Magazine article Clinical Psychiatry News

Mood and Stress May Influence HIV Progression

Magazine article Clinical Psychiatry News

Mood and Stress May Influence HIV Progression

Article excerpt

SAN FRANCISCO -- Depression and stress appear to be important considerations in the treatment of HIV-infected patients, Dr. Frederick Hecht said at a meeting on HIV management sponsored by the University of California, San Francisco.

Although research on the topic is not conclusive, available evidence suggests that being able to experience positive emotions may protect somewhat against CD4 cell count loss, he said.

And, in a small pilot study of yoga practice, he obtained intriguing, but not definitive, evidence that there might be ways to mitigate depression and response to stress.

The first studies associating depression with CD4 cell loss, published in 1993, were not entirely convincing, said Dr. Hecht, research director of the UCSF Os-her Center for Integrative Medicine.

Subsequent studies have suggested that it is not depression per se that is associated with rapid HIV disease progression, and that negative affective symptoms have little or no impact on HIV progression.

Instead these studies have shown that positive affect--the ability to experience positive thoughts and emotions, and enjoy some aspects of life, even despite sadness--can have a large effect, Dr. Hecht said.

One study, the San Francisco Men's Health Study, included 407 HIV-positive men followed over 10 years.

The relative risk of AIDS mortality was 0.89 in those who scored highly on positive affect. Negative affect, however, had little relationship. (Psychosom. Med. 2003:65:620-66).

In another study, of 82 HIV-positive men followed an average 5 years, stress was associated with risk of progression. One major stressful event in a 6-month period, such as the dissolution of an intimate relationship or loss of a loved one, doubled the risk of progression.

Studies by researchers at the University of California, Los Angeles, have hinted at how mood and affect might be tied to the immune system in the setting of HIV. That research suggests that the connection might be through the CCR5 receptor, the major coreceptor of HIV on CD4 cells. Persons who have rapidly progressing disease may have more CCR5 receptors, and the researchers have shown that neurotransmitters such as norepinephrine can increase receptor expression in vitro. …

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