Issues in psychoneuroimmunology research

Careful design of studies is crucial for meaningful progress in this area of inquiry. Along with systematic evaluation of immunologic factors, clear understanding of antecedent factors is also important. Age, sex, and other sociodemographic factors might play a major role in how an individual reacts to a given situation when compared with another individual. Assessment of the impact of these factors on the immune system might be further complicated by immunosuppressive viruses like HIV or by the use of many common medications such as beta-blockers for hypertension (Kiecolt-Glaser & Glaser, 1988). Longitudinal studies are needed to understand the process of change and the dynamic patterning of psychosocial and immunologic relationships over time. Additionally, use of multimodal measures to assess psychological events such as stress is imperative (Baum, Grunberg, & Singer, 1982). It will not serve our understanding of psychological influences on the immune system to jump to the conclusion that an event is "stressful" because it seems as if it should be. Finally, establishing a "core" battery of widely accepted immune tests will be important in establishing comparability across studies. The standardization and acceptance of specific biochemical measures will facilitate the infusion of talented clinical and basic scientists into the area of psychoneuroimmunology.     

Stress management effects on psychological, endocrinological, and immune functioning in men with HIV infection: empirical support for a psychoneuroimmunological model

We present a psychoneuroimmunologic (PNI) model for Human Immunodeficiency Virus (HIV) infection, describe a 10-week group-based cognitive behavioral stress management (CBSM) intervention and summarize research demonstrating the effects of this intervention on mood, neuroendocrine (Hypothalamic Pituitary Adrenal [HPA], Hypothalamic Pituitary Gonadal [HPG] and Sympathetic Nervous System [SNS] hormones) and immune system status (lymphocyte subsets, anti-viral immune function) in HIV-infected persons. This work demonstrates that changes in relaxation skills, cognitive coping strategies and social support may mediate the mood effects of CBSM, and that these mood changes may mediate adrenal hormone regulation indicated by reductions in 24-h urinary cortisol (with reduced depressed mood) and norepinephrine (with reduced anxiety) and increases in serum DHEA-S and testosterone levels (with reduced depressed mood). Results also suggest that CBSM-related changes in production of these hormones may explain, in part, the effects of this intervention on short-term changes in IgG antibody titers to herpesviruses (with increased DHEA-S-to-cortisol ratio), and longer-term changes in lymphocyte subpopulations such as CD8 suppressor/cytotoxic cells (with reductions in urinary noradrenaline output) and transitional na?ve CD4 cells (with reductions in urinary cortisol output). Thus a multi-modal CBSM intervention is associated with alterations in mood, neuroendocrine functioning and immunologic status that may have health implications for HIV infection.     

Homeless youths and HIV infection.

Risk of human immunodeficiency virus (HIV) infection exacerbates the already difficult lives of 1.5 million homeless adolescents in the United States. Homeless youths engage in sexual and substance-abuse behaviors that place them at increased risk of contracting HIV, and they demonstrate other problem behaviors that reduce their coping responses. Model HIV prevention programs and interventions for HIV-positive youths, implemented for homeless adolescents, need to be disseminated on a national level. Social policies must recognize adolescents' rights to satisfaction of basic survival needs; comprehensively address the needs of dysfunctional, disenfranchised, and single-parent families; and provide continuity of care for adolescents to facilitate independent living. Special provisions must be made when designing programs for gay, sexually abused, and substance-abusing youths.     

HIV infection: neuropsychiatric symptoms

Basing on the actual publications, the most important neurological and psychopathological symptoms of HIV-infection are systematically reported. Opportunistic infections are producing important neurological symptoms. A case of Cryptococcus neoformans-Infection of the brain is described.     

Stress management: Approaches and interventions

The different approaches, possible interventions and subsequent evaluation problems related to stress management and counselling are discussed in relation to the other symposium papers.     

Stress and strain in blue-collar and white-collar management staff

Previous research has demonstrated the relationship of work stress to indices of job strain, as well as underscoring the importance of moderating variables. In the present study of a mining organization it was hypothesized that personnel associated with actual mining operations would demonstrate stress-strain relationships different from those associated with administrative and staff work. Measures of stress and strain were obtained from management staff of blue-collar and white-collar groups to assess the moderating influence of collar color. Results strongly support collar color as a moderator variable. In particular, the two groups differ significantly with respect to how role conflict, job security, quantitative work load, variation in work load, and utilization of skills impact various strains. The effect of job function on stress and strain and possible practical implications of these results are discussed.     

Psychological trauma associated with AIDS and HIV infection in women

The growing numbers of women faced with HIV infection and AIDS has specific counselling implications. This paper analyses the psychological needs of all women patients seen by the psychology department (n = 33) over the past 12 months. The mean age was 32.3 years. Psychological crisis was high. Four women reported rapes (three accounting for their HIV infection). Two women had suicide attempts (one on two occasions), Death experiences were notable, including multiple bereavement. Conjidentiality was problematic for many of the women. Problems were reported around pre- and post-test counselling which was absent for three women, and often surrounded the diagnosis of a loved one (child, husband or partner). Most women were first seen as in-patients (when disease progression was extensive) or when their partners or children were in-patients. Despite offers of out-patients follow-up, only four HIV + ve women attended, three of which were irregular. A group of ten women were only seen indirectly when provision of care wasgiven to their children. A consistent group were seen with worries about HIV (either due to sexual contact with a known HZV+ ve or at risk individual) or to unfounded concerns often reflecting underlying psychological problems. This paper explores the counselling challenges of AIDS and HIV for women.     

Prospective memory in youth with perinatally-acquired HIV infection

Youth with perinatal HIV infection (PHIV) are at increased risk for neurocognitive impairment (NCI). Prospective memory (PM) is a complex neurocognitive function that has been shown to be impaired in adults with HIV disease and independently associated with poorer daily living skills, including medication nonadherence. The current study sought to determine the presence and extent of PM deficits in youth with PHIV. Participants included 173 youth with PHIV and 85 youth perinatally HIV-exposed but uninfected (PHEU), mean age 14.1 years, 75% black, 18% Hispanic. Among youth with PHIV, 26% had a past AIDS-defining condition (Centers for Disease Control and Prevention [CDC], Class C), 74% did not (non-C). Adjusted generalized estimating equation models were used to compare groups (PHIV/C, PHIV/non-C, and PHEU) on the Naturalistic Event-Based Prospective Memory Test (NEPT) and the Prospective Memory Assessment for Children & Youth (PROMACY). Secondarily, subgroups defined by HIV serostatus and global NCI were compared (PHIV/NCI, PHIV/non-NCI, PHEU). PHIV/C had significantly lower NEPT scores than PHEU, with decreases of 40% in mean scores, but did not differ from PHIV/non-C. PHIV/NCI had 11–32% lower PROMACY scores and 33% lower NEPT scores compared to PHIV/non-NCI (all p < .05); significantly, lower scores for PHIV/NCI versus PHEU also were observed for PROMACY and NEPT indices. Findings suggest a subset of youth with PHIV (those with a prior AIDS-defining diagnosis) is vulnerable to PM deficits. The extent to which PM deficits interfere with development and maintenance of independent living and health-related behaviors during transition to adulthood requires further study.     

HIV infection in the South African construction industry

South Africa has one of the highest HIV prevalences in the world, and compared with other sectors of the national economy, the construction industry is disproportionately adversely affected. Using data collected nationally from more than 57,000 construction workers, HIV infection among South African construction workers was estimated, together with an assessment of the association between worker HIV serostatus and worker characteristics of gender, age, nature of employment, occupation, and HIV testing history. The HIV infection of construction workers was estimated to be lower than that found in a smaller 2008 sample. All worker characteristics are significantly associated with HIV serostatus. In terms of most at-risk categories: females are more at risk of HIV infection than males; workers in the 30–49 year old age group are more at risk than other age groups; workers employed on a less permanent basis are more at risk; as are workers not having recently tested for HIV. Among occupations in the construction industry, general workers, artisans, and operator/drivers are those most at risk. Besides yielding more up-to-date estimated infection statistics, this research also identifies vulnerable sub-groups as valuable pointers for more targeted workplace interventions by construction firms.     

HIV infection: trauma and coping with trauma

The initial results of a German-Swedish research project demonstrate the at times active-resistant and at times passive-resigned approaches of AIDS patients toward their illness.     

Youth attitudes and perspectives on HIV infection and AIDS

Conclusions As an adolescent, I am concerned that as a society we are not doing enough to curb the spread of HIV infection and AIDS, particularly in those of my age-group. Current school curriculum on sex education is ineffective and inappropriate. The focus of educational programs must change from increasing knowledge to changing attitudes and behavior. Such education must begin early in the lives of children, perhaps as early as in the latter part of elementary school. Parents should be aware that it is their responsibility not only to teach their children about the dangers of engaging in behaviors that are high risk for infecting HIV but also that they themselves should not engage in behaviors that they do not wish their children to imitate, often with deadly consequences.     

Stress and stress management at the workplace

Anxiety sensitivity (AS), the fear of anxiety-related symptoms, is strongly implicated in the development of anxiety disorders and is associated with other types of psychopathology. Little is known, though, about the processes through which AS might precipitate distress. As a preliminary step in understanding mechanisms, the mediational role of stress perception was evaluated in a nonclinical sample using a cross sectional design. We conducted a comparison between trait anxiety (TA) and AS to test whether any observed relations were specific to fear of anxiety (AS) or whether associations could be explained by the more general construct. Perceived stress mediated the relation between AS, and specific AS components, and panic symptoms and depression; but not in analyses where TA was statistically controlled. Perceived stress was not found to mediate the relation between TA and panic symptoms or depression, although TA, perceived stress and depression were highly correlated. Although incremental validity was not demonstrated in the present study, stress perception may be an important process through which AS amplifies reactivity to demanding life circumstances and further study is warranted.     

Development of the HIV/AIDS Stress Scale

Development of a self-report measure of stress specific to HIV/AIDS is needed to advance our understanding of the role of stress in adaptation to HIV/AIDS; hence, the aim of this study was the development of the HIV/AIDS Stress Scale. A total of 132 homosexual/bisexual men with HIV/AIDS were interviewed and completed the HIV/AIDS Stress Scale and measures of coping strategies, appraisal, social support and adjustment (global distress, depression, social adjustment, number of HIV symptoms, and subjective health status) at three time points. Thirty-nine primary caregivers were interviewed and completed measures of stress and adjustment. Exploratory factor analyses of the HIV/AIDS Stress Scale items revealed three factors: Social, Instrumental and Emotional/Existential Stress. Factors had adequate internal reliabilities and were stable over 12 months. Construct validation data are consistent with recent stress/coping research that links higher levels of stress with more HIV symptoms, reliance on emotion-focused coping, lower social support, poorer levels of adjustment and higher levels of caregiver stress. Results extend this research by revealing new differential relations between various stress dimensions and stress/coping variables. Convergent validation data suggest that the HIV/AIDS Stress Scale shares conceptual similarity with threat appraisal, and differs from controllability and challenge appraisals. The HIV/AIDS Stress Scale shows potential for the elucidation of the role of stress in coping and adaptation to HIV/AIDS and disease progression in both research and clinical applications.     

Cognitive and motor development in children with vertically transmitted HIV infection

This study was designed to examine mental and motor development in infants with vertically transmitted human immunodeficiency virus (HIV) infection. Early neurodevelopment was examined in 25 young children with HIV infection acquired through vertical transmission. Compared with 25 children born to HIV-positive mothers but not infected with the virus, and after controlling for developmental risk factors, the HIV-infected group showed impairments in mental and motor development. Mental and motor development were assessed using the Bayley Scales of Infant Development. On the mental scale (MDI), the HIV-infected infants obtained significantly lower scores than the uninfected infants. On the performace scale (PDI), the HIV-infected infants obtained significantly lower standard scores than the uninfected infants. CT scan results were available for 20 of the HIV-infected children. CT abnormalities were associated with developmental delays, particularly for motor development. The results point to the importance of early abnormalities in myelination and of subcortical lesions of cognitive and motor development.     

HIV infection and mental health: suicidal behaviour--systematic review

Suicide has long been associated with serious illness generally and HIV specifically. New treatments have affected prognosis in HIV positively, but it is unclear how they impact on suicidal burden (thoughts, self-harm and completions). This review examines all published suicide and HIV data for a definitive account of (1) prevalence of HIV-related suicidality, (2) measurement within studies and (3) effectiveness of interventions. Standard systematic research methods were used to gather quality published papers on HIV and suicide, searching published databases according to quality inclusion criteria. From the search, 332 papers were generated and hand searched resulting in 66 studies for analysis. Of these, 75% were American/European, but there was representation from developing countries. The breakdown of papers provided 12, which measured completed suicides (death records), five reporting suicide as a cause of attrition. Deliberate self-harm was measured in 21, using 22 instruments; 16 studies measured suicidal ideation using 14 instruments, suicidal thoughts were measured in 17, using 15 instruments. Navigating the diverse range of studies clearly points to a high-suicidal burden among people with HIV. The overview shows that autopsy studies reveal 9.4% of deceased HIV+?individuals had committed suicide; 2.4% HIV+?study participants commit suicide; approximately 20% of HIV+?people studied had deliberately harmed themselves; 26.9% reported suicidal ideation, 28.5% during the past week and 6.5% reported ideation as a side effect to medication; 22.2% had a suicide plan; 19.7% were generally "suicidal" (11.7% of people with AIDS, 15.3% at other stages of HIV); 23.1% reported thoughts of ending their own life; and 14.4% expressed a desire for death. Only three studies recruited over 70% female participants (39 studies recruited over 70% men), and six focussed on injecting drug users. Only three studies looked at interventions - predominantly indirect. Our detailed data suggest that all aspects of suicide are elevated and urgently require routine monitoring and tracking as a standard component of clinical care. There is scant evidence of direct interventions to reduce any aspect of suicidality, which needs urgent redress.     

Stress management interventions for HIV+ adults: a meta-analysis of randomized controlled trials, 1989 to 2006.

OBJECTIVE: Numerous studies document that stress accelerates disease processes in a variety of diseases including HIV. As a result, investigators have developed and evaluated interventions to reduce stress as a means to improve health among persons living with HIV. Therefore, the current meta-analysis examines the impact of stress-management interventions at improving psychological, immunological, hormonal, and other behavioral health outcomes among HIV+ adults. DESIGN: This meta-analytic review integrated the results of 35 randomized controlled trials examining the efficacy of 46 separate stress management interventions for HIV+ adults (N=3,077). MAIN OUTCOME MEASURES: Effect sizes were calculated for stress processes (coping and social support), psychological/psychosocial (anxiety, depression, distress, and quality of life), immunological (CD4+ counts and viral load), hormonal (cortisol, dehydroepiandrosterone sulfate [DHEA-S], cortisol/DHEA-S ratio, and testosterone) and other behavioral health outcomes (fatigue). RESULTS: Compared to controls, stress-management interventions reduce anxiety, depression, distress, and fatigue and improve quality of life (d+s=0.16 to 0.38). Stress-management interventions do not appear to improve CD4+ counts, viral load, or hormonal outcomes compared with controls. CONCLUSION: Overall, stress-management interventions for HIV+ adults significantly improve mental health and quality of life but do not alter immunological or hormonal processes. The absence of immunological or hormonal benefits may reflect the studies' limited assessment period (measured typically within 1-week postintervention), participants' advanced stage of HIV (HIV+ status known for an average of 5 years), and/or sample characteristics (predominately male and White participants). Future research might test these hypotheses and refine our understanding of stress processes and their amelioration.     

Cortical and subcortical dynamics of aging with HIV infection

Given pharmaceutical advancements, more people with HIV will be living to old age. Cognitive declines have been observed both during normal aging and in people with HIV; whether there are cumulative cognitive declines in adults aging with HIV remains unknown. Based on current literature, adults aging with HIV may be at risk for psychomotor declines that resemble parkinsonianism.     

Stress management and exercise training in chronic stable angina pectoris

Abstract

Patients suffering from chronic stable angina pectoris were allocated to one of four conditions: stress management training, exercise training, combined stress management and exercise, or waiting list control. Patients undertook an exercise tolerance test before and after intervention, and at follow-up assessment eight weeks later. They also kept a daily diary of the frequency, duration and intensity of all angina episodes, and recorded the amount of medication taken, for the week preceding and the week following intervention, as well as for the eighth week of follow-up. Patients who undertook the combined stress management and exercise programme faired best. They showed sustained gains in achieved workload on the exercise tolerance test at no cost in terms of ischaemia, as measured by ST-segment depression. They also registered less frequent angina attacks following intervention than the exercise only and waiting list control patients, and reported reduced reliance on medication; the latter benefit was sustained at follow-up. These clinical dividends invite further study of combined stress management and exercise training in angina pectoris.