title: Stress as a predictor of symptomatic genital herpes virus recurrence in women with human immunodeficiency virus.
abstract: OBJECTIVE
  Genital herpes (Herpes Simplex Virus Type 2, HSV-2) is a significant public health problem for HIV+ women, who have high rates of HSV-2 seropositivity and elevated risk for HSV-2 associated morbidity and mortality. Life stress has been identified as a co-factor in genital herpes recurrence. However, no research has evaluated the relationship between stress and genital herpes recurrences in HIV+ women. The purpose of this study was to determine whether stress was associated with symptomatic genital herpes recurrences in women seropositive for HIV and HSV-2.
  
  
  METHODS
  Thirty-four HIV-infected African-American and Caribbean-American women underwent a psychosocial interview, blood draw and gynecologic examination to assess gynecologic symptoms (including genital herpes) at study entry. Life stress was measured using a 10-item modified version of the Life Experiences Survey (LES). Genital herpes recurrence over 1-year follow-up was abstracted using medical chart review.
  
  
  RESULTS
  Using hierarchical linear regression analysis, life stress at study entry was significantly associated with number of genital herpes recurrences during 1-year follow-up (beta=.38, P=.03) after controlling for HIV disease variables and relevant behavioral factors. Recent life stress, in particular, was highly predictive of genital herpes recurrence during follow-up (beta=.57, P=.002). The relationship between life stress and genital herpes recurrence persisted after controlling for HSV-2 viral reactivation (i.e., HSV-2 IgG titers) at study entry.
  
  
  CONCLUSIONS
  These findings suggest that stress may be a significant predictor of genital herpes recurrence in women with HIV and HSV-2. Stress management interventions may buffer HSV-related morbidity and mortality in women with HIV.
authors.affiliation: University of Miami, Department of Psychology, Coral Gables, FL 33124, USA. dpereira@miami.edu
authors.forename: Deidre Byrnes
authors.initials: DB
authors.lastname: Pereira
authors.forename: Michael H
authors.initials: MH
authors.lastname: Antoni
authors.forename: Aimee
authors.initials: A
authors.lastname: Danielson
authors.forename: Trudi
authors.initials: T
authors.lastname: Simon
authors.forename: JoNell
authors.initials: J
authors.lastname: Efantis-Potter
authors.forename: Charles S
authors.initials: CS
authors.lastname: Carver
authors.forename: Ron E F
authors.initials: RE
authors.lastname: Durán
authors.forename: Gail
authors.initials: G
authors.lastname: Ironson
authors.forename: Nancy
authors.initials: N
authors.lastname: Klimas
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Fletcher
authors.forename: Mary Jo
authors.initials: MJ
authors.lastname: O'Sullivan
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006558:Herpes Genitalis / Q000276:immunology* / Q000523:psychology* / Q000821:virology; D006801:Humans; D008875:Middle Aged; D012008:Recurrence; D012044:Regression Analysis; D012307:Risk Factors; D013315:Stress, Psychological