a theoretical rationale interrelating the broad set of psychosocial and psychiatric measures assessed and driving the statistical hypotheses. As a theoretical model, the 'stress-coping-social support model' is proposed. Identifying psychosocial risk factors for progression can help in further developing psychosocial interventions that may slow down disease progression and enhance the effects of medical treatments.