Psychoneuroimmunology and AIDS: Challenge or "Challenger"?
Samuel Perry Cornell University Medical College
By 1983, a couple of years into the AIDS epidemic, the National Institute of Mental Health (NIMH) sent out requests for applications that targeted AIDS- related psychoimmunologic research. There were basically three reasons for thinking that psychoimmunologists could make a valuable contribution.
First, animal and human studies over the previous decade had shown an intriguing relationship between the brain and the body's defense system. These were not just the usual epidemiological and clinical studies showing relationships between stress and physical illness, a relationship described by Hippocrates and many a clinician thereafter. These advances went beyond documenting that when you get overworked or run-down, you're more likely to get sick. Rather, bench- researchers were coming closer to identifying not only which specific changes in the immune system may be affected by stress and depression (such as natural killer cell function or lymphocyte proliferative response to a mitogen) but also how the brain and immune cells might be communicating with one another through the neuroendocrine system or, more properly, systems.
Second, by 1983 clinical impression and a few pilot studies already suggested two facts that we now know well: The progression of HIV disease is highly variable; and adults with AIDS--or at perceived risk for AIDS--have on average high levels of emotional distress and grief. Putting these two early observations together--variable clinical course and high rates of distress and grief-- could not one reasonably conclude that an altered emotional state was affecting the immune system and, as a result, was increasing susceptibility to opportunistic infections and tumors and maybe even susceptibility to HIV itself? And even more ambitiously, perhaps interventions that reduced distress or depression could reduce physical morbidity and mortality.