Impact of stressful life events, depression, social support, coping, and cortisol on progression to AIDS

Objective: This study examined prospectively the effects of stressful event s, depressive symptoms, social support, coping methods, and cortisol levels on progression of HIV-1 infection. Method: Eighty-two homosexual men with HIV type-1 infection without AIDS or symptoms at baseline were studied every 6 months for up to 7.5 years. Men were recruited from rural and urban areas in North Carolina, and none was u sing antiretroviral medications at entry. Disease progression was defined a s CD4(+) lymphocyte count <200/mu l or the presence of an AIDS indicator co ndition. Results: Cox regression models with time-dependent covariates were used adj usting for race, baseline CD4(+) count and viral load, and cumulative avera ge antiretroviral medications. Faster progression to AIDS was associated wi th higher cumulative average stressful life events, coping by means of deni al, and higher serum cortisol as well as with lower cumulative average sati sfaction with social support. Other back ground (e.g., age, education) and health habit variables (e.g., tobacco use, risky sexual behavior) did not s ignificantly predict disease progression. The risk of AIDS was approximatel y doubled for every 1.5-unit decrease in cumulative average support satisfa ction and for every cumulative average increase of one severe stressor, one unit of denial, and 5 mu g/dl of cortisol. Conclusions: Further research is needed to determine if treatments based on these findings might alter the clinical course of HIV-1 infection.