Coping as a multisystem construct associated with pathways mediating HIV-relevant immune function and disease progression

Quality of life, social support, coping strategies, and their association with psychological morbidity among people living with HIV

Objectives

Enhancement of quality of life and social support havebecome important therapeutic goals among people living with HIV. However, research from developing countries is sparse in this area. Index study was aimed to assess association of social support, coping, and quality of life with psychological morbidity among people living with HIV.

Materials and Methods

In this cross-sectional study, 100 people with HIV were recruited through purposive sampling who were not receiving antiretroviral therapy. To assess social support, coping, and quality of life social support questionnaire, coping strategy check list and World Health Organization quality of life-HIV BREF were administered, respectively.

Results

Quality of life domain scores fell in the moderate category and spirituality, religion, and personal belief domain had maximum score. Educated, married, employed, and male subjects reported better quality of life. Females reported greater use of internalization and emotional outlet coping strategies. Low social support, lower quality of life (in all domains and total score), and greater use of internalization coping strategy were significantly associated with psychiatric morbidity.

Conclusion

Internalization coping, low social support, and lower quality of life were associated with greater psychiatric morbidity. Therefore, to improve their mental health and overall course of HIV, multipronged interventions should be implemented for promoting the adaptive coping, social support and quality of life.

Association of Self-Reported Coping Strategies With Speech Recognition Outcomes in Adult Cochlear Implant Users

OBJECTIVE

To characterize the degree to which individual coping strategies may influence speech perception after cochlear implantation.

STUDY DESIGN

Retrospective cohort study.

SETTING

Tertiary referral center.

PATIENTS

Adult, postlingually deaf cochlear implant recipients.

INTERVENTIONS

The Coping Orientation to Problems Experience inventory, a validated, multidimensional self-reported coping scale, was administered preoperatively.

MAIN OUTCOME MEASURES

Speech perception was measured using consonant-nucleus-consonant (CNC) phoneme and word scores, AzBio sentence accuracy in quiet and noise, and Hearing in Noise Test sentences in quiet preoperatively and at 1, 3, and 6 months postoperatively. Quality of life was measured with the Hearing Implant Sound Quality Index and the Nijmegen Cochlear Implant Questionnaire.

RESULTS

Thirty-six patients were included in this study. Mean age at surgery was 70.7 ± 11.4 years. Acceptance was associated with a decreased AzBio in noise score in the 6 months after CI (regression coefficient b = -0.05; 95% confidence interval [CI], -0.07 to -0.03; p < 0.01). Denial was associated with a decreased AzBio in quiet score (b = -0.05; 95% CI, -0.09 to -0.01; p < 0.05), whereas humor was associated with an increased AzBio in quiet score (b = 0.02; 95% CI, 0.01 to 0.04; p < 0.05). Humor was also associated with an increased Hearing in Noise Test score (b = 0.05; 95% CI, 0.02 to 0.07; p < 0.05). Denial was associated with decreased CNC word (b = -0.04; 95% CI, -0.06 to -0.02; p < 0.01) and phoneme (b = -0.04; 95% CI, -0.07 to -0.02; p < 0.01) scores, whereas substance use was associated with increased CNC word (b = 0.03; 95% CI, 0.01 to 0.05, p < 0.01) and phoneme (b = 0.04; 95% CI, 0.02 to 0.06; p < 0.01) scores. Scores on self-reported quality of life measures were not significantly correlated with coping strategies.

CONCLUSION

A variety of adaptive and maladaptive coping strategies are used by postlingually deaf adult cochlear implant users. Denial and acceptance may be more predictive of poor speech performance, whereas humor and substance use may be more predictive of improved speech performance.

Effect of aprepitant on kynurenine to tryptophan ratio in cART treated and cART naïve adults living with HIV

Changes in tryptophan metabolism affect human physiology including the immune system, mood, and sleep and are associated with human immunodeficiency virus (HIV) pathogenesis. This study investigates whether the treatment of HIV-infected individuals with the neurokinin-1 receptor antagonist, aprepitant, alters tryptophan metabolism.This study utilized archival samples from 3 phase 1B clinical trials "Anti-HIV Neuroimmunomodulatory Therapy with Neurokinin-1 Antagonist Aprepitant"-2 double-blinded, placebo-controlled, and 1 open-label study. We tested samples from a total of 57 individuals: 26 combination antiretroviral therapy (cART) naïve individuals receiving aprepitant, 19 cART naïve individuals receiving placebo, and 12 individuals on a ritonavir-containing cART regimen receiving aprepitant. We evaluated the effect of aprepitant on tryptophan metabolism by measuring levels of kynurenine and tryptophan in archival plasma samples and calculating the kynurenine to tryptophan ratio.Aprepitant treatment affected tryptophan metabolism in both cART treated and cART naïve individuals with more profound effects in patients receiving cART. While aprepitant treatment affected tryptophan metabolism in all HIV-infected patients, it only significantly decreased kynurenine to tryptophan ratio in cART treated individuals. Aprepitant treatment offers an opportunity to target inflammation and mood disorders frequently co-existing in chronic HIV infection.

<p>Cross-Sectional Study on the Coping Strategies Among Glaucoma Patients Attending a Secondary Eye Clinic in Calabar, Nigeria</p>

Purpose

The major objective of this cross-sectional study was to examine the coping strategies of glaucoma patients at a secondary eye care unit with a view to deciding whether an intervention programme would be justified.

Patients and Methods

The coping styles of 130 consenting adult glaucoma patients aged 18 years and above who were being treated for glaucoma in the Cross River State Eye Care Programme clinic in Calabar, Nigeria, were investigated by means of the 28-item Brief-COPE inventory in this descriptive cross-sectional study.

Results

The mean age of the participants was 54.2 years (±14.3) while almost three quarters (73.8%) of them were married. About four out of every five persons examined (81.5%) had a minimum of primary education. “Substance (alcohol and other drug) use”, “self-blame” and “behavioural disengagement” are coping styles that were reported by 33%, 42% and 42% of the participants, respectively. This group of patients should be identified in the clinic for appropriate psychological intervention.

Conclusion

The present study confirms previous findings and contributes additional evidence that suggests that coping strategies should be considered in the holistic management of glaucoma patients. The information from the current study can be used to develop targeted interventions aimed at improving the coping styles of glaucoma patients.

Adverse childhood experiences and coping strategies: identifying pathways to resiliency in adulthood

OBJECTIVE

The current study examined whether coping strategies mediate the link between adverse childhood experiences (ACEs) and adult psychiatric and physical health outcomes.

METHODS

Data were drawn from wave I (N = 7108), wave II (N = 4963), and wave III (N = 3294) of the Midlife Development in the United States (MIDUS) Survey. An ACE count was created using seven aspects of early adversity based on prior literature. Coping variables were created using subscales of the COPE inventory. Psychiatric and health outcomes were assessed at baseline and at the 20-year follow-up. Bootstrapping mediation analyses were conducted using MPLUS to examine the link between ACEs and health outcomes and to determine if coping strategies mediate these relationships.

RESULTS

Results of path analyses in Mplus showed that ACEs, reported at Wave I, were associated with worse psychiatric and physical health outcomes at Wave III. ACEs at Wave I were associated with greater use of avoidant emotion-focused coping and lower use of problem-focused strategies at Wave II. Avoidant emotion-focused coping at Wave II partially mediated the relationship between ACEs, reported at Wave I, and psychiatric and physical health outcomes reported at Wave III. No significant mediation was detected for problem-focused coping.

CONCLUSIONS

Coping strategies may be an important point target for prevention or intervention for individuals who have experienced ACEs.

Coping strategies and associated factors among older Chinese people living with HIV/AIDS

Coping strategies play a prominent role in maintaining mental health, but little is known about the main coping strategies and potential influential factors among older Chinese adults with HIV/AIDS. Cross-sectional data of 254 older with HIV/AIDS aged 50 ~ 84 years (160 males and 94 females) from Hunan, China were analyzed to evaluate influential factors associated with coping strategies. The scores of all participants in the different sub-scales of confrontation, avoidance and acceptance-resignation were 15.16 ± 4.03, 16.44 ± 2.70, and 11.06 ± 4.00, respectively. For the confrontation coping strategy, higher scores were obtained by those with a higher education level, non-sexually transmitted HIV, and a first diagnosis at less than 50 years old. Avoidance as a coping strategy was significantly associated with a longer period living with the diagnosis. The participants who were females, unemployed, annual income less than 1000 yuan, had lived with HIV for a longer period, and had disclosed their infection status to their family members were more likely to adopt the acceptance-resignation coping strategy in response to HIV/AIDS. These preliminary findings can provide evidence for effective interventions to improve coping capacity and psychological status in this population.

Maladaptive coping strategies and glaucoma progression

The identification of modifiable risk factors for glaucoma progression is needed. Our objective was to determine whether maladaptive coping styles are associated with recent glaucoma progression or worse visual field mean deviation.A hospital-based case-control study was conducted in the Glaucoma Service of Maisonneuve-Rosemont Hospital in Montreal, Canada. Patients with primary open angle glaucoma or normal tension glaucoma with ≥4 years of follow-up and ≥5 Humphrey visual fields were included. Cases had recent visual field progression as defined according to the Early Manifest Glaucoma Trial pattern change probability maps. Controls had stable visual fields. The Brief Cope questionnaire, a 28-item questionnaire about 14 different ways of coping with the stress of a chronic disease, was asked. Questions were also asked about demographic and medical factors, and the medical chart was examined. Outcomes included glaucoma progression (yes, no) and visual field mean deviation. Logistic and linear regressions were used.A total of 180 patients were included (82 progressors and 98 nonprogressors). Although none of the 14 coping scales were associated with glaucoma progression (P > 0.05), higher denial was correlated with worse visual field mean deviation (r = -0.173, P = 0.024). In a linear regression model including age, sex, education, depression, intraocular pressure, and family history of glaucoma, greater levels of denial (β = -1.37, 95% confidence interval [CI] -2.32, -0.41), Haitian ethnicity (β = -7.78, 95% CI -12.52, -3.04), and the number of glaucoma medications (β = -1.20, 95% CI -2.00, -0.38) were statistically significantly associated with visual field mean deviation.The maladaptive coping mechanism of denial was a risk factor for worse visual field mean deviation. Further prospective research will be required to verify the pathways by which denial may exert an effect on glaucomatous visual field loss.

The Selective Serotonin Reuptake Inhibitor Citalopram Decreases Human Immunodeficiency Virus Receptor and Coreceptor Expression in Immune Cells

BACKGROUND

This study investigated whether the selective serotonin reuptake inhibitor (SSRI) citalopram downregulates the expression of the human immunodeficiency virus (HIV) receptor cluster of differentiation 4 (CD4) and coreceptors chemokine receptor type 5 and chemokine-related receptor type 4 (CCR5 and CXCR4) on peripheral blood mononuclear cells (PBMCs) and macrophages ex vivo as a potential mechanism of reducing susceptibility to HIV infection.

METHODS

The sample included 150 participants 18-58 years old (59% women, 65% African American, 61% with depression). Monocyte-depleted PBMCs were treated with phytohemagglutinin for 72 hours and then cultured in the presence of interleukin-2 with vehicle control or the SSRI (10(-6) mol/L) for 2 hours. To generate monocyte-derived macrophages, monocytes were cultured for 7 days, after which either vehicle control or SSRI (10(-6) mol/L) was added for 2 hours. RNA was collected from both cell types, and messenger RNA expression of CD4, CCR5, and CXCR4 was measured by real-time polymerase chain reaction.

RESULTS

In PBMCs, SSRI treatment decreased expression of CD4 (p = .009), CCR5 (p = .008), and CXCR4 (p < .0001). In monocyte-derived macrophages, SSRI treatment decreased expression of CD4 (p < .0001) and CXCR4 (p = .0003), but not CCR5 (p = .71). The suppressive effects of the SSRI on receptor expression did not differ as a function of depression diagnosis or depressive symptom severity.

CONCLUSIONS

Treatment with the SSRI at a physiologic dose decreased CD4, CCR5, and CXCR4 expression on PBMCs and macrophages ex vivo. These findings suggest that SSRI treatment, independent of depression status, downregulates HIV receptor and coreceptor expression and may reduce susceptibility of immune cells to HIV infection and decrease inflammation. If clinical trials confirm the present findings, ultimately there may be a role for using SSRI treatment adjunctively in HIV and acquired immunodeficiency syndrome.

A Prospective Examination of the Mechanisms Linking Childhood Physical Abuse to Body Mass Index in Adulthood

Previous research has reported associations between childhood physical abuse and body mass index (BMI) in adulthood. This article examined the role of four potential mediators (anxiety, depression, posttraumatic stress, and coping) hypothesized to explain this relationship. Using data from a prospective cohort design, court-substantiated cases of childhood physical abuse (N = 78) and nonmaltreated comparisons (N = 349) were followed up and assessed in adulthood at three time points (1989-1995, 2000-2002, and 2003-2005) when participants were of age 29.2, 39.5, and 41.2, respectively. At age 41, average BMI of the current sample was 29.97, falling between overweight and obese categories. Meditation analyses were conducted, controlling for age, sex, race, smoking, and self-reported weight. Childhood physical abuse was positively associated with subsequent generalized anxiety, major depression, and post-traumatic stress disorder symptoms at age 29.2 and higher levels of depression and posttraumatic stress predicted higher BMI at age 41.2. In contrast, higher levels of anxiety predicted lower BMI. Coping did not mediate between physical abuse and BMI. Anxiety symptoms mediated the relationship between physical abuse and BMI for women, but not for men. These findings illustrate the complexity of studying the consequences of physical abuse, particularly the relationship between psychiatric symptoms and adult health outcomes.

Personal coping strategies for managing the side effects of antiretroviral therapy among patients at an HIV/AIDS clinic in Uganda

The side effects of antiretroviral (ARV) medications negatively impact patients' quality of life and adherence to treatment. This study describes the burden of side effects from ARV treatment as experienced by a sample of HIV/AIDS patients and identifies the personal strategies they used to cope with the side effects. A total of 166 participants were recruited from a non-governmental HIV/AIDS clinic in Entebbe, Uganda. Most of the participants (76%) were females and the mean age of the sample was 38 years. Although the participants had taken ARV medications for an average period of nine months, a large proportion (76%) could not name the medications they were taking. The mean side-effects burden for the participants was five side effects. The most common adverse effects reported were tiredness, nightmares, mood swings, nausea, poor appetite, insomnia, vomiting and dizziness. The main strategies the patients used for coping with the side effects were those categorised under information-seeking, social-support seeking and positive-emotion-focused coping. However, 27% of the participants reported non-adherence to their ARV medications as a strategy to cope with the side effects. The findings show a significant relationship between the side-effects burden and a patient's age (r = 0.530, p ≤ 0.01) and level of education (r = 0.394, p ≤ 0.01). The findings indicate that in the short term after initiating ARV treatment most patients are able to cope with the high burden of side effects through appropriate strategies, but a sizable portion will fail to cope appropriately and thus resort to non-adherence. Clinicians should assist patients with continuous health education and counselling that focuses on appropriate strategies to cope with the side effects of ARVs in order to buffer the negative impact of HIV treatment on patients' adherence and quality of life.

Illness perceptions and coping strategies among individuals diagnosed with HIV

Illness perceptions can influence the coping strategies used in response to HIV-related stressors, and ultimately patients' clinical status. With this work, we aimed to: (1) identify illness perception-related profiles of HIV-positive patients; (2) evaluate the association between the profiles, illness-related coping strategies, HIV-progression biomarkers (CD4+ cell counts and viral load) and antiretroviral therapy use. Data about illness perceptions, HIV-related coping strategies and HIV-progression biomarkers (CD4+ and viral load) were collected from 248 Italian HIV-positive patients. Three latent classes ("high," "moderate" and "low" influence perception) that differed on consequences, emotional representation, personal control and identity were identified. A greater perception of illness influence was associated with dysfunctional coping strategies (e.g., passive coping and alcohol use), and greater viral load was observed among patients with high and moderate influence perception. In conclusion, patients with detectable or high viral load may show a greater perception of illness influence (i.e., consequences), which is associated with dysfunctional coping strategies in response to HIV-related stressors.

Gender-specific effects of an augmented written emotional disclosure intervention on posttraumatic, depressive, and HIV-disease-related outcomes: a randomized, controlled trial

OBJECTIVE

Trauma histories and symptoms of PTSD occur at very high rates in people with HIV and are associated with poor disease management and accelerated disease progression. The authors of this study examined the efficacy of a brief written trauma disclosure intervention on posttraumatic stress, depression, HIV-related physical symptoms, and biological markers of HIV disease progression.

METHOD

HIV-infected men and women were randomized to four 30-min expressive writing sessions in either a treatment (trauma writing) or an attention control (daily events writing) condition. The disclosure intervention augmented the traditional emotional disclosure paradigm with probes to increase processing by focusing on trauma appraisals, self-worth, and problem solving. Outcomes were assessed at baseline, 1-, 6-, and 12-month follow-up.

RESULTS

Hierarchical linear modeling (N = 244, intent-to-treat analyses) revealed no significant treatment effects for the group as a whole. Gender by treatment group interactions were significant such that women in the trauma-writing group had significantly reduced posttraumatic stress disorder (PTSD) symptoms (p = .017), depression (p = .009), and HIV-related symptoms (p = .022) compared with their controls. In contrast, men in the trauma-treatment condition did not improve more than controls on any outcome variables. Unexpectedly, men in the daily-event-writing control group had significantly greater reductions in depression then men in the trauma-writing group. Treatment effects were magnified in women when the analysis was restricted to those with elevated PTSD symptoms at baseline.

CONCLUSIONS

A brief (4-session) guided written emotional disclosure intervention resulted in significant and meaningful reductions in PTSD, depression, and physical symptoms for women with HIV, but not for men.

Psychometric properties of the Cook Medley hostility scale and its association with inflammatory markers in African Americans

Dispositional hostility as measured by the Cook Medley Hostility (Ho) Scale has been associated with inflammation and cardiovascular disease (CVD) risk. There is evidence that suggests that factors of hostility are more useful in predicting poor cardiovascular health outcomes than a single hostility construct. The purpose of this study was to investigate the latent factors of hostility and their association with inflammatory markers interleukin-6 (IL-6) and C-reactive protein (CRP) in an African-American community sample. This racial/ethnic group has been largely excluded from this line of research despite their disproportionate burden of CVD and its risk factors. Blood samples for plasma IL-6 and CRP were collected on the same day the Ho Scale was administered. Plasma IL-6 and CRP levels were determined using enzymatic-linked immunosorbent assay. Confirmatory factor analysis revealed three latent main factors of hostility: Neuroticism, Manichaeism and Moral Primitiveness, and seven intermediary subfactors. Of the subfactors, hostile affect was significantly associated with greater CRP levels and predatory self interest was significantly associated with greater IL-6 levels. Findings suggest that African Americans have a unique pattern of hostility and two latent subfactors are associated with a marker of CVD. Based on the findings, future studies should aim to further delineate how hostility influences health outcomes in African Americans.

Physical and psychological maltreatment in childhood and later health problems in women: an exploratory investigation of the roles of perceived stress and coping strategies

OBJECTIVE

This retrospective, cross-sectional study investigated the association between childhood physical and psychological maltreatment and self-reported physical health concerns in adult women. The mediating roles of perceived stress and coping strategies were examined.

METHODS

Participants were 235 women (aged 18-59 years) recruited from the community. Semi-structured interviews and questionnaires were used to assess self-reported childhood maltreatment and current perceived stress, coping strategies, and health status. Data were analyzed using structural equation modeling.

RESULTS

After controlling for a history of child sexual abuse and relevant demographic variables, child physical and psychological maltreatment were significantly associated with greater physical health concerns. Support was found for models in which perceived stress and emotion-focused coping partially mediate the relation between maltreatment and health problems; problem-focused and avoidance coping did not operate as mediators. Multi-mediation model testing indicated that emotion-focused coping and perceived stress together better explain the relationship between child maltreatment and physical health than either variable alone.

CONCLUSION

Findings suggest that child maltreatment is an important risk factor for adverse health outcomes in later life and that current stress and coping strategies may influence this relationship. Implications for the physical health of maltreatment survivors are discussed.

PRACTICE IMPLICATIONS

The management of perceived stress and the use of adaptive emotion-focused coping responses in the everyday lives of maltreated women may be particularly useful points of intervention in order to mitigate physical health concerns in adulthood.

Selective serotonin reuptake inhibitor suppression of HIV infectivity and replication

OBJECTIVE

To test the hypothesis that the selective serotonin reuptake inhibitor (SSRI) citalopram would down-regulate human immunodeficiency virus (HIV) infectivity and that the greatest effects would be seen in people with depression. Depression is a risk factor for morbidity and mortality in HIV/acquired immune deficiency syndrome. Serotonin (5-HT) neurotransmission has been implicated in the pathobiology of depression, and pharmacologic therapies for depression target this system. The 5-HT transporter and 5-HT receptors are widely distributed throughout the central nervous and immune systems. Depression has been associated with suppression of natural killer cells and CD8(+) lymphocytes, key regulators of HIV infection.

METHODS

Ex vivo models for acute and chronic HIV infection were used to study the effects of citalopram on HIV viral infection and replication in 48 depressed and nondepressed women. For both the acute and chronic infection models, HIV reverse transcriptase activity was measured in the citalopram treatment condition and the control condition.

RESULTS

The SSRI significantly down-regulated the reverse transcriptase response in both the acute and chronic infection models. Specifically, citalopram significantly decreased the acute HIV infectivity of macrophages. Citalopram also significantly decreased HIV viral replication in the latently infected T-cell line and in the latently infected macrophage cell line. There was no difference in down-regulation by depression status.

CONCLUSIONS

These studies suggest that an SSRI enhances natural killer/CD8 noncytolytic HIV suppression in HIV/acquired immune deficiency syndrome and decreases HIV viral infectivity of macrophages, ex vivo, suggesting the need for in vivo studies to determine a potential role for agents targeting serotonin in the host defense against HIV.

Adverse psychosocial factors predict poorer prognosis in HIV disease: a meta-analytic review of prospective investigations

There is a growing epidemiological literature focusing on the association between psychosocial stress and human immunodeficiency virus (HIV) disease progression or acquired immunodeficiency syndrome (AIDS), but inconsistent findings have been published. We aimed to quantify the association between adverse psychosocial factors and HIV disease progression. We searched Medline; PsycINFO; Web of Science; PubMed up to 19 January 2009, and included population studies with a prospective design that investigated associations between adverse psychosocial factors and HIV disease progression or AIDS. Two reviewers independently extracted data on study characteristics, quality, and estimates of associations. The overall meta-analysis examined 36 articles including 100 psychosocial and disease related relationships. It exhibited a small, but robust positive association between adverse psychosocial factors and HIV progression (correlation coefficient as combined size effect 0.059, 95% confidence interval 0.043-0.074, p<0.001). Notably, sensitivity analyses showed that personality types or coping styles and psychological distress were more strongly associated with greater HIV disease progression than stress stimuli per se, and that all of the immunological and clinical outcome indicators (acquired immunodeficiency syndrome stage, CD4+ T-cell decline, acquired immunodeficiency syndrome diagnosis, acquired immunodeficiency syndrome mortality, and human immunodeficiency virus disease or acquired immunodeficiency syndrome symptoms) except for viral load exhibited detrimental effects by adverse psychosocial factors. In conclusion, the current review reveals a robust relationship between adverse psychosocial factors and HIV disease progression. Furthermore, there would appear to be some evidence for particular psychosocial factors to be most strongly associated with HIV disease progression.

Do positive psychosocial factors predict disease progression in HIV-1? A review of the evidence

Adding to a traditional stress perspective, behavioral medicine has been focusing increasingly on investigating the potential impact of positive psychosocial factors on disease course in HIV. Dispositional optimism, active coping, and spirituality show the most evidence for predicting slower disease progression, although the data are not entirely consistent. Findings for the role of social support are mixed, although indications are that it may be particularly helpful at later stages of illness. Many of the other constructs (positive affect, finding meaning, emotional expression/processing, openness, extraversion, conscientiousness, altruism, and self-efficacy) have only been examined in one or two studies; results are preliminary but suggestive of protective effects. Plausible behavioral and biological mechanisms are discussed (including health behaviors, neurohormones, and immune measures) as well as suggestions for clinicians, limitations, future directions, and a discussion of whether these constructs can be changed. In conclusion, investigating the importance and usefulness of positive psychosocial factors in predicting disease progression in HIV is in its beginning scientific stages and shows good initial evidence and future promise.

Overview of HIV

This article provides an overview and reviews the HIV pandemic, the basic biology and immunology of the virus (e.g., genetic diversity of HIV and the viral life cycle), the phases of disease progression, modes of HIV transmission, HIV testing, immune response to the infection, and current therapeutic strategies. HIV is occurring in epidemic proportions, especially in Sub-Saharan Africa. In the US, men who have sex with men account for over half of AIDS diagnoses; racial and ethnic minorities are disproportionally affected. Factors influencing the progression and severity of HIV infection include type of immune response, coinfection (e.g., another sexually transmitted infection, including hepatitis B or C), age and behavioral and psychosocial factors. Antiretroviral therapies can achieve reduction in blood levels of the HIV virus below the limits of detection by current technology. However, effective treatment requires adherence to therapy. Patient failure to adhere to treatment regimens results in detectible circulating virus and in HIV disease progression, and is the primary cause of drug resistance. In addition to research on the immunology and virology of the disease, other studies focus on behavioral and psychosocial factors that may affect medication adherence and risk behaviors.

Psychosocial influences on HIV-1 disease progression: neural, endocrine, and virologic mechanisms

This review surveys empirical research pertinent to the hypothesis that activity of the hypothalamus-pituitary-adrenal (HPA) axis and/or the sympathetic nervous system (SNS) might mediate biobehavioral influences on HIV-1 pathogenesis and disease progression. Data are considered based on causal effects of neuroeffector molecules on HIV-1 replication, prospective relationships between neural/endocrine parameters and HIV-relevant biological or clinical markers, and correlational data consistent with in vivo neural/endocrine mediation in human or animal studies. Results show that HPA and SNS effector molecules can enhance HIV-1 replication in cellular models via effects on viral infectivity, viral gene expression, and the innate immune response to infection. Animal models and human clinical studies both provide evidence consistent with SNS regulation of viral replication, but data on HPA mediation are less clear. Regulation of leukocyte biology by neuroeffector molecules provides a plausible biological mechanism by which psychosocial factors might influence HIV-1 pathogenesis, even in the era of effective antiretroviral therapy. As such, neural and endocrine parameters might provide useful biomarkers for gauging the promise of behavioral interventions and suggest novel adjunctive strategies for controlling HIV-1 disease progression.