Distress, denial, and low adherence to behavioral interventions predict faster disease progression in gay men infected with human immunodeficiency virus

Abstract

This study examined psychological prediction of 2-year disease progression in gay men after finding out their human immunodeficiency virus (HIV) serostatus. Psychological and immune status of asymptomatic gay men who did not know their HIV serostatus was monitored during the 5 weeks before and after serostatus notification. The men were randomly assigned to an exercise. cognitive-behavioral stress-management intervention, or control group. At 2-year follow-up for the 23 men who turned out to be seropositive. 9 had developed symptoms, including 5 with acquired immune deficiency syndrome--4 of whom died. Distress at diagnosis, denial (5 weeks post-diagnosis minus pre-diagnosis). and low adherence during interventions were significant predictors of 2-year disease progression. Denial and adherence remained significant predictors of disease progression even after controlling for CD4 number at entry. Furthermore. change in denial was significantly correlated with immune status 1 year later; l-year immune status was significantly correlated with 2-year disease progression. The present study therefore demonstrates significant relations between psychological variables on the one hand and both immune measures and HIV-1 disease progression on the other. We conclude that distress, denial, and low protocol compliance predict subsequent disease progression.

Psychosocial Factors Predict CD4 and Viral Load Change in Men and Women With Human Immunodeficiency Virus in the Era of Highly Active Antiretroviral Treatment

“…Coping strategies were assessed using the COPE (40), a 24-item scale, modified for HIV populations, which assesses the endorsement of each of 12 cognitive and behavioral coping strategies. Two subscales, denial and behavioral disengagement, were combined for an avoidant coping composite because of previous work relating them to disease outcomes in HIV (4,11,14). Life event stress was assessed using the Sarason et al (41) life events scale sum of the weighted (−3 to +3) negative life events excluding health related events.…”

“…Thus, depression has been related to faster CD4 decline (1), progression to acquired immunodeficiency syndrome (AIDS) (2)(3)(4)(5), and mortality (6)(7)(8). Similarly, stress has predicted faster CD4 cell decline (9,10), clinical symptoms (11,12), and progression to AIDS (3,4). Longitudinal studies of coping found that denial predicts greater CD4 decline (11), progression to AIDS (11,13,14), and mortality (11).…”

“…Similarly, stress has predicted faster CD4 cell decline (9,10), clinical symptoms (11,12), and progression to AIDS (3,4). Longitudinal studies of coping found that denial predicts greater CD4 decline (11), progression to AIDS (11,13,14), and mortality (11). Conversely, active coping predicted decreased clinical progression (15), AIDS (16), and lower mortality (17).…”

Dispositional optimism and the mechanisms by which it predicts slower disease progression in HIV: proactive behavior, avoidant coping, and depression

“…NIH-PA Author Manuscript NIH-PA Author Manuscript strategies such as denial and giving up, which have been associated with negative affect and the development of symptoms and death in HIV (Ironson et al, 1994).…”

“…Furthermore, optimists persist in goal attainment even in the face of obstacles (Carver & Scheier, 1998). As noted in Segerstrom, Taylor, Kemeny, and Fahey (1998), dispositional optimists make less use of avoidant coping strategies such as denial and giving up, which have been associated with negative affect and the development of symptoms and death in HIV (Ironson et al, 1994).…”