Progression to AIDS: The effects of stress, depressive symptoms, and social support

Citation
J. Leserman et al., Progression to AIDS: The effects of stress, depressive symptoms, and social support, PSYCHOS MED, 61(3), 1999, pp. 397-406
Citations number
49
Categorie Soggetti
Psychiatry,"Clinical Psycology & Psychiatry","Neurosciences & Behavoir
Journal title
PSYCHOSOMATIC MEDICINE
ISSN journal
00333174 → ACNP
Volume
61
Issue
3
Year of publication
1999
Pages
397 - 406
Database
ISI
SICI code
0033-3174(199905/06)61:3<397:PTATEO>2.0.ZU;2-D
Abstract
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.