title: Psychosocial and Neurohormonal Predictors of HIV Disease Progression (CD4 Cells and Viral Load): A 4 Year Prospective Study.
abstract: Most studies of psychosocial predictors of disease progression in HIV have not considered norepinephrine (NE), a neurohormone related to emotion and stress, even though NE has been related to accelerated viral replication in vitro and impaired response to antiretroviral therapy (ART). We therefore examined NE, cortisol, depression, hopelessness, coping, and life event stress as predictors of HIV progression in a diverse sample. Participants (n = 177) completed psychological assessment, blood draws [CD4, viral load (VL)], and a 15 h urine sample (NE, cortisol) every 6 months over 4 years. Hierarchical linear modeling (HLM) was used to model slope in CD4 and VL controlling for ART at every time point, gender, age, race, SES, and initial disease status. NE (as well as depression, hopelessness, and avoidant coping) significantly predicted a greater rate of decrease in CD4 and increase in VL. Cortisol was not significantly related to CD4, but predicted VL increase. To our knowledge, this is the first study relating NE, in vivo, to accelerated disease progression over an extended time. It also extends our previous 2 year study by relating depressed mood and coping to accelerated disease progression over 4 years.
authors.affiliation: Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd., Coral Gables, Miami, FL, 33146, USA, gironson@aol.com.
authors.forename: G
authors.initials: G
authors.lastname: Ironson
authors.forename: C
authors.initials: C
authors.lastname: O'Cleirigh
authors.forename: M
authors.initials: M
authors.lastname: Kumar
authors.forename: L
authors.initials: L
authors.lastname: Kaplan
authors.forename: E
authors.initials: E
authors.lastname: Balbin
authors.forename: C B
authors.initials: CB
authors.lastname: Kelsch
authors.forename: M A
authors.initials: MA
authors.lastname: Fletcher
authors.forename: N
authors.initials: N
authors.lastname: Schneiderman
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D044966:Anti-Retroviral Agents / Q000494:pharmacology / Q000627:therapeutic use; D001362:Avoidance Learning; D015415:Biomarkers / Q000097:blood; D018791:CD4 Lymphocyte Count; D003863:Depression / Q000523:psychology; D003866:Depressive Disorder / Q000175:diagnosis / Q000523:psychology; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy / Q000523:psychology* / Q000652:urine / Q000821:virology; D006801:Humans; D006854:Hydrocortisone / Q000652:urine*; D008016:Life Change Events; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D009638:Norepinephrine / Q000652:urine*; D011446:Prospective Studies; D012944:Social Support; D013315:Stress, Psychological / Q000097:blood* / Q000523:psychology / Q000652:urine*; D019562:Viral Load
chemical_list: D044966:Anti-Retroviral Agents; D015415:Biomarkers; D006854:Hydrocortisone; D009638:Norepinephrine