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Am J Psychiatry 1997; 154:630-634
Copyright © 1997 by American Psychiatric Association
Severe life stress as a predictor of early disease progression in HIV infection
DL Evans, J Leserman, DO Perkins, RA Stern, C Murphy, B Zheng, D Gettes, JA Longmate, SG Silva, CM van der Horst, CD Hall, JD Folds, RN Golden and JM Petitto
Department of Psychiatry, University of Florida College of Medicine, Gainesville 32610-0256, USA.
OBJECTIVE: Although there is evidence that stress is associated with
alterations in immunity, the role of emotional factors in the onset and
course of immune-based diseases such as cancer and AIDS has not been
established. This prospective study was designed to test the hypothesis
that stressful life events accelerate the course of HIV disease. METHOD:
Ninety-three HIV-positive homosexual men who were without clinical symptoms
at the time of entry into the study were studied for up to 42 months.
Subjects received comprehensive medical, neurological, neuropsychological,
and psychiatric assessments every 6 months, including assessment of
stressful life events during the preceding 6- month interval. Several
statistical approaches were used to assess the relation between stress and
disease progression. RESULTS: The time of the first disease progression was
analyzed with a proportional hazard survival method, which demonstrated
that the more severe the life stress experienced, the greater the risk of
early HIV disease progression. Specifically, for every one severe stress
per 6-month study interval, the risk of early disease progression was
doubled. Among a subset of 66 subjects who had been in the study for at
least 24 months, logistic regression analyses showed that higher severe
life stress increased the odds of developing HIV disease progression nearly
fourfold. the degree of disease progression was also predicted by severe
life stress when a proportional odds logistic regression model was used for
analysis. CONCLUSIONS: This report presents the first evidence from a
prospective research study that severe life event stress is associated with
an increased rate of early HIV disease progression.
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