PSYCHONEUROIMMUNOLOGICAL ASPECTS OF DISEASE PROGRESSION AMONG WOMEN WITH HUMAN PAPILLOMAVIRUS-ASSOCIATED CERVICAL DYSPLASIA AND HUMAN-IMMUNODEFICIENCY-VIRUS TYPE-1 COINFECTION

Objective: Psychosocial associations have been observed with level of cervical dysplasia or ''pre-cancer'' and invasive cervical cancer [rel ated to human papillomavirus (HPV) infection]. Psychoneuroimmunologica l relationships have been observed in human immunodeficiency virus typ e 1 (HIV-1) infection, which is being described in an increasing numbe r of women' Our objective was to review these relationships regarding effects that might be expected in HIV-1 and HPV co-infected women. Met hod: This review was based on a Medline literature search supplemented by a manual search of selected journals unrepresented in that databas e. Results: Relationships of psychosocial factors and level of cervica l dysplasia were similarly observed with reference to immunological an d health status in asymptomatic and early symptomatic HIV-1 infected h omosexual men, suggesting that a potentiating effect may occur in HIV- 1 and HPV co-infected women. Consistency of relationships across studi es appeared to be enhanced by the use of a biopsychosocial model integ rating the effects of life stressors, social support and coping style as well as psychiatric disorders. Conclusions: Research is indicated o n the relationships between psychosocial factors, immunological status and clinical health status in this group of women. Because of the hig h prevalence of psychosocial risk factors for chronic psychological di stress in these women and the known immunological and health status de crements occurring with progression of these two infections, a clinica l screening program based on the biopsychosocial model is recommended as a means of secondary prevention. If effective in generating treatme nt referrals, such a program would likely improve quality of life and could aid in the determination of relationships with immunological and health status as well.