SEVERE LIFE STRESS AS A PREDICTOR OF EARLY DISEASE PROGRESSION IN HIV-INFECTION

Objective: Although there is evidence that stress is associated with a lterations in immunity, the role of emotional factors in the onset and course of immune-based diseases such as cancer and AIDS has not been established This prospective study was designed to test the hypothesis that stressful life events accelerate the course of HIV disease. Meth od: Ninety-three HIV-positive, homosexual men who were without clinica l symptoms at the time of entry into the study were studied for up to 42 months. Subjects received comprehensive medical, neurological, neur opsychological, and psychiatric assessments every 6 months, including assessment of stressful life events during the preceding 6-month inter val. Several statistical approaches were used to assess the relation b etween stress and disease progression. Results: The time of the first disease progression was analyzed with a proportional hazard survival m ethod, which demonstrated that the more severe the life stress experie nced, the greater the risk of early HIV disease progression. Specifica lly, for every one severe stress per 6-month study interval, the risk of early disease progression was doubled. Among a subset of 66 subject s who had been in the study for at least 24 months, logistic regressio n analyses showed that higher severe life stress increased the odds of developing HIV disease progress nearly fourfold. The degree of diseas e progress was also predicted by severe life stress when a proportiona l odds logistic regression model was used for analysis. Conclusions: t his report presents the first evidence from a prospective research stu dy that severe life event stress is associated with an increased rate of early HIV disease progression.