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By Alan Mozes
NEW YORK, Mar 14 (Reuters Health) - Stress, hostility and lack of social support may be dangerous to individuals infected with HIV, dampening the positive effects of antiretroviral medications and resulting in faster progression to full-blown AIDS, according to researchers.
"The bottom line is that when physicians are interacting with patients with HIV, they should not ignore psycho-social issues," said Dr. Jane Leserman of the University of North Carolina School of Medicine in Chapel Hill. "Stressful life events and social support may play an important role in the disease course."
Leserman is the lead author of one of four studies recently conducted on the relationship between HIV and psycho-social factors. The findings of all four studies were presented last week at the annual meeting of the American Psychosomatic Society held in Monterey, California.
In her study, Leserman followed 96 HIV-positive men over a 9-year period. None of the men displayed symptoms of AIDS-related health complications at the start of the study. Leserman and colleagues monitored the progression of the disease every 6 months--evaluating the development of any HIV-related complications while regularly calculating the amount of virus in the men's blood. They also measured levels of the stress hormone cortisol and recorded the men's self-reported levels of stress, anger and social support.
Leserman's team found that those who had higher average stress, anger and cortisol levels--as well as less social support--displayed a faster progression to AIDS. They also noted that incremental increases in any of these factors could at times more than double a patient's risk of developing AIDS.
According to the other studies, while stressful life events may worsen the immune system of HIV-positive patients, researchers found that social support, optimistic approaches to life, spiritual affiliations and a good relationship with one's doctor can have a positive impact on the patient's immune system.
Also, treatment was impeded by negative personality characteristics, but behavioral stress management interventions seemed to be effective in reducing anxiety, stress, depression and cortisol levels, as well as boosting the patient's immune system.
Leserman told Reuters Health that doctors should be on the lookout for signs of stress and social problems among their HIV-positive patients, and need to be ready to direct those experiencing such difficulties to appropriate psycho-social therapies.
Encouraging patients to join groups that "provide social support or (assist in)...stress management may be helpful," she suggested. "And it's a positive thing for patients, because it's something they can do themselves proactively so they can help their mental state and perhaps their physical state."
Leserman further cautioned that doctors should exercise sensitivity when treating an HIV patient's mental health--distinguishing between those issues which are a function of having HIV and those which are a general matter of lifestyle.
"Sometimes we see fatigue or various symptoms that we might associate with HIV--but it may be associated with depression or other kinds of mood disturbances. So we should not just assume that all the symptoms that patients are showing are HIV related," she noted.
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