Effects of negative life events on immune suppression in children and youth infected with human immunodeficiency virus type 1

Objectives. To evaluate the association of negative stressful life events e xperienced over 12 months and the risk of moderate to severe immune suppres sion among children and youth infected with human immunodeficiency virus ty pe 1 (HIV-1). Methods. Longitudinal study of 618 HIV-1-infected children, baseline ages 1 to 20 years (mean age: 6.4 years), who completed 52 weeks of participation in the Pediatric Late Outcomes Study (Pediatric AIDS Clinical Trials Group Protocol 219). Severity of immune suppression was indicated by the Centers for Disease Control and Prevention Pediatric HIV Disease Classification Sy stem, based on CD4 percentages. The total number of negative life events-ca tegorized as none, 1, or >1 life event reported as having occurred in the p revious 12 months (previous 6 months for children <3 years of age)-was the predictor variable. Multiple logistic regressions were estimated to assess the relationship of negative life events and immune suppression at outcome, controlling for baseline measures of immune suppression, continuous CD4%, negative life events, age, race/ethnicity, gender, primary caretaker, educa tion level of caretaker, and acquired immunodeficiency syndrome status. Results. At week 52, 379 subjects (61% of total study population) had moder ate to severe immune suppression. Of 275 children with normal immune functi on at baseline, 68 (24.7%) subsequently developed moderate to severe suppre ssion levels by week 52 of follow-up. Of 343 children with immune suppressi on at baseline, 32 (9.2%) had recovered to normal CD4% levels by week 52. M ore than 1 negative life event was associated with an increased risk (preva lence) of immune suppression (odds ratio [OR]: 2.76; 95% confidence interva l [CI]: 1.44,5.31), controlling for baseline CD4%, total life events, and o ther covariates. Children without immune suppression at baseline who experi enced >1 negative life event had an increased incidence of immune suppressi on (OR: 2.93; 95% CI: 1.34,6.39), controlling for baseline covariates. Conclusions. Results indicate that negative stressful life events increase the risk of children with HIV-1 infection having impaired immune function. Further research is needed to identify potential mechanisms of the relation ship between stressful life events and impaired immune function. These mech anisms include psychoneuroendocrinologic response and difficulties in adher ence to therapy after exposure of a child to major negative life events.