Progression to AIDS: The effects of stress, depressive symptoms, and social support

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  • Leserman, Jane
    • Affiliation: School of Medicine, Department of Psychiatry
  • Jackson, Eric D.
    • Affiliation: School of Medicine, Department of Psychiatry
  • Petitto, John M.
    • Other Affiliation: Departments of Psychiatry, Neuroscience, and Pharmacology, University of Florida College of Medicine, Gainesville, FL
  • Golden, Robert N.
    • Affiliation: School of Medicine, Department of Psychiatry
  • Silva, Susan G.
    • Affiliation: School of Medicine, Department of Psychiatry
  • Perkins, Diana
    • Affiliation: School of Medicine, Department of Psychiatry
  • Cai, Jianwen
    • Affiliation: Gillings School of Global Public Health, Department of Biostatistics
  • Folds, James D.
    • Affiliation: School of Medicine, Department of Pathology and Laboratory Medicine
  • Evans, Dwight L.
    • Other Affiliation: Departments of Psychiatry, Medicine, and Neuroscience, University of Pennsylvania School of Medicine, Philadelphia, PA
Abstract
  • Objective: We examined the effects of stress, depressive symptoms, and social support on the progression of HIV infection. Methods: Eighty-two HIV- infected gay men without symptoms or AIDS at baseline were followed up every 6 months for up to 5.5 years. Men were recruited from rural and urban areas in North Carolina as part of the Coping in Health and Illness Project. Disease progression was defined using criteria for AIDS (CD4+ lymphocyte count of less than 200/μl and/or an AIDS-indicator condition). Results: We used Cox regression models with time-dependent covariates, adjusting for age, education, race, baseline CD4+ count, tobacco use, and number of antiretroviral medications. Faster progression to AIDS was associated with more cumulative stressful life events (p = .002), more cumulative depressive symptoms (p = .008), and less cumulative social support (p = .0002). When all three variables were analyzed together, stress and social support remained significant in the model. At 5.5 years, the probability of getting AIDS was about two to three times as high among those above the median on stress or below the median on social support compared with those below the median on stress or above the median on support, respectively. Conclusions: These data are among the first to demonstrate that more stress and less social support may accelerate the course of HIV disease progression. Additional study will be necessary to elucidate the mechanisms that underlie these relationships and to determine whether interventions that address stress and social support can alter the course of HIV infection.
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  • Article
Rights statement
  • In Copyright
Journal title
  • Psychosomatic Medicine
Journal volume
  • 61
Journal issue
  • 3
Page start
  • 397
Page end
  • 406
Language
  • English
Version
  • Postprint
ISSN
  • 1534-7796

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