Cognitive-behavioral stress management intervention buffers distress responses and immunologic changes following notification of HIV-1 seropositivity.

Antoni, Michael H.; Baggett, Lane; Ironson, Gail; LaPerriere, A.; August, Sharon; Klimas, Nancy G.; Schneiderman, Neil; Fletcher, Mary A

doi:10.1037/0022-006x.59.6.906

Cited by 265 publications

(215 citation statements)

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“…However, it is also possible that psychological and social variables, such as depression, social support or coping style, may mediate or moderate the relationship between stress and CD4 cell count, as other studies suggest (e.g. Antoni et al, 2000). Future studies should examine the mediation or moderation effects of these variables in stress experience and between stress and immunological outcomes, such as CD4 cell count.…”

Section: Discussionmentioning

confidence: 99%

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Perceived stress is associated with CD4+ cell decline in men and women living with HIV/AIDS in Spain

et al. 2007

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This study assessed whether perceived stress as measured by the Perceived Stress Scale (PSS) was associated with a decline in CD4'/ cell counts over a six-month period in 59 men and 41 women living with HIV-1. Participants underwent psychological and medical assessment at the study entry (baseline) and again at six months post-baseline. In a hierarchical regression model controlling for sociodemographic (e.g. age, gender, education, income) and disease-related variables (e.g. duration of antiretroviral treatment, antiretroviral treatment and adherence, CD4'/ cell count and viral load), perceived stress was associated with the decline in CD4'/ cell count over the six-month period. These findings suggest perceived psychosocial stress is associated with CD4'/ cell count decline independent of sociodemographic factors and disease status among men and women on antiretroviral medication for HIV/AIDS.

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Section: Discussionmentioning

confidence: 99%

“…Antoni et al, 2000;Evans et al, 1989;Evans et al, 1997;Godkin et al, 1994;Leserman et al, 2000;Mayne et al, 1996;Pereira et al, 2003;Weaver et al, 2004). Although there is limited evidence supporting a direct relationship between stress and AIDS progression, there are few studies suggesting that stress influences HIV disease course.…”

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Perceived stress is associated with CD4+ cell decline in men and women living with HIV/AIDS in Spain

et al. 2007

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“…Higher concordance could also increase efficacy with respect to the capacity to cope with HIV infection and its treatment [29], which has been shown to be associated with better psychological state (e.g. less depression) [30], which is itself associated with better immunological outcomes [31]. Indeed, trends were also observed for less anxiety/depression and fewer suicidal thoughts with higher concordance, but the relationship between concordance and CD4 cell count remained significant after controlling for quality of lifeanxiety/depression scores.…”

Section: Discussionmentioning

confidence: 99%

Doctor-patient concordance during HIV treatment switching decision-making

et al. 2010

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The aim of the study was to explore levels of doctor-patient concordance during the making of decisions regarding HIV treatment switching and stopping in relation to patient health-related outcomes. MethodsAdult patients attending five HIV clinics in the United Kingdom were requested to complete the study questionnaire, which included a Concordance Scale, and measures of symptoms [Memorial Symptom Assessment Short Form (MSAS) index], quality of life (EuroQol), satisfaction, adherence and sexual risk behaviour. Clinical health measures (HIV viral load and CD4 cell count) were also obtained. A total of 779 patients completed the questionnaire, giving a response rate of 86%; of these 779 patients, 430 had switched or stopped their HIV treatment and were thus eligible for inclusion. Of these patients, 217 (50.5%) fully completed the Concordance Scale. ResultsConcordance levels were high (88% scored between 30 and 40 on the scale; score range 10-40). Higher concordance was related to several patient outcomes, including: better quality of life (P 5 0.003), less severe and burdensome symptom experience (lower MSAS-physical score, P 5 0.001; lower MSAS-psychological score, P 5 0.008; lower MSAS-global distress index score, P 5 0.011; fewer symptoms reported, P 5 0.007), higher CD4 cell count (at baseline, P 5 0.019, and 6-12 months later, P 5 0.043) and greater adherence (P 5 0.029). ConclusionsHigh levels of doctor-patient concordance in HIV treatment decision-making are associated with greater adherence and better physical and psychological functioning. More research is needed to establish a causal relationship between concordance and these outcomes.

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“…As Ironson and colleagues (2002) note in their review, stress management interventions tend to improve psychosocial outcomes but the effects on immune functioning have been inconsistent. For example, some investigators have found improvements in immunological markers such as CD4+ counts for intervention but not control participants (Antoni et al, 1991) whereas other investigators have found similar increases in CD4+ counts for both the intervention and control groups (Mulder et al, 1995). In addition, the association between stressful life events and CD4+ counts among people with HIV tends to be delayed.…”

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confidence: 99%

Stress management interventions for HIV+ adults: A meta-analysis of randomized controlled trials, 1989 to 2006.

Scott-Sheldon¹,

Kalichman²,

Carey³

et al. 2008

Health Psychology

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Objective: Numerous studies document that stress accelerates disease processes in a variety of diseases including HIV. As a result, investigators have developed and evaluated interventions to reduce stress as a means to improve health among persons living with HIV. Therefore, the current meta-analysis examines the impact of stress-management interventions at improving psychological, immunological, hormonal, and other behavioral health outcomes among HIV+ adults.Design-This meta-analytic review integrated the results of 35 randomized controlled trials examining the efficacy of 46 separate stress-management interventions for HIV+ adults (N = 3,077).Main Outcome Measures-Effect sizes were calculated for stress processes (coping and social support), psychological/psychosocial (anxiety, depression, distress, and quality of life), immunological (CD4+ counts and viral load), hormonal (cortisol, dehydroepiandrosterone sulfate [DHEA-S], cortisol/DHEA-S ratio, and testosterone) and other behavioral health outcomes (fatigue).Results-Compared to controls, stress-management interventions reduce anxiety, depression, distress, and fatigue and improve quality of life (d + s = 0.16 to 0.38). Stress-management interventions do not appear to improve CD4+ counts, viral load, or hormonal outcomes compared with controls.Conclusion-Overall, stress-management interventions for HIV+ adults significantly improve mental health and quality of life but do not alter immunological or hormonal processes. The absence of immunological or hormonal benefits may reflect the studies' limited assessment period (measured typically within 1-week post-intervention), participants' advanced stage of HIV (HIV+ status known for an average of 5 years), and/or sample characteristics (predominately male and Caucasian participants). Future research might test these hypotheses and refine our understanding of stress processes and their amelioration. Coping with a chronic, life-threatening disease, however, is not without consequence as disease progression often involves a series of psychological and physical stressors that may impair daily functioning and quality of life. These stressors may involve a variety of physical symptoms, pain, concerns over disclosure of and stigma associated with HIV, and distress regarding one's own mortality (Derlega, Winstead, Greene, Serovich, & Elwood, 2002;Kalichman & Catz, 2000). NIH Public AccessResearch has demonstrated that such psychological and physical stressors can alter physiological processes and undermine health (see Kemeny, 2003;McEwen, 1998;Tosevski & Milovancevic, 2006;Vanable, Carey, Blair, & Littlewood, 2006). Although acute activation of these physiological processes is adaptive, chronic activation may lead to negative health effects including impaired immune functioning (see Segerstrom and Miller, 2004). Indeed, increased stress associated with chronic medical diseases such as HIV/AIDS appears to accelerate immune impairment, including reduced lymphocyte circulation and increased cortisol levels and a m...

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Cognitive-behavioral stress management intervention buffers distress responses and immunologic changes following notification of HIV-1 seropositivity.

Cited by 265 publications

References 33 publications

Perceived stress is associated with CD4+ cell decline in men and women living with HIV/AIDS in Spain

Perceived stress is associated with CD4+ cell decline in men and women living with HIV/AIDS in Spain

Doctor-patient concordance during HIV treatment switching decision-making

Stress management interventions for HIV+ adults: A meta-analysis of randomized controlled trials, 1989 to 2006.

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