| NEWS RELEASE: | |
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TRAUMA, DEPRESSION, COPING AND BEHAVIORAL TREATMENT AFFECT HIV DISEASE COURSE | |
| Contact: Jane Leserman, PhD Phone: 919/966-4755 Email: JLes@med.unc.edu Embargoed until: March 5, 2005 |
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Vancouver, BC, Canada - Despite the availability of highly active antiretroviral therapies (HAART) for HIV, there is still great variation in HIV disease progression. Before the era of HAART, studies demonstrated a relationship of stress and depression with HIV disease change. Questions still remain. Do stress, depression, optimism and coping affect HIV disease progression in persons using HAART? Do trauma, stress and coping affect adherence to HIV medications, and ultimately HIV disease course? And will treating depression and poor coping with cognitive behavioral therapies affect the course of HIV? This symposium will address these questions. In the first presentation, Dr. Ironson examines whether persons who are optimists had slower HIV disease progression. She studied a diverse group of 177 HIV infected persons every six-months for 2 years. At study entry, all persons had CD4 counts between 150 and 500 and all were free of any clinical symptoms associated with AIDS. Ironson found that optimists had greater decreases in HIV viral load (amount of HIV in the blood), and greater increases in CD4 (immune cells that help fight infections). In other words, optimists had a better HIV disease course. Optimists did better because they were less depressed, were less likely to cope by avoiding problems and were more active in solving their problems. In studying the same persons, Dr. O'Cleirigh found that persons who were depressed had the greatest decline in CD4 cells and the greatest increase in viral load. Depression had this negative effect partially because those who were depressed were more likely to use cocaine. These results underscore the importance of identifying depression in people with HIV and providing effective treatments for depression and related drug use issues. Despite simplified medication regimens, adherence to HIV therapies continues to be problematic; non-adherence leads to drug resistance and disease progression. Dr. Leserman studied the issue of adherence to HIV therapies among 474 patients taking at least one antiretroviral medication. The sample included men and women from 8 rural HIV clinics in 5 southern states. Dr. Leserman and colleagues found that patients with more lifetime trauma, more recent stressful events, and more dysfunctional coping (e.g., substance abuse, self-blame) were more likely to report that they skipped a dose of their HIV medication within the past 3 months. Trauma was also related to higher viral load in the subsequent year, over and above the effects of non-adherence. Thus, trauma, recent stress, and poor coping may affect adherence to medications and ultimately impact on HIV disease course. Finally, Dr. Pereira reports a study of cognitive behavioral stress management (CBSM) for HIV positive women with human papillomavirus. Women with poorly controlled HIV viral load are at risk for cervical dysplasia which is caused by Human Papillomavirus (HPV). Cervical dysplasia is the precursor to cervical cancer. Dr. Pereira and colleagues examined the effects on cervical dyspasia of a 10-wk CBSM intervention (N=12) versus a 1-day CBSM workshop (N=16); all women had human papillomavirus. They found that women in the cognitive behavioral stress management group were more likely to be free of or have decline in cervical dysplasia at 9-month follow-up compared to controls. These preliminary results suggest that stress management interventions may decrease progression of cervical dysplasia among women at risk for cervical cancer due to HIV and human papillomavirus infection. These studies suggest that stress, depression, optimism and coping may affect HIV disease progression and adherence to HIV medications in the era of new more highly effective HIV medications. Furthermore, there is evidence that treating depression and poor coping with cognitive behavioral therapy may affect the course of HIV in selected patients. | |
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Psychosomatic Medicine is the official peer-reviewed journal of the American Psychosomatic Society, published bimonthly. For information about the journal, contact Vicki White, Managing Editor for Manuscript Production,
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