A road well traveled (although not yet a super highway)

Psychoneuroimmunology of infection: implications for occupational therapy

Background: Psychoneuroimmunology is the study of the interactive relationships between the mind and immune system. This article looks at psychological factors influencing infection susceptibility. A thorough review of the research evidence on this topic is beyond the scope of this article. Recent infection-specific psychoneuroimmunology literature is therefore highlighted and possible underlying mechanisms are summarized.

Content: Current evidence shows that susceptibility to infections and allergies can be increased by chronic stress through suppression of the T-helper 1 immune response in favour of a T-helper 2 immune response.

Conclusions: Holistic interventions such as stress management, lifestyle changes, and career management could be considered to reduce susceptibility to infection. Further research however is required in this area to contribute to an evidence base underpinning psychosocial interventions for preventative health care.

The impact of mental health and traumatic life experiences on antiretroviral treatment outcomes for people living with HIV/AIDS

Potent antiretroviral therapy (ART) has transformed HIV from a death sentence to a chronic illness. Accordingly, the goal of HIV care has shifted from delaying death to achieving optimal health outcomes through ART treatment. ART treatment success hinges on medication adherence. Extensive research has demonstrated that the primary barriers to ART adherence include mental illness, especially depression and substance abuse, as well as histories of traumatic experiences such as childhood sexual and physical abuse. These psychosocial factors are highly prevalent in people living with HIV/AIDS (PLWHA) and predict poor ART adherence, increased sexual risk behaviours, ART treatment failure, HIV disease progression and higher mortality rates. The efficacy of standard mental health interventions, such as antidepressant treatment and psychotherapy, has been well-defined, and a small but growing body of research demonstrates the potential for such interventions to improve ART adherence and reduce sexual risk behaviours. Despite this evidence, mental disorders in PLWHA frequently go undiagnosed and untreated. Challenges to the provision of mental healthcare for PLWHA in HIV clinical settings include time and resource constraints, lack of expertise in psychiatric diagnosis and treatment, and lack of available mental health referral services. Future research should prioritize the evaluation of mental health interventions that are cost-effective and feasible for widespread integration into HIV clinical care; the impact of such interventions on ART adherence and clinical outcomes; and interventions to identify individuals with histories of traumatic experiences and to elucidate the mechanisms through which such histories pose barriers to effective HIV treatment.