title: Life stress and cervical squamous intraepithelial lesions in women with human papillomavirus and human immunodeficiency virus.
abstract: OBJECTIVE
  Human immunodeficiency virus (HIV)-infected women are at risk for cervical intraepithelial neoplasia (CIN) and cancer due to impaired immunosurveillance over human papillomavirus (HPV) infection. Life stress has been implicated in immune decrements in HIV-infected individuals and therefore may contribute to CIN progression over time. The purpose of this study was to determine whether life stress was associated with progression and/or persistence of squamous intraepithelial lesions (SIL), the cytologic diagnosis conferred by Papanicolaou smear, after 1-year follow-up among women co-infected with HIV and HPV.
  
  
  METHODS
  Thirty-two HIV-infected African-American and Caribbean-American women underwent a psychosocial interview, blood draw, colposcopy, and HPV cervical swab at study entry. Using medical chart review, we then abstracted SIL diagnoses at study entry and after 1-year follow-up.
  
  
  RESULTS
  Hierarchical logistic regression analysis revealed that higher life stress increased the odds of developing progressive/persistent SIL over 1 year by approximately seven-fold after covarying relevant biological and behavioral control variables.
  
  
  CONCLUSIONS
  These findings suggest that life stress may constitute an independent risk factor for SIL progression and/or persistence in HIV-infected women. Stress management interventions may decrease risk for SIL progression/persistence in women living with HIV.
authors.affiliation: Department of Psychology, University of Miami, Coral Gables, Florida 32610-0165, USA. dpereira@hp.ufl.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 Jo
authors.initials: MJ
authors.lastname: O'Sullivan
mesh_terms: D001741:Black or African American / Q000523:psychology; D003601:Cytotoxicity Tests, Immunologic; D018450:Disease Progression; D005260:Female; D005431:Florida / Q000453:epidemiology; D017144:Focus Groups; D015658:HIV Infections / Q000150:complications* / Q000276:immunology / Q000523:psychology; D006801:Humans; D016867:Immunocompromised Host; D007157:Immunologic Surveillance; D008016:Life Change Events; D016131:Lymphocyte Subsets; D009364:Neoplasm Recurrence, Local; D027383:Papillomaviridae; D030361:Papillomavirus Infections / Q000150:complications* / Q000276:immunology / Q000523:psychology; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology / Q000523:psychology; D011446:Prospective Studies; D011598:Psychoneuroimmunology; D012307:Risk Factors; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000150:complications* / Q000276:immunology; D014412:Tumor Virus Infections / Q000150:complications* / Q000276:immunology / Q000523:psychology; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology / Q000209:etiology* / Q000276:immunology / Q000523:psychology; D014900:West Indies / Q000208:ethnology; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology / Q000209:etiology* / Q000523:psychology