Article

Stress management and psychoneuroimmunology in HIV infection

Department of Psychology, University of Miami, PO Box 248185, Coral Gables, FL 33124, USA.
CNS spectrums (Impact Factor: 1.3). 02/2003; 8(1):40-51.
Source: PubMed

ABSTRACT Does stress management affect psychological and immune functioning in persons with human immunodeficiency virus infections? Stress-management techniques, such as relaxation training and imagery, cognitive restructuring, coping-skills training, and interpersonal-skills training, may reduce anxiety, depression, and social isolation in HIV-infected persons by lowering physical tension and increasing a sense of control and self-efficacy. A psychoneuroimmunologic model is proposed wherein these psychological changes are hypothesized to be accompanied by an improved ability to regulate neuroendocrine functioning, which in turn may be associated with a partial normalization of immune system functions such as lymphocyte proliferation and cytotoxicity, providing more efficient surveillance of latent viruses that may contribute directly to increased HIV replication and generate opportunistic infections or cancer if left unchecked. Such a normalization of stress-associated immune system decrements are hypothesized to forestall or minimize increases in viral load and expression of clinical symptoms. This model is useful for testing the factors contributing to the health effects of stress-management interventions in HIV-infected persons. In this context, one general research strategy for testing the effects of stress-management interventions is to target them toward the more prevalent psychosocial challenges that HIV-infected people face at various points in the disease process; enroll an HIV-infected population (eg, HIV-positive homosexual and bisexual men) into a randomized trial; and monitor changes in cognitive, affective, behavioral, and social factors in parallel with hormonal, immunologic, viral, and clinical changes over the course of time. This article will review the major psychoneuroimmunologic findings that have emerged using this paradigm and suggest future research directions and clinical applications.

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    • "Depressive symptoms are a salient predictor of faster disease progression in people living with HIV (Leserman, 2008). Although much research focuses on the links between depression and disease factors in individuals living with HIV (Antoni, 2003; Gordillo, del Amo, Soriano, & Gonzalez-Lahoz, 1999; Ickovics et al., 2001), few studies consider the associations between neuroendocrine dysregulation and depressive symptoms in these individuals (Antoni, 2003; Moneyham, Sowell, Seals, & Demi, 2000). Even fewer studies have examined OT in individuals living with HIV (Fekete et al., 2011; Kelsch et al., 2013). "
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    ABSTRACT: The current study examines both linear and curvilinear relationships between oxytocin (OT) and depressive symptoms over time in ethnic minority women living with human immunodeficiency virus (HIV; WLWH). Participants were 70 WLWH aged 20–49 (86% African-American or Caribbean). OT was measured at baseline via enzyme-linked immunosorbent assay immunoassay procedures. Depressive symptoms were measured at both baseline and 10-week post-baseline via the Beck Depression Inventory-II (BDI-II). Multiple regression analyses revealed marginal linear and significant quadratic OT terms to be predictors of T2 BDI scores. Results indicate that to a point, OT may have salutary effects on depressive symptoms in ethnic minority WLWH. However, extremely high OT levels may be related to greater depressive symptoms.
    Journal of Applied Biobehavioral Research 03/2014; 19(1). DOI:10.1111/jabr.12016
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    • "Receiving an HIVdiagnosis has a cumulative effect on the likelihood of developing HIV-related PTSD (Martin and Kagee, 2011). Indeed, HIV is formidable challenge to psychological health as persons living with the disease must contend with and manage a daily bombardment of psychosocial and disease-related stress (Antoni, 2003). The current study shows that difficulty identifying feelings or sensations is associated with a hyper-responsive sympathetic nervous state. "
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    ABSTRACT: The neuropathological changes which result from infection of the Human Immunodeficiency Virus (HIV) infection may manifest in alexithymia (AL), a multidimensional trait characterized by impairments in affective and cognitive emotional processing. A sample of 93 HIV survivors scoring high, i.e., ⩾ 74 on the 26-item Toronto Alexithymia Scale (TAS-26) were compared to 79 low AL (TAS-26 ⩽ 54) survivors on measures of neurocognitive, psychological, neuroendocrine and immune function. Neurocognitive measures probed visual attention and task switching, levels of HIV Dementia and general cognitive status. Patients were also screened for levels of depression, anxiety and psychological stress. A 24-hr urinary norepinephrine (NE) and cortisol (CORT) collection was taken and blood drawn for T lymphocyte subset counts (CD4+CD3+) and HIV-1 viral load. Alexithymic patients exhibited greater executive dysfunction, psychological distress, norepinephrine-to-cortisol (NE/CORT) ratios and viral load. Linear regression models accounting for sociodemographic and disease-related variables within the entire sample revealed two AL subscales, difficulties identifying and describing feelings, predicted and explained a significant proportion of variance in the outcome measures. Specifically, poorer executive task-switching ability was associated with greater difficulty describing feelings; dysregulated autonomic response (high NE/CORT ratio) and depressive symptoms were predicted by level of difficulty identifying feelings; higher levels of anxiety and psychological stress were predicted by greater difficulty describing and identifying feelings. The psychoneuroimmunological profile of alexithymia in HIV positive persons at mid-stage of infection suggests a greater vulnerability for disease progression.
    Brain Behavior and Immunity 10/2013; 36. DOI:10.1016/j.bbi.2013.10.024 · 6.13 Impact Factor
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    • "To better understand the impact of stress on the daily care of HIV, a number of stress reductions interventions have been tested in PLWH. Promisingly, stress management interventions for PLWH tend to improve coping skills, social support, and mental health, but almost all of these studies have been conducted in men under the age of 50 (Antoni, 2003; Scott-Sheldon, et al., 2008) leaving out two important populations-older adults, and women living with HIV. "
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    ABSTRACT: People living with HIV (PLWH) have increasingly longer life spans. This age group faces different challenges than younger PLWH, which may include increased stress and social isolation. The purpose of this study was to determine whether the age and sex of PLWH are associated with measures of physiologic stress, perceived stress, and social isolation. In this cross-sectional study, we enrolled 102 PLWH equally into four groups divided by age (younger or older than 50 years) and gender. Participants completed well-validated survey measurements of stress and isolation, and their heart rate variability over 60 minutes was measured by Holter monitor. The mean (SD) Perceived Stress Scale score was 17.4 (6.94), mean Visual Analog Stress Scale score was 3.51 (2.79), and mean Hawthorne Friendship Scale score, a measure of social isolation, was 17.03 (4.84). Mean heart rate variability expressed as the SD of successive N-N intervals was 65.47 (31.16) msec. In multivariable regression models that controlled for selected demographic variables, there was no relationship between the Perceived Stress Scale and age (coefficient = -0.09, p = - 0.23) or female gender (coefficient = -0.12, p = 0.93); however, there was a modest relationship between female gender and stress using the Visual Analog Stress Scale (coefficient = 1.24, p = 0.05). Perceived Stress was negatively associated with the Hawthorne Friendship score (coefficient = -0.34, p = 0.05). Hawthorne Friendship score was positively associated with younger age (coefficient = 0.11, p = 0.02). Age was the only independent predictor of physiologic stress as measured by heart rate variability (coefficient = -1.3, p < 0.01). Our findings suggest that younger PLWH may experience more social isolation; however, age-related changes in heart rate variability do not appear to be related to perceived stress or social isolation. Future longitudinal research is required to more thoroughly understand this relationship and its impact on the health of PLWH.
    AIDS Care 10/2013; 26(5). DOI:10.1080/09540121.2013.845288 · 1.60 Impact Factor
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