title: Psychological Distress Mediates the Effect of Alexithymia on 2-Year Change in HIV Viral Load.
abstract: Individuals with trait alexithymia (AL) display poor cognitive assimilation of thoughts, feelings, and emotions. This may result in the persistence of stress, anxiety, and depressive disorders. The cumulative effect of this psychological distress is also linked clinical markers of human immunodeficiency virus (HIV) disease progression. This study examines the indirect effect of AL on HIV viral load as a function of baseline levels and change in psychological distress.
  
  
  
  N = 123 HIV positive adults aged 37.9 ± 9.2 years provided blood samples for HIV-1 viral RNA and CD4 T lymphocytes along with self-reported stress, anxiety, and depression every 6 months for 2 years. A second-order conditional latent growth model was used to represent baseline and 2-year change in cumulative levels of psychological distress and to test the indirect effect of baseline levels of trait AL on change in HIV-1 viral load through this latent measure.
  
  
  
  AL was associated with baseline and latent change in psychological distress. Furthermore, baseline psychological distress predicted 2-year change in HIV-1 viral RNA after controlling for viral load at baseline. Altogether, trait AL had a significant indirect effect on change in viral load (β = 0.16, p = 0.03) as a function of baseline levels of distress.
  
  
  
  Identification and communication of thoughts, feelings, and emotions are important for long-term psychological adaptation in HIV. Greater psychological distress, in turn, allows for persistence of peripheral viral replication.
authors.affiliation: Department of Health Psychology, University of Miami, Miami, FL, 33124, USA. r.mcintosh@miami.edu.
authors.forename: Roger C
authors.initials: RC
authors.lastname: McIntosh
authors.affiliation: Department of Health Psychology, University of Miami, Miami, FL, 33124, USA.
authors.forename: Gail
authors.initials: G
authors.lastname: Ironson
authors.affiliation: Department of Health Psychology, University of Miami, Miami, FL, 33124, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Antoni
authors.affiliation: School of Public Health, Georgia State University, Atlanta, GA, USA.
authors.forename: Betty
authors.initials: B
authors.lastname: Lai
authors.affiliation: Departments of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Mahendra
authors.initials: M
authors.lastname: Kumar
authors.affiliation: Department of Clinical Immunology, Institute of Neuro Immune Medicine, Nova Southeastern University, Davie, FL, USA.
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Fletcher
authors.affiliation: Department of Health Psychology, University of Miami, Miami, FL, 33124, USA.
authors.forename: Neil
authors.initials: N
authors.lastname: Schneiderman
mesh_terms: D000328:Adult; D000342:Affective Symptoms / Q000523:psychology*; D001007:Anxiety / Q000453:epidemiology; D003863:Depression / Q000453:epidemiology; D003866:Depressive Disorder / Q000453:epidemiology; D004644:Emotions; D005260:Female; D015658:HIV Infections / Q000523:psychology*; D006679:HIV Seropositivity; D015497:HIV-1 / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008875:Middle Aged; D013315:Stress, Psychological / Q000150:complications*; D019562:Viral Load
keywords: Alexithymia; Anxiety; Depression; Human immunodeficiency virus; Latent growth modeling; Stress