Objective-Most previous longitudinal studies demonstrating relationships between psychosocial variables and human immunodeficiency virus (HIV) disease progression utilized samples of gay men accrued before the era of highly active antiretroviral treatment (HAART), without including viral load (VL) as an indicator of disease progression or assessing the impact of medication adherence. This study sought to determine whether psychosocial variables would predict both CD4 and VL changes in a diverse sample assessed entirely during the era of HAART and accounting for adherence effects.Methods-This longitudinal study assessed a multiethnic HIV+ sample (n = 177) of men and women in the midrange of illness (CD4 number between 150 and 500; no previous acquired immunodeficiency syndrome [AIDS]-defining symptom) every 6 months for 2 years. Hierarchical linear modeling was used to model change in CD4 and VL controlling for sociodemographics (age, gender, ethnicity, education) and medical variables (baseline CD4/VL, antiretroviral medications at each time point, adherence).Results-Baseline depression, hopelessness, and education predicted the slope of CD4 and VL. Avoidant coping and life event stress predicted VL change. Cumulative variables produced stronger relationships (depression, avoidant coping, and hopelessness with CD4/VL slope and life events stress with VL slope). High cumulative depression and avoidant coping were associated with approximately twice the rate of decline in CD4 as low scorers and greater relative increases in VL. Social support was not significantly related to CD4 or VL slope.Conclusions-Psychosocial factors contribute significantly to the variance in HIV disease progression (assessed through CD4 number and VL) in a diverse sample, accounting for adherence and do so in the era of HAART.

The purpose of this study was to determine the reliability and validity of an instrument that measures both spirituality and religiousness, to examine the relation between spirituality and religiousness and important health outcomes for people living with HIV and to examine the potential mediators of these relations. One aim was to determine whether subscales of spirituality, religiousness, or both would be independently related to long survival in people living with AIDS. The Ironson-Woods Spirituality/Religiousness (SR) Index is presented with evidence for its reliability and validity. Four factors were identified on the Ironson-Woods SR Index (Sense of Peace, Faith in God, Religious Behavior, and Compassionate View of Others). Each subscale was significantly related to long survival with AIDS. That is, the long-term survivor (LTS) group (n = 79) scored significantly higher on these factors than did the HIV-positive comparison (COMP) group (n = 200). Long survival was also significantly related to both frequency of prayer (positively) and judgmental attitude (negatively). In addition, the Ironson-Woods SR Index yielded strong and significant correlations with less distress, more hope, social support, health behaviors, helping others, and lower cortisol levels. The relation between religious behavior and health outcomes was not due to social support. Further analyses were conducted, which identified urinary cortisol concentrations and altruistic behavior as mediators of the relation between SR and long survival.

Few data are available on the response of the human immune system to acute psychological stressors under controlled laboratory conditions. Young female subjects (21-41 years) showed increases in natural killer (NK) cell activity, and in the numbers of circulating CD8 suppressor/cytotoxic T cells, and natural killer lymphocytes following a brief (12 minute) stressful mental arithmetic examination. Older female subjects (65-85 years) failed to show the stress-related increase in NK activity. The psychological stress did lead to increases in the numbers of circulating CD8 suppressor/cytotoxic T cells and NK lymphocytes in old subjects to a similar degree as that seen in the young group. No changes in the numbers of helper/inducer T cells (CD4), total T cells (CD3), or B cells (CD20) were found following the stressor for either group. Cardiovascular, catecholamine, and subjective stress responses were similar for the two age groups. These results demonstrate that brief psychological stress is associated with some rapid immune cell changes, including release of CD8 suppressor/cytotoxic T cells and NK cells into circulation, and in young subjects, increases in NK activity. The absence of an NK activity increase in the older subjects indicates that NK cell mobilization and cell lysis induced by NK cells may be differentially affected by stress. The results also suggest the possibility of an age-related deficit in the up-regulation of NK activity under some environmental demands.

The issue of whether optimism may prospectively protect against disease progression is one that has generated much interest, with mixed results in the literature. The purpose of this study was to determine whether dispositional optimism predicts slower disease progression in HIV. Two indicators of disease progression, CD4 counts and viral load, were assessed over 2 years in a diverse group (men, women, White, African American, Hispanic) of 177 people with HIV in the midrange of disease at entry to the study. Optimism predicted slower disease progression (less decrease in CD4 and less increase in viral load) controlling for baseline CD4 and viral load, antiretroviral treatment, gender, race, education, and drug use. Those low on optimism (25th percentile) lost CD4 cells at a rate 1.55 times faster than those high on optimism (75th percentile). Optimists had higher proactive behavior, less avoidant coping, and less depression: These variables mediated the linear optimism-disease progression relationship. Thus, optimists may reap health benefits partly through behavioral (proactive behavior), cognitive (avoidant coping), and affective (depression) pathways. Implications, limitations, and interpretations are discussed. Taylor et al., 2000). One of the most intriguing of these is optimism. There is the popular belief that maintaining hope or optimism may influence survival. Many doctors encourage their patients to develop a positive attitude believing it may be helpful to patients (Schofield et al., 2004). However, there have only been a few studies scientifically examining this.One study gaining widespread attention (Schofield et al., 2004) recently found that dispositional optimism did not predict progression-free survival in patients with lung cancer and concluded that "encouraging patients to 'be positive' may only add to the burden of having cancer while providing little benefit" (p. 1276). Schulz, Bookwala, Knapp, Scheier, and Williamson (1996) found that, although dispositional optimism did not predict survival in patients with recurrent or metastasized cancer receiving palliative radiation treatment, pessimistic life orientation was a risk factor for mortality but only in younger (age < 59) patients. In contrast, dispositional optimism predicted survival over 1 year in head and neck cancer patients (Allison, Guichard, Fung, & Gilain, 2003). Several studies not restricted to cancer patients found that dispositional optimism is related to better health outcomes including better recovery and less rehospitalization from coronary bypass surgery Scheier et al., 1999) and lower all cause and cardiovascular mortality (Giltay, Geleijnse, Zitman, Hoeskstra, & Evert, 2004). In addition, one study found that a "cognitive adaptation index," which included dispositional optimism, situational-specific optimism, self-esteem, and mastery, predicted fewer new coronary events after Percutaneous Transluminal Coronary Angioplasty (PTCA) (Helgeson & Fritz, 1999).Although most of the studies noted previously focused on dis...

It is posited that over the next years civilian mental health professionals will encounter stress response syndromes in Vietnam veterans, will misread etiological factors, and will be unable to treat such persons effectively. This paper attempts to describe the types of problems which may be expected and suggests special approaches which will be required and may assist the treatment process.