Psychological Medicine

Progression to AIDS, a clinical AIDS condition and mortality: psychosocial and physiological predictors

J.  LESERMAN  a1 c1, J. M.  PETITTO  a1, H.  GU  a1, B. N.  GAYNES  a1, J.  BARROSO  a1, R. N.  GOLDEN  a1, D. O.  PERKINS  a1, J. D.  FOLDS  a1 and D. L.  EVANS  a1
a1 From the Departments of Psychiatry, Medicine and Pathology and Laboratory Medicine, University of North Carolina School of Medicine, and School of Nursing, University of North Carolina, Chapel Hill, North Carolina; Departments of Psychiatry, Neuroscience and Pharmacology, University of Florida College of Medicine, Gainesville, Florida; and Departments of Psychiatry, Medicine and Neuroscience, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA


Background. The primary aim of this study is to examine prospectively the association of stressful life events, social support, depressive symptoms, anger, serum cortisol and lymphocyte subsets with changes in multiple measures of human immunodeficiency virus (HIV) disease progression.

Methods. Ninety-six HIV-infected gay men without symptoms or anti-retroviral medication use at baseline were studied every 6 months for up to 9 years. Disease progression was defined in three ways using the Centers for Disease Control (CDC) classifications (e.g. AIDS, clinical AIDS condition and mortality). Cox regression models with time-dependent covariates were used, adjusting for control variables (e.g. race, age, baseline, CD4 T cells and viral load, number of anti-retroviral medications).

Results. Higher cumulative average stressful life events and lower cumulative average social support predicted faster progression to both the CDC AIDS classification and a clinical AIDS condition. Higher anger scores and CD8 T cells were associated with faster progression to AIDS, and depressive symptoms were associated with faster development of an AIDS clinical condition. Higher levels of serum cortisol predicted all three measures of disease progression.

Conclusions. These results suggest that stressful life events, dysphoric mood and limited social support are associated with more rapid clinical progression in HIV infection, with serum cortisol also exerting an independent effect on disease progression.

c1 Address for correspondence: Dr Jane Leserman, Department of Psychiatry, CB 7160, UNC School of Medicine, Chapel Hill, NC 27599-7160, USA.