Stress management effects on perceived stress and cervical neoplasia in low-income HIV-infected women.
OBJECTIVE
Risk for developing cervical neoplastic disease is greatly increased in women infected with oncogenic sexually transmitted human papillomaviruses (HPVs) and who have lowered cellular immunity due to coinfection with human immunodeficiency virus (HIV) infection. The majority of these individuals are low-income minority women. Factors associated with promotion of HPV to cervical neoplasia in HIV-infected populations include degree of immunosuppression as well as behavioral factors such as tobacco smoking and psychological stress. This study examined the effects of a cognitive behavioral stress management (CBSM) intervention on life stress and cervical neoplasia in HIV+ minority women.


METHODS
Participants were 39 HIV+ African-American, Caribbean, and Hispanic women with a recent history of an abnormal Papanicolaou smear. Participants underwent colposcopic examination, psychosocial interview, and peripheral venous blood draw at study entry and 9 months after being randomly assigned to either a 10-week CBSM group intervention (n=21) or a 1-day CBSM workshop (n=18).


RESULTS
Women assigned to the 10-week group-based CBSM intervention reported decreased perceived life stress and had significantly lower odds of cervical neoplasia over a 9-month follow-up. CBSM effects on life stress and neoplasia appeared independent of presence of neoplasia at study entry, HPV type, CD4+CD3+ cell count, HIV viral load, and substance use. Furthermore, CBSM intervention effects on cervical neoplasia were especially pronounced among women with residual life stress at follow-up.


CONCLUSIONS
These findings suggest that stress management decreases perceived life stress and may decrease the odds of cervical neoplasia in women with HIV and a history of abnormal Papanicolaou smears. Although preliminary, these findings suggest the utility of stress management as a cancer prevention strategy in this high-risk population.
Antoni
Michael H
MH
Department of Psychology, University of Miami, 5665 Ponce DeLeon Boulevard, Coral Gables, FL 33124, USA. mantoni@miami.edu
Pereira
Deidre B
DB
Marion
Ilona
I
Ennis
Nicole
N
Andrasik
Michele Peake
MP
Rose
Rachel
R
McCalla
Judith
J
Simon
Trudi
T
Fletcher
Mary Ann
MA
Lucci
Joseph
J
Efantis-Potter
Jonell
J
O'Sullivan
Mary Jo
MJ
D000328:Adult; D001294:Attitude to Health; D001521:Behavior Therapy / Q000379:methods*; D017252:CD3 Complex / Q000276:immunology; D015704:CD4 Antigens / Q000276:immunology; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000276:immunology / Q000523:psychology*; D006801:Humans; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000517:prevention & control* / Q000523:psychology*; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000523:psychology*
D017252:CD3 Complex; D015704:CD4 Antigens