Objective: We examined the effects of stress, depressive symptoms, and soci
al support on the progression of HIV infection. Methods: Eighty-two HIV-inf
ected 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. Dise
ase progression was defined using criteria for AIDS (CD4(+) lymphocyte coun
t of <200/mu l and/or an AIDS-indicator condition). Results: We used Cox re
gression models with time-dependent covariates, adjusting for age, educatio
n, race, baseline CD4+ count, tobacco use, and number of antiretroviral med
ications. Faster progression to AIDS was associated with more cumulative st
ressful life events (p = .002), more cumulative depressive symptoms (p = .0
08), and less cumulative social support (p = .0002). When all three variabl
es were analyzed together, stress and social support remained significant i
n 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 me
dian on social support compared with those below the median on stress or ab
ove the median on support, respectively. Conclusions: These data are among
the first to demonstrate that more stress and less social support may accel
erate the course of HIV disease progression. Additional study will be neces
sary to elucidate the mechanisms that underlie these relationships and to d
etermine whether interventions that address stress and social support can a
lter the course of HIV infection.