title: Increases in a marker of immune system reconstitution are predated by decreases in 24-h urinary cortisol output and depressed mood during a 10-week stress management intervention in symptomatic HIV-infected men.
abstract: BACKGROUND
  Stress management interventions reduce distress symptoms and hypothalamic-pituitary-adrenal (HPA) axis hormones such as cortisol, which has been related to a down-regulation of immune system components relevant to the human immunodeficiency virus (HIV) infection. We previously showed that HIV+ men assigned to a 10-week cognitive behavioral stress management (CBSM) intervention showed more CD4+CD45RA+CD29+ lymphocytes, an indicator of immune system reconstitution, at a 6- to 12-month follow-up compared with controls. Here, we tested whether reductions in urinary cortisol output and depressed mood during the 10-week CBSM intervention period mediated its effects on this immune system reconstitution marker at follow-up.
  
  
  METHODS
  Twenty-five HIV-infected men randomized to either a 10-week CBSM intervention or a wait-list control provided 24-h urine samples and psychological responses pre- to postintervention, which were related to changes in immune status over a 6- to 12-month follow-up period.
  
  
  RESULTS
  Greater reductions in cortisol output and depressed mood during CBSM appeared to mediate the effects of this intervention on this indicator of immune system reconstitution over the 6- to 12-month follow-up period. Changes in mood were maintained over the follow-up period, although these did not add explanatory information beyond the cortisol and mood changes that were observed during the 10-week intervention period. These findings were not explained by the changes in medications or health behaviors during follow-up.
  
  
  CONCLUSIONS
  A time-limited CBSM intervention may affect the rate of immune system reconstitution in HIV-infected men by modifying the stress of symptomatic disease. This intervention may work by decreasing depressed mood and normalizing HPA axis functioning.
authors.affiliation: Department of Psychology, University of Miami, Coral Gables, FL 33146, USA. mantoni@miami.edu
authors.forename: Michael H
authors.initials: MH
authors.lastname: Antoni
authors.forename: Dean G
authors.initials: DG
authors.lastname: Cruess
authors.forename: Nancy
authors.initials: N
authors.lastname: Klimas
authors.forename: Adam W
authors.initials: AW
authors.lastname: Carrico
authors.forename: Kevin
authors.initials: K
authors.lastname: Maher
authors.forename: Stacy
authors.initials: S
authors.lastname: Cruess
authors.forename: Suzanne C
authors.initials: SC
authors.lastname: Lechner
authors.forename: Mahendra
authors.initials: M
authors.lastname: Kumar
authors.forename: Susan
authors.initials: S
authors.lastname: Lutgendorf
authors.forename: Gail
authors.initials: G
authors.lastname: Ironson
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Fletcher
authors.forename: Neil
authors.initials: N
authors.lastname: Schneiderman
mesh_terms: D000293:Adolescent; D000328:Adult; D015415:Biomarkers; D017252:CD3 Complex / Q000276:immunology*; D015704:CD4 Antigens / Q000276:immunology*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003863:Depression / Q000209:etiology / Q000276:immunology / Q000652:urine; D005500:Follow-Up Studies; D006679:HIV Seropositivity / Q000523:psychology*; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism / Q000652:urine*; D007030:Hypothalamo-Hypophyseal System / Q000378:metabolism; D019012:Integrin beta1 / Q000276:immunology*; D017493:Leukocyte Common Antigens / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D018670:Monitoring, Ambulatory; D010913:Pituitary-Adrenal System / Q000378:metabolism; D013315:Stress, Psychological / Q000209:etiology* / Q000628:therapy*
chemical_list: D015415:Biomarkers; D017252:CD3 Complex; D015704:CD4 Antigens; D019012:Integrin beta1; D017493:Leukocyte Common Antigens; D006854:Hydrocortisone