title: Disclosure of HIV status and sexual orientation independently predicts increased absolute CD4 cell counts over time for psychiatric patients.
abstract: OBJECTIVE
  The objective of this study was to replicate the relationship between disclosure of sexual orientation and immune functioning in HIV-positive persons and to extend those findings to a different type of disclosure (HIV status) and a different population (psychiatric outpatients in a publicly funded HIV/AIDS clinic).
  
  
  METHODS
  A sample of psychiatric outpatients (N = 373) from a large, urban HIV clinic was assessed for level of sexual orientation and HIV status disclosure as well as absolute CD4 cell counts over time. Mixed-effects random regression analysis was used to build a predictor model that included biobehavioral covariates.
  
  
  RESULTS
  Consistent disclosure of both sexual orientation and HIV status independently predicted increased CD4 cell counts over time controlling for important biobehavioral covariates. The only other significant effects in the model were baseline CD4 cell count and number of days between assessment of disclosure and assessment of CD4 cell count.
  
  
  CONCLUSIONS
  Relieving potential psychological distress by disclosing sexual orientation and HIV status has a positive impact on CD4 cell counts over time even among outpatients stressed by psychiatric illness and economic disadvantage. Additional research is needed to understand whether and under what conditions disclosure should be part of HIV disease management.
authors.affiliation: University of Washington School of Medicine, Department of Psychiatry and Behavioral Sciences, Seattle, WA 98104, USA. erstrach@u.washington.edu
authors.forename: Eric D
authors.initials: ED
authors.lastname: Strachan
authors.forename: W R Murray
authors.initials: WR
authors.lastname: Bennett
authors.forename: Joan
authors.initials: J
authors.lastname: Russo
authors.forename: Peter P
authors.initials: PP
authors.lastname: Roy-Byrne
mesh_terms: D000328:Adult; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000276:immunology* / Q000523:psychology*; D006801:Humans; D008297:Male; D008603:Mental Health; D010045:Outpatients; D011237:Predictive Value of Tests; D012725:Sexual Behavior; D013315:Stress, Psychological; D014342:Truth Disclosure