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Stress Management and Psychoneuroimmunology in HIV Infection

Published online by Cambridge University Press:  07 November 2014

Michael H. Antoni
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Abstract

Does stress management affect psychological and immune functioning in persons with human immunodeficiency virus infections? Stress-management techniques, such as relaxation training and imagery, cognitive restructuring, coping-skills training, and interpersonal-skills training, may reduce anxiety, depression, and social isolation in HIV-infected persons by lowering physical tension and increasing a sense of control and self-efficacy. A psychoneuroimmunologic model is proposed wherein these psychological changes are hypothesized to be accompanied by an improved ability to regulate neuroendocrine functioning, which in turn may be associated with a partial normalization of immune system functions such as lymphocyte proliferation and cytotoxicity, providing more efficient surveillance of latent viruses that may contribute directly to increased HIV replication and generate opportunistic infections or cancer if left unchecked. Such a normalization of stress-associated immune system decrements are hypothesized to forestall or minimize increases in viral load and expression of clinical symptoms. This model is useful for testing the factors contributing to the health effects of stress-management interventions in HIV-infected persons. In this context, one general research strategy for testing the effects of stress-management interventions is to target them toward the more prevalent psychosocial challenges that HIV-infected people face at various points in the disease process; enroll an HIV-infected population (eg, HIV-positive homosexual and bisexual men) into a randomized trial; and monitor changes in cognitive, affective, behavioral, and social factors in parallel with hormonal, immunologic, viral, and clinical changes over the course of time. This article will review the major psychoneuroimmunologic findings that have emerged using this paradigm and suggest future research directions and clinical applications.

Type
Review
Information
CNS Spectrums , Volume 8 , Issue 1: Neuropsychiatric HIV Infection , January 2003 , pp. 40 - 51
Copyright
Copyright © Cambridge University Press 2003

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References

REFERENCES

1.Pantaleo, G, Graziosi, C, Fauci, AS. The immunopathogenesis of human immunodeficiency virus infection. N Eng J Med. 1993;328:327–335.Google ScholarPubMed
2.Kaplan, LD, Wofsky, CB, Volberding, PA. Treatment of patients with acquired immunodeficiency syndrome and associated manifestations. JAMA. 1987;257:1367–1376.CrossRefGoogle ScholarPubMed
3.Maiman, M, Fruchter, R. Cervical neoplasia and the human immunodeficiency virus. In: Rubino, S, Hoskins, W, eds. Cervical Cancer and Preinvasive Neoplasia. Philadelphia, Pa: Lippincott-Raven; 1996:405–416.Google Scholar
4.Zur Hausen, H. Papillomaviruses and cancer: from basic studis to clinical application. Nat Rev Cancer. 2002;2:342–350.CrossRefGoogle Scholar
5.Ironson, G, Friedman, A, Klimas, N, et al.Distress, denial and low adherence to behavioral interventions predict faster disease progression in gay men infected with human immunodeficiency virus. Int J Behav Med. 1994;1:90–105.CrossRefGoogle ScholarPubMed
6.Antoni, MH, Schneiderman, N, Fletcher, MA, et al.Psychoneuroimmunology and HIV-1. J Consult Clin Psychol. 1990;58:38–49.CrossRefGoogle ScholarPubMed
7.Schneiderman, N, Antoni, MH, Saab, P, Ironson, G. Health psychology: psychosocial and biobehavioral aspects of chronic disease management. Annu Rev Psychol. 2001;52:555–580.CrossRefGoogle ScholarPubMed
8.Antoni, MH, Schneiderman, N. HIV/AIDS. In: Bellack, A, Hersen, M, eds. Comprehensive Clinical Psychology. New York, NY: Elsevier Science; 1998:237–275.CrossRefGoogle Scholar
9.Klimas, N, Caralis, P, LaPerriere, A, et al.Evaluation of immunological status in a cohort of HIV-1 positive and negative healthy gay men. J Clin Microbiol. 1991;29:1413–1421.CrossRefGoogle Scholar
10.Ironson, G, Balbin, E, Solomon, G, et al.Relative preservation of natural killer cell cytotoxicity and number in healthy AIDS patients with low CD4 cell counts. AIDS. 2001;15:2065–2073.CrossRefGoogle ScholarPubMed
11.Antoni, MH, Esterling, B, Lutgendorf, S, Fletcher, MA, Schneiderman, N. Psychosocial stressors, herpesvirus reactivation and HIV-1 infection. In: Stein, M, Baum, A, eds. AIDS and Oncology: Perspectives in Behavioral Medicine. Hillsdale, NJ: Erlbaum; 1995:135–168.Google Scholar
12.Glaser, R, Kiecolt-Glaser, J. Stress-associated depression in cellular immunity: implications for acquired immune deficiency syndrome (AIDS). Brain Behav Immun. 1987;1:107–112.CrossRefGoogle ScholarPubMed
13.Carbonari, M, Fiorilli, M, Mezzaroma, I, Cherchi, M, Aiuti, F. CD4 as the receptor for retroviruses of the HTLV family: immunopathogenetic implications. Adv Exp Med Biol. 1989;257:3–7.CrossRefGoogle ScholarPubMed
14.Rosenberg, ZF, Fauci, AS. Activation of latent HIV infection. J NIH Res. 1991;2:41–45.Google Scholar
15.Boshoff, C, Weiss, R. AIDS-related malignancies. Nat Rev Cancer. 2002;2:373–382.CrossRefGoogle ScholarPubMed
16.Byrnes, D, Antoni, MH, Goodkin, K, et al.Stressful events, pessimism, natural killer cell cytotoxicity and cytotoxic/suppressor T cells in HIV+ Black women at risk for cervical cancer. Psychosom Med. 1998;60:714–722.CrossRefGoogle ScholarPubMed
17.Pereira, D, Antoni, MH, Simon, T, et al.Stress and squamous intraepithelial lesions in women with human papillomavirus and human immunodeficiency virus. Psychosom Med. In press.Google Scholar
18.Griffiths, PD, Grundy, JE. Molecular biology and immunology of cytomegalovirus. J Biochem (Tokyo). 1987;241:313–324.CrossRefGoogle ScholarPubMed
19.McEwen, B. Protective and damaging effects of stress mediators. N Engl J Med. 1998;338:171–179.CrossRefGoogle ScholarPubMed
20.Calabrese, J, King, M, Gold, P. Alterations in immunocompetence during stress, bereavement, and depression: focus on neuroendocrine regulation. Am J Psychiatry. 1987;144:1123–1134.Google ScholarPubMed
21.Kiecolt-Glaser, J, Ricker, D, George, J, et al.Urinary cortisol levels, cellular immunocompetency, and loneliness in psychiatric inpatients. Psychosom Med. 1984;46:15–23.CrossRefGoogle ScholarPubMed
22.Markham, P, Salahuddin, S, Veren, K, Orndorff, S, Gallo, R. Hydrocortisone and some other hormones enhance the expression of HTLV-III. Int J Cancer. 1986;37:67–72.CrossRefGoogle ScholarPubMed
23.Clerici, M, Trabattoni, D, Piconi, S, et al.A possible role for the cortisol/anticortisols imbalance in the progression of human immunodeficiency virus. Psychoneuroendocrinology. 1997;22(suppl 1):S27–S31.CrossRefGoogle ScholarPubMed
24.Lortholary, O, Christeff, N, Casassus, Pet al.Hypothalamic-pituitary-adrenal function in human immunodeficiency virus-infected men. J Clin Endocrin Metabol. 1996;81:791–796.Google Scholar
25.Kumar, M, Kumar, A, Morgan, R, Szapocznik, J, Eisdorfer, C. Abnormal pituitary-adrenocortical response in early HIV-1 infection. J Acquir Immune Defic Syndr. 1993;6:61–65.Google ScholarPubMed
26.Rondanelli, M, Solerte, S, Fioravanti, M, et al.Circadian secretory pattern of growth hormone, insulin-like growth factor type I, cortisol, adrenocorticotropic hormone, thyroid-stimulating hormone, and prolactin during HIV infection. AIDS Res Hum Retroviruses. 1997;13:1243–1249.CrossRefGoogle ScholarPubMed
27.Plaut, M. Lymphocyte hormone receptors. Annu Rev Immunol. 1987;5:621–669.CrossRefGoogle ScholarPubMed
28.Manuck, S, Cohen, S, Rabin, B. Individual differences in cellular immune responses to stress. Psychol Sci. 1991:2:111–115.CrossRefGoogle Scholar
30.Cole, S, Korin, Y, Fahey, J, Zack, J. Norepinephrine accelerates HIV replication via protein kinase-A dependent effects on cytokine production. J Immunol. 1998;161:610–616.CrossRefGoogle ScholarPubMed
31.Webster, E, Elenkov, I, Chrousos, G. The role of corticotropin-releasing hormone in neuroendocrine-immune interactions. Mol Psychiatry. 1997;2:368–372.CrossRefGoogle ScholarPubMed
32.Cole, S, Kemeny, M. Psychosocial influences on the progression of HIV infection. In: Ader, R, Cohen, N, Felten, D, eds. Psychoneuroimmunology. 3rd ed. New York, NY: Academic Press; 2001:583–612Google Scholar
33.Cole, S, Kemeny, M, Naliboff, B, Fahey, J, Zack, J. ANS enhancement of HIV pathogenesis. Brain Behav Immun. 2001;15:121.Google Scholar
34.Maier, SF, Watkins, LR, Fleshner, M. Psychoneuroimmunology: the interface between behavior, brain, and immunity. Am Psychol. 1994;49:1004–1017.CrossRefGoogle ScholarPubMed
35.Ironson, G, Antoni, MH, Schneiderman, N, et al.Coping: interventions for optimal disease management. In: Chesney, M, Antoni, MH, eds. Health Psychology Innovations: New Target Populations for Prevention and Care. Washington, DC: American Psychological Association; 2002:167–196.Google Scholar
36.Coates, T, McKusick, L, Stites, D, Kuno, R. Stress management training reduced number of sexual partners but did not improve immune function in men infected with HIV. Am J Public Health. 1989;79:885–887.CrossRefGoogle Scholar
37.Auerbach, JH, Oleson, TD, Solomon, GF. A behavioral medicine intervention as an adjunctive treatment for HIV-related illness. Psychol Health. 1992;6:325–334.CrossRefGoogle Scholar
38.Simons, A, Garfield, S, Murphy, G. The process of change in cognitive therapy and pharmacotherapy: changes in mood and cognition. Arch Gen Psychiatry. 1984;41:45–51.CrossRefGoogle ScholarPubMed
39.Folkman, S, Chesney, M, McKusick, L, et al.Translating coping theory into intervention. In: J., Eckenrode, ed. The Social Context of Stress. New York, NY: Plenum; 1991;239–260.CrossRefGoogle Scholar
40.Antoni, MH. Cognitive behavioral stress management for gay men learning of their HIV-1 antibody test results. In: Spira, J, ed. Group Therapy for Patients With Chronic Medical Diseases. New York, NY: Guilford Press; 1997:55–91.Google Scholar
41.Antoni, MH, Ironson, G, Lutgendorf, S. Psychosocial intervention in HIV infection. In: Nott, K, Vedhara, K, eds. Psychosocial And Biomedical Interactions in HIV Infection. Amsterdam, Netherlands: Harwood Academic Publishers; 2000;253–296.Google Scholar
42.Antoni, MH, Baggett, L, Ironson, G, et al.Cognitive behavioral stress management intervention buffers distress responses and immunologic changes following notification of HIV-1 seropositivity. J Consult Clin Psychol. 1991;59:906–915.CrossRefGoogle ScholarPubMed
43.Esterling, B, Antoni, M, Schneiderman, N, et al.Psychosocial modulation of antibody to Epstein-Barr viral capsid antigen and herpes virus type-6 in HIV-1 infected and at-risk gay men. Psychosom Med. 1992;54:354–371.CrossRefGoogle ScholarPubMed
44.Antoni, MH, Lutgendorf, S, Ironson, G, Fletcher, MA, Schneiderman, N. CBSM intervention effects on social support, coping, depression and immune function in symptomatic HIV-infected men [abstract]. Psychosom Med. 1996;58:86.Google Scholar
45.LaPerriere, A, Antoni, MH, Schneiderman, N, et al.Exercise intervention attenuates emotional distress and natural killer cell decrements following notification of positive serologic status for HIV-1. Biofeedback Self Regul. 1990;15:125–131.CrossRefGoogle ScholarPubMed
46.Cruess, D, Antoni, MH, Schneiderman, N, et al.Cognitive behavioral stress management effects on DHEA-S and serum cortisol in HIV seropositive men. Psychoneuroendocrinology. 1999;24:537–549.CrossRefGoogle Scholar
47.Cruess, D, Antoni, MH, Schneiderman, N, et al.Cognitive behavioral stress management increases free testosterone and decreases psychological distress in HIV seropositive men. Health Psychol. 2000;19:12–20.CrossRefGoogle ScholarPubMed
48.Cruess, D, Antoni, MH, Kumar, M, Schneiderman, N. Reductions in salivary cortisol are associated with mood improvement during relaxation training among HIV-1 seropositive men. J Behav Med. 2000;23:107–122.CrossRefGoogle Scholar
49.Cruess, S, Antoni, MH, Cruess, D, et al.Reductions in HSV-2 antibody titers after cognitive behavioral stress management and relationships with neuroendocrine function, relaxation skills, and social support in HIV+ gay men. Psychosom Med. 2000;62:828–837.CrossRefGoogle Scholar
50.Antoni, MH, Wagner, S, Cruess, D, et al.Cognitive behavioral stress management reduces distress and 24-hour urinary free cortisol among symptomatic HIV-infected gay men. Ann Behav Med. 2000;22:29–37.CrossRefGoogle ScholarPubMed
51.Antoni, MH, Cruess, D, Wagner, S, et al.Cognitive behavioral stress management effects on anxiety, 24-hour urinary catecholamine output, and T-cytotoxic/suppressor cells over time among symptomatic HIV-infected gay men. J Consult Clin Psychol. 2000;68:31–45.CrossRefGoogle Scholar
52.Antoni, MH, Cruess, D, Klimas, N, et al.Stress management and immune system reconstitution in symptomatic HIV-infected gay men over time: effects on transitional naïve T-cells (CD4+CD45RA+CD29+). Am J Psychiatry. 2002;159:143–145.CrossRefGoogle Scholar
53.Kubler-Ross, E. On Death and Dying. New York, NY: MacMillan; 1969.Google Scholar
54.Lechner, S, Antoni, MH, Lydston, D, et al.Cognitive-behavioral interventions improve quality of life in women with AIDS. J Psychosom Res. In press.Google Scholar
56.Friedman, A, Antoni, MH, Ironson, G, et al. Behavioral interventions, changes in perceived social support and depression following notification of HIV-1 seropositivity. Paper presented at: Annual Meeting of the Society of Behavioral Medicine; April, 1991; Washington, DC.Google Scholar
57.Lutgendorf, S, Antoni, MH, Schneiderman, N, Ironson, G, Fletcher, MA. Psychosocial interventions and quality of life changes across the HIV spectrum. In: Baum, A, Dimsdale, J, eds. Perspectives in Behavioral Medicine. Lawrence Elbaum Associates, Inc.: Mahwah, NJ; 1994:205–239.Google Scholar
58.Kelly, J, Murphy, D, Bahr, R, et al.Outcome of cognitive-behavioral and support group brief therapies for depressed, HIV-infected persons. Am J Psychiatry. 1993;150:1679–1686.Google ScholarPubMed
59.Mulder, CL, Emmelkamp, P, Antoni, MH, et al.Cognitive-behavioral and experiential group psychotherapy for HIV-infected homosexual men: a comparative study. Psychosom Med. 1994;56:423–431.CrossRefGoogle ScholarPubMed
60.Chesney, MA, Folkman, S, Chambers, D. Coping effectiveness training for men living with HIV: preliminary findings. Int J STD AIDS. 1996;7(suppl 2):75–82.CrossRefGoogle ScholarPubMed
61.Goodkin, K, Tuttle, R, Blaney, NT, et al.A bereavement support group intervention is associated with immunological changes in HIV-1+ and HIV-1-homosexual men [abstract]. Psychosom Med. 1996;58:83–84.Google Scholar
62.Goodkin, K, Feaster, D, Asthana, D, et al.A bereavement support group intervention is longitudinally associated with salutary effects on the CD4 cell count and number of physician visits. Clin Diagn Lab Immunol. 1998;5:382–391.CrossRefGoogle ScholarPubMed
63.Goodkin, K, Baldewicz, T, Asthana, DP, et al.A bereavement support group intervention affects plasma burden of HIV-1. J Hum Virol. 2001;4:44–54.Google Scholar
64.Lutgendorf, S, Antoni, M, Ironson, G, et al.Changes in cognitive coping skills and social support during cognitive behavioral stress management intervention and distress outcomes in symptomatic human immunodeficiency virus (HIV)-seropositive gay men. Psychosom Med. 1998;60:204–214.CrossRefGoogle ScholarPubMed
65.Cruess, S, Antoni, MH, Hayes, A, et al.Changes in mood and depressive symptoms and related change processes during cognitive behavioral stress management in HIV-infected men. Cognit Ther Res. 2002;26:373–392.CrossRefGoogle Scholar
66.Antoni, MH, Lehman, J, Kilbourn, K, et al.Cognitive-behavioral stress management intervention decreases the prevalence of depression and enhances benefit finding among women under treatment for early-stage breast cancer. Health Psychol. 2001;20:20–32.CrossRefGoogle ScholarPubMed
67.Yang, JY, Schwartz, A, Henderson, EE. Inhibition of 3' azido-3' deoxythymidine-resistant HIV-1 infection by dehydroepiandrosterone in vitro. Biochem Biophys Res Commun. 1994;201:1424–1432.CrossRefGoogle ScholarPubMed
68.Yang, JY, Schwartz, A, Henderson, EE. Inhibition of HIV-1 latency reactivation by dehydroepiandrosterone (DHEA) and an analog of DHEA. AIDS Res Hum Retroviruses. 1993;9:747–754.CrossRefGoogle Scholar
69.Ironson, G, Antoni, M, Lutgendorf, S. Can psychological interventions affect immunity and survival? Present findings and suggested targets with a focus on cancer and human immunodeficiency virus. Adv Mind Body Med. 1995;1:85–110.Google Scholar
70.Ironson, G, Field, T, Scafidi, F, et al.Massage therapy is associated with enhancement of the immune systems cytotoxic capacity. Int J Neurosci. 1996;84:205–217.CrossRefGoogle ScholarPubMed
71.Madden, K, Sanders, V, Felten, D. Catecholamine influences and sympathetic neural modulation of immune responsiveness. Annu Rev Pharmacol Toxicol. 1995;35:417–448.CrossRefGoogle ScholarPubMed
72.Mills, P, Ziegler, M, Patterson, T, et al.Plasma catecholamine and lymphocyte beta 2-adrenergic receptor alterations in elderly Alzheimer caregivers under stress. Psychosom Med. 1997;59:251–256.CrossRefGoogle ScholarPubMed
73.Landmann, R. Beta-adrenergic receptors in human leukocyte subpopulations. European Journal of Clinical Investigations [abstract]. 1992;22(suppl 1):30.Google ScholarPubMed
74.Felten, D. Changes in the neural innervation of lymphoid tissues with age. In: Hall, N, Altman, F, Blumenthal, S, eds. Mind-Body Interactions and Disease and Psychoneuroimmunological Aspects of Health and Disease. Washington, DC: Health Dateline Press; 1996:157–164.Google Scholar
75.Maher, K, Klimas, N, Dickinson, G, et al.T lymphocyte subsets and Highly Active Antiretroviral Therapy (HAART) of HIV infection. Applications in Clinical Cytometry. In press.Google Scholar
76.Musey, L, Hughes, J, Schacker, T. Cytotoxic T-cell responses, viral load and disease progression in early human immunodeficiency virus type I infection. N Engl J Med. 1997;337:1267–1274.CrossRefGoogle Scholar
77.Picker, L, Treer, J, Ferguson-Darnell, B, et al.Control of lymphocyte recirculation in man. I. Differential regulation of the peripheral lymph node homing receptor L-Selectin on T cells during the virgin to memory cell transition. J Immunol. 1993;150:1105–1121.CrossRefGoogle Scholar
78.Connors, M, Kovacs, J, Krevat, S, et al.HIV infection induces changes in CD4+ T-cell phenotype and depletions within the CD4+ T-cell repertoire that are not immediately restored by antiviral or immune-based therapies. Nat Med. 1997;3:533–540.CrossRefGoogle ScholarPubMed
79.West-Edwards, C, Pereira, D, Greenwood, D, et al.An investigation of the psychological and immune effects of a cognitive behavioral stress management (CBSM) intervention for HIV+ African American women [abstract]. Ann Behav Med. 2001;23:12.Google Scholar
80.Markowitz, JC, Kocsis, JH, Fishman, B, et al.Treatment of depressive symptoms in human immunodeficiency virus-positive patients. Arch Gen Psychiatry. 1998;55:452–457CrossRefGoogle ScholarPubMed
81.Ekstrand, M, Chesney, M. Adhering to complex medication regimens. In: Chesney, M, Antoni, MH, eds. Health Psychology Innovations: New Target Populations for Prevention and Care. Washington, DC: American Psychological Association; 2002:283–306Google Scholar
82.Schneiderman, N, Antoni, MH, Ironson, G. Cognitive behavioral stress management and secondary prevention in HIV/AIDS. Psychology and AIDS Exchange. 1997;22:1–8.Google Scholar
83.Motivala, S, Hurwitz, B, Antoni, MH, et al.Psychological distress is associated with decreased memory T-cells and B-cells in pre-AIDS HIV seropositive men and women. Psychosom Med. In press.Google Scholar
84.Spiegel, D, Bloom, GC, Kraemer, JS, Gottheil, E. Effect of psychosocial treatment on survival of patients with metastatic breast cancer. Lancet. 1989;2:888–891.CrossRefGoogle ScholarPubMed
85.Goodwin, P, Leszcz, M, Ennis, M, et al.The effect of group psychosocial support on survival in metastatic breast cancer. N Engl J Med. 2001;345:1719–1726.CrossRefGoogle ScholarPubMed