Depression and HIV infection: impact on immune function and disease progression

Can psychological factors, such as depression, affect human immunodeficiency virus progression? HIV infection is viewed as a chronic illness in which those infected often confront a number of emotional challenges and physical health and disease-related issues. Over the past 20 years, there has been increasing evidence that depression and other mood-related disturbances are commonly observed among HIV-positive individuals. There is also mounting data showing that depressive symptoms might further impact upon specific elements of immune system functioning and influence quality of life and health status. This paper will highlight studies examining the prevalence of depression during HIV infection and review some of the evidence examining the impact of depressive symptoms on immune function and HIV disease progression.     

Negative affectivity,coping, immune status,and disease progression in hiv iwected individuals

Abstract

The primary goal of the study was to assess the relationship between personality dispositions, coping styles, immune markers, clinical status, and subjective somatic symptoms in a mixed sample of HIV positive individuals. Specifically, the prognostic value of psychological and immunological measures in HIV progression was emphasized. Subjects (n = 104) were recruited from a cohort of 422 HIV positive individuals enrolled in the Oslo HIV Cohort Study. The partkipants were given self-administered questionnaires assessing behavioral, psychological, and psychdal variables. Clinical assessment and immunological tests were performed at regular follow-up visits. Clinical status was assessed according to the Centers for Disurse Control criteria. The immune markers used were CD4 T cell counts, beta2-microglobulin concentration, sewn levels of HIV-1 p24 core protein, and levels of antibodies to core protein. In addition, subjective somatic symptoms were assessed.

The results showed that measure-s of negative affectivity (NA; e.g. anxiety, distress, tension) were consistently related to subjective somatic symptoms and passivedefensive coping style. However, no amistent association between NA measures and immune markers was found. Individuals who developed AIDS in the study period had significantly lower initial CD4 cell counts as well as lower scores on measures of active-pmblem related wping (e.g. Positive reappraisal, Seeking social support) and passivedefensive coping (i.e. Escape-Avoidance, Self-control).

The results suggest (1) that coping styles may merit a specific focus in future research of psychological factors and medical outcomes in HIV infection, and (2) because of associations of NA measures with symptom reports studies of the relationship between e.g. stress, depression and HIV outcome should consider these variables as confounders.     

Counselling implications of anxiety and depression in AIDS and HIV infection: A pilot study

Anxiety and depression are two major psychological reactions to HIV infection. The recognition and treatment of these are of fundamental importance as they may alleviate the suffering for those with a potentially terminal illness, may increase coping and may improve the quality of their life. Furthermore, many of the physical symptoms associated with anxiety mirror AIDS symptoms. For prompt care it is important that those with HIV/AIDS, and those caring for them, recognize the role of anxiety to minimize unnecessary symptoms and recognize those which could respond to medical intervention. In this study a group of front line AIDS/HIV workers were given an in-depth training course on anxiety and depression. Evaluation of the course revealed a high number of patients suffering from anxiety (80.1%) and depression (31%). The evaluation revealed gains in counselling proficiency, knowledge and symptom recognition. Some of the entrenched myths, particularly surrounding suicide, were not resolved. These findings are discussed in the light of the difficulties of training non-mental health workers in the use of counselling skills.     

艾滋病恐惧症的研究初探

“艾滋病恐惧症”是一种混合性神经症,核心症状可表现为焦虑、疑病、恐惧、强迫、抑郁症状中的一种或几种的组合,可伴有与艾滋病的临床症状相似的躯体症状,患者感到痛苦,反复求医。该文综合了国外文献和部分案例,对“艾滋病恐惧症”的定义、临床症状、心理病理机制、诊断与治疗等进行了初步的总结与探讨。     

Psychische Störungen bei HIV-Infektion und Aids

The human immunodeficiency virus (HIV) is the pathogen responsible for acquired immune deficiency syndrome (AIDS). Worldwide there are currently about 40 million people infected with HIV and an estimated 44,000 in Germany. If left untreated after a few years the infection leads to the manifestation of AIDS and eventually to death through opportunistic infections and malignant tumors. Infection with HIV is not curable. Nevertheless, antiretroviral treatment can slow the progress of the disease and prolong life expectancy significantly. Once antiretroviral treatment has started the medication must be taken regularly and lifelong. Serious side effects of the medication pose a significant stress on physical and psychological well-being and impair adherence. Infection with HIV means a total change in life perspectives and requires extensive adaptations in lifestyle. Problems with adaptation and mental disorders (e.g. depression, anxiety disorders, adjustment disorder) are, therefore, frequent. With disease progression neurocognitive impairments are increasingly likely. Mental disorders and neurocognitive impairments adversely affect treatment adherence, increase health risk behavior and reduce immune function. Psychological interventions contribute significantly to the reduction in health risk behavior, improve treatment adherence and are successful in the treatment of depression and anxiety.     

Contributions of the functional analysis of behavior to the problem of AIDS

Epidemiological patterns in the spread of HIV infection and the potential role of psychologists in encouraging behavioral changes intended to reduce risks of infection are examined. The 1st great wave of AIDS cases in the industrialized countries occurred primarily in specific, fairly self-contained subgroups such as male homosexuals, hemophiliacs, and IV drug users. Large proportions in these groups are either infected or have adapted risk reduction behavior. The risk of infection for the general heterosexual population in industrialized countries is very low but likely to increase progressively unless measures are taken to reduce risks. Psychologists, who expend considerable effort researching and attempting to effect behavioral changes, thus have a potentially significant role in slowing the spread of the AIDS epidemic. The means of avoiding HIV infection in sexually active persons and drug users are known, but the means of motivating individuals to change to less risky behaviors are not as well understood. Several factors have been identified that appear to influence the vulnerability of the organism to HIV infection or to development of AIDS once infected. Several are capable of modification through behavioral changes, such as high-risk sexual practices, use of particular contraceptive methods, inadequate hygiene, poor nutrition, and self-administration of drugs. Several aspects of HIV infection and its spread are capable of producing psychological stress, including anxiety over possible infection and testing, reaction to diagnosis, fear of rejection by others, watching friends and relatives sicken and die of AIDS, encountering suspicious symptoms, and perceiving signs of physical deterioration. Psychological support in these situations can help to prolong life and improve its quality. Examples abound of individuals who continue to display a risk behavior despite being well informed of its risks; physicians who smoke are 1 such group. Information is a necessary but not sufficient condition for adapting preventive behaviors. Functional behavioral analysis suggests that immediate pleasure, ephemeral though it may be, outweighs the mere possibility of an unpleasant consequence at some hypothetical future date.     

The Relation Between Emotional Dysregulation and Anxiety and Depressive Symptoms, Pain-Related Anxiety, and HIV-Symptom Distress Among Adults with HIV/AIDS

The current study investigated the relations between emotional dysregulation and anxiety and depressive symptoms, pain-related anxiety, and HIV-symptom distress among individuals living with HIV/AIDS. This research is important in its explanatory value regarding the unique effects of emotional dysregulation as it relates to psychological and disease-specific distress given high rates of distress specific to HIV infection (e.g. medicatin side-effects, stigma). Participants included 164 adults (17.1 % female, Mage = 48.40, SD?=?9.57) with HIV/AIDS. Results indicated that emotional dysregulation was significantly and positively related to anxiety and depressive symptoms, pain-related anxiety, and HIV-symptom distress. All emotional dyregulation effects were evidenced above and beyond the variance accounted for by demographic and HIV-specific characteristics, and the main effects of anxiety sensitivity and distress intolerance. Findings are discussed in terms of the importance of emotional dysregulation in negative affective experiences within the HIV/AIDS population.     

Disengagement and Engagement Coping with HIV/AIDS Stigma and Psychological Well-Being of People with HIV/AIDS

The stigma associated with HIV/AIDS poses a psychological challenge to people living with HIV/AIDS. We hypothesized that that the consequences of stigma-related stressors on psychological well-being would depend on how people cope with the stress of HIV/AIDS stigma. Two hundred participants with HIV/AIDS completed a self-report measure of enacted stigma and felt stigma, a measure of how they coped with HIV/AIDS stigma, and measures of depression and anxiety, and self-esteem. In general, increases in felt stigma (concerns with public attitudes, negative self-image, and disclosure concerns) coupled with how participants reported coping with stigma (by disengaging from or engaging with the stigma stressor) predicted self-reported depression, anxiety, and self-esteem. Increases in felt stigma were associated with increases in anxiety and depression among participants who reported relatively high levels of disengagement coping compared to participants who reported relatively low levels of disengagement coping. Increases in felt stigma were associated with decreased self-esteem, but this association was attenuated among participants who reported relatively high levels of engagement control coping. The data also suggested a trend that increases in enacted stigma predicted increases in anxiety, but not depression, among participants who reported using more disengagement coping. Mental health professionals working with people who are HIV positive should consider how their clients cope with HIV/AIDS stigma and consider tailoring current therapies to address the relationship between stigma, coping, and psychological well-being.     

The association between body image and smoking cessation among individuals living with HIV/AIDS

Lower smoking cessation rates are associated with body image concerns in the general population. This relationship is particularly important to study in individuals living with HIV/AIDS due to alarmingly high smoking rates and considerable bodily changes experienced with HIV disease progression and treatment. The association between body image and smoking cessation rates was examined among individuals living with HIV/AIDS participating in a smoking cessation intervention. Body image concerns were significantly associated with depression, anxiety, stress, and social support, all variables known to affect cessation rates. However, reduced quit rates were found among individuals reporting elevated and low levels of body image concerns at the end of treatment. These findings suggest a unique relationship between smoking and body image among individuals living with HIV/AIDS. Further research is needed to examine these effects and whether moderate levels of body image concerns in this population reflect realistic body perceptions associated with positive mental health.     

The psychological impact of AIDS on gay men

The profound psychological impact of the acquired immunodeficiency syndrome (AIDS) epidemic on gay men needs to receive greater attention from mental health professionals. The specific treatment approach depends upon the individual's location on the AIDS-related conditions continuum. For men already diagnosed with AIDS, psychological themes include fears of death and dying, guilt, concerns about exposure of a homosexual life-style, fear of contagion, loss of self-esteem, decreased social support and increased dependency needs, stigmatization, loss of occupational and financial security, confusion over medical treatment options, and severe depression. The integration of a mental health service into AIDS special care hospital wards and participation in support groups are particularly useful for men with AIDS. Anxiety is the major clinical symptom among those who have not developed full-blown AIDS, but show signs of immune suppression. Issues for men in this "gray zone" include isolation, poor social and occupational functioning due to fatigue, shame, and frustration of achievement needs. Stress- reduction techniques are especially important with this population, to eliminate further compromise to the immune system or even to strengthen it. Many asymptomatic gay men ("the worried well") are manifesting acute psychological symptoms such as panic, generalized anxiety, obsessional thinking about AIDS, and somatization. Training in the negotiation of safe-sex agreements can reduce some of this anxiety. In general, the AIDS epidemic has introduced an existential component to psychotherapy with gay men, with a concern over issues such as the meaning of life and death.     

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.     

Psychoimmunology and aids: Psychological distress and herpes simplex virus in human immunodeficiency virus infected individuals

Abstract

No studies investigating the relationship of herpesviruses and psychological distress in Human Immunodeficiency Virus (HIV) infection are available in the literature. Antibody titers for Cytomegalovirus (CMV), Epstein-Barr (EBV) and Herpes Simplex virus (HSV) were assessed from sera drawn at the lime of psychological testing for one hundred HIV seropositive subjects. Increased psychological distress was correlated with increased titers of antibody to HSV, but not to CMV or EBV. Psychological distress may play a role in the devastating HSV infections experienced by immune deficient individuals. A stress mediated reactivation/potentiation hypothesis is discussed, where distress reactivates latent HSV which in turn potentiates HIV replication. These results may have implications for treatment of individuals co-infected with HIV and HSV.     

Treating an HIV/AIDS Patient’s PTSD and Medication Nonadherence With Cognitive-Behavioral Therapy: A Principle-Based Approach

HIV/AIDS patients with medication adherence problems are vulnerable to developing drug resistance, immune system degradation, and opportunistic infections. Poor adherence to antiretroviral medication regimens can be aggravated by psychiatric problems, including depression and posttraumatic stress disorder. This article presents the case study of a patient with HIV/AIDS who was unable to adhere to his antiretroviral medication regimen primarily because of PTSD and depressive symptoms resulting from a sexual assault that had caused his seroconversion. Exposure-based cognitive-behavioral therapy was instrumental in helping the patient overcome his PTSD and depressive symptoms so that he could tolerate his HIV medications. The patient’s symptom relief was evidenced by improved scores on the Impact of Event Scale and Beck Depression Inventory. The article discusses the importance of accurate assessment, therapist flexibility, and principle-based treatment versus strict adherence to manual-based protocols.     

有偿献血艾滋病患者的情绪状况及影响因素分析

考察有偿献血艾滋病患者的情绪状况 ,探讨他们面临的艾滋病压力和家庭状况、周围环境、身体状况等对情绪的影响。采用Beck抑郁量表、焦虑自评量表、艾滋病压力量表作为测查工具 ,测查了 1 85名有偿献血艾滋病患者 ,并收集了他们的人口学资料和生理学指标信息。结果发现 :( 1 )有偿献血艾滋病患者存在着严重的情绪障碍 ,他们的焦虑程度不但显著高于正常人 ,而且显著高于神经衰弱者和焦虑症者 ,且 92 %的患者有中、重度抑郁障碍 ;( 2 )身体症状和情绪 /生存压力能够显著预测焦虑的程度 ,社会压力和情绪 /生存压力能够显著预测抑郁的程度。因此 ,有偿献血艾滋病患者抑郁、焦虑情绪障碍严重 ,症状和艾滋病压力是情绪障碍的有效预测因素。     

Meta-analysis of cognitive-behavioral interventions on HIV-positive persons' mental health and immune functioning.

OBJECTIVE: To evaluate the efficacy of cognitive-behavioral interventions (CBIs) for improving the mental health and immune functioning of people living with HIV (PLWH). DESIGN: Comprehensive searches of electronic databases from 1988 to 2005, hand searches of journals, reference lists of articles, and contacts with researchers. Meta-analytic approaches were used in synthesizing findings. MAIN OUTCOME MEASURES: Intervention effects on symptoms of depression, anxiety, and anger, stress, and CD4 cell counts were assessed. RESULTS: Data from 15 controlled trials were analyzed. Significant intervention effects were observed for improving symptoms of depression (d = 0.33), anxiety (d = 0.30), anger (d = 1.00), and stress (d = 0.43). There is limited evidence suggesting intervention effects on CD4 cell counts (d = 0.08). The aggregated effect size estimates for depression and anxiety were statistically significant in trials that provided stress management skills training and had more than 10 intervention sessions. CONCLUSION: CBIs are efficacious in improving various psychological states of PLWH. Future research should examine the relationship among interventions, psychological states, medication adherence, and immune functions, and identify other relevant factors associated with intervention effects.     

Trajectory of change in anxiety sensitivity in relation to anxiety,depression, and quality of life among persons living with HIV/AIDS following transdiagnostic cognitive-behavioral therapy

ABSTRACT

Persons living with HIV/AIDS (PLHIV) disproportionately suffer from anxiety and depressive symptoms and disorders. Although past work has examined the efficacy of cognitive-behavioral therapy (CBT) for depression, and to a lesser extent anxiety, among PLHIV, little is known regarding potential mechanisms underlying improvement in anxiety/depression among this group. Anxiety sensitivity is a well-established risk/maintenance factor for anxiety and depressive disorders and is hypothesized to play an important role in maintaining anxiety among PLHIV. Past work has identified anxiety sensitivity as a mechanism of action underlying changes in various anxiety domains yet it is unknown whether changes in anxiety sensitivity relate to changes in anxiety symptoms among PLHIV undergoing transdiagnostic CBT for anxiety. The current study sought to examine treatment-related changes in anxiety sensitivity and how the trajectory of change relates to anxiety and depressive symptoms as well as overall quality of life. Individuals (n = 35) with HIV/AIDS and elevated anxiety symptoms received CBT for anxiety. Results indicated that reductions in anxiety sensitivity were significantly related to changes in anxiety, depression, and quality of life. Together, these data suggest that changes in anxiety sensitivity are significantly related to changes in anxiety/depression and quality of life among PLHIV seeking treatment.     

Stress management and psychoneuroimmunology in HIV infection

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.     

In the Face of Uncertainty: A Twin Study of Ambiguous Information,Anxiety and Depression in Children

Anxiety and depression share genetic influences, and have been associated with similar cognitive biases. Psychological theories of anxiety and depression highlight threat interpretations of ambiguity. Little is known about whether genes influence cognitive style, or its links to symptoms. We assessed ambiguous word and scenario interpretations, anxiety and depression symptoms in 300 8-year-old twin pairs. There were significant correlations between both negative interpretations of ambiguous words and scenarios and depression symptoms after controlling for anxiety symptoms (r = .13 and .31, respectively), but no significant correlations with anxiety independent of depression. Genetic effects ranged from 16% for depression to 30% for ambiguous word interpretations. Non-shared environmental influences were large (68–70%). Both genetic and environmental influences contributed to the association between depression and ambiguous scenario interpretations. These findings support psychological theories, which emphasise the role of environmental stress both on the development of threat interpretations and on their links with symptoms. The data also support a role for genetic influence on threat interpretations, which may mediate responses to stress.     

Factor influencing suicide intent in gay and bisexual suicide ideators: differing models for men with and without human immunodeficiency virus.

Of 778 gay and bisexual men (none with acquired immunodeficiency syndrome [AIDS]), 27% (n = 212) reported suicidal ideation over the previous 6 months. Covariance structure models were used to explore predictors of suicide intent among (n = 112) suicide ideators with (n = 100) and without (n = 112) human immunodeficiency virus (HIV). Current AIDS-related stressors (deaths and illnesses and perceived AIDS risk) and past levels of adaptive functioning (social isolation and depression) were significantly more powerful predictors of suicide intent among HIV-positive than among HIV-negative ideators. Biological AIDS risk predicted neither suicide intent, current distress, nor perceived AIDS risk. Pathways to suicide intent appear to be psychologically, rather than biologically, mediated. Among HIV-positive ideators, AIDS-related death and illness events predicted suicide intent but not current distress symptoms. Some suicidal ideation in response to AIDS-related events may be an effort to cope rather than a manifestation of psychological distress.