RELATION OF STRESSORS AND DEPRESSIVE SYMPTOMS TO CLINICAL PROGRESSIONOF VIRAL ILLNESS

Objective: The aim of this research was to determine whether and in wh om stressors and depressive symptoms facilitate clinical recurrence of herpes simplex virus (HSV) and progression of HIV. Method: Meta-analy tic techniques were used to review the relations of stressors and depr essive symptoms to clinical recurrence of HSV in 16 published studies and to indicators of HIV progression in 19 published studies. The auth ors calculated average effect sizes, performed fixed effect and random effect inferential analyses, tested for heterogeneous findings, and i dentified potential moderating variables. Results: Depressive symptoms were associated with a slightly increased risk of HSV recurrence and increased reports of HIV-related symptoms, whereas stressors were not. However; depressive symptoms were not associated with objective indic ators of accelerated HIV progression. Stressor studies, especially tho se that ascertained population-specific life events, found numerical a nd functional decrements in circulating natural killer cell population s. The candidate moderators identified include, for HSV recurrence, ag e, sex, and medication status, and for HIV-related symptoms, age, race , disease stage, and co-infection with HSV. Conclusions: Depressive sy mptoms, but not stressors, increase the risk of HSV recurrence general ly. Depressive symptoms do not appear to accelerate HIV progression ub iquitously, although they are associated with increased reporting of H IV-related symptoms. Future studies that ascertain population-specific stressors should determine whether reductions in cytotoxic lymphocyte s influence HIV disease progression. Moreover, researchers should inve stigate the role of the identified moderators and recognized psychoimm une moderators in existing and novel study groups. These analyses coul d confirm that certain individuals are especially susceptible to the e ffects on disease progression of stressors, depressive symptoms, or bo th.