title: Progression to AIDS: the effects of stress, depressive symptoms, and social support.
abstract: OBJECTIVE
  We examined the effects of stress, depressive symptoms, and social support on the progression of HIV infection.
  
  
  METHODS
  Eighty-two HIV-infected gay men without symptoms or AIDS at baseline were followed up every 6 months for up to 5.5 years. Men were recruited from rural and urban areas in North Carolina as part of the Coping in Health and Illness Project. Disease progression was defined using criteria for AIDS (CD4+ lymphocyte count of <200/microl and/or an AIDS-indicator condition).
  
  
  RESULTS
  We used Cox regression models with time-dependent covariates, adjusting for age, education, race, baseline CD4+ count, tobacco use, and number of antiretroviral medications. Faster progression to AIDS was associated with more cumulative stressful life events (p = .002), more cumulative depressive symptoms (p = .008), and less cumulative social support (p = .0002). When all three variables were analyzed together, stress and social support remained significant in the model. At 5.5 years, the probability of getting AIDS was about two to three times as high among those above the median on stress or below the median on social support compared with those below the median on stress or above the median on support, respectively.
  
  
  CONCLUSIONS
  These data are among the first to demonstrate that more stress and less social support may accelerate the course of HIV disease progression. Additional study will be necessary to elucidate the mechanisms that underlie these relationships and to determine whether interventions that address stress and social support can alter the course of HIV infection.
authors.affiliation: Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill 27599-7160, USA. Leserman@css.unc.edu
authors.forename: J
authors.initials: J
authors.lastname: Leserman
authors.forename: E D
authors.initials: ED
authors.lastname: Jackson
authors.forename: J M
authors.initials: JM
authors.lastname: Petitto
authors.forename: R N
authors.initials: RN
authors.lastname: Golden
authors.forename: S G
authors.initials: SG
authors.lastname: Silva
authors.forename: D O
authors.initials: DO
authors.lastname: Perkins
authors.forename: J
authors.initials: J
authors.lastname: Cai
authors.forename: J D
authors.initials: JD
authors.lastname: Folds
authors.forename: D L
authors.initials: DL
authors.lastname: Evans
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000503:physiopathology; D000328:Adult; D018791:CD4 Lymphocyte Count; D003863:Depression / Q000503:physiopathology* / Q000523:psychology; D018450:Disease Progression; D005500:Follow-Up Studies; D015658:HIV Infections / Q000503:physiopathology* / Q000523:psychology*; D018451:Homosexuality, Male; D006801:Humans; D008016:Life Change Events; D008297:Male; D011446:Prospective Studies; D012944:Social Support; D013315:Stress, Psychological / Q000503:physiopathology* / Q000523:psychology; D016019:Survival Analysis