San Francisco Chronicle - Wednesday, December 1, 1993
David Perlman, Chronicle Science Editor

In many diseases, scientists have learned that emotional well-being can exert a powerful and positive effect on the human body: slowing the progression of cancer, for example, or speeding recovery from strokes and heart disease -- perhaps even strengthening resistance to the common cold.

Many researchers have also found opposite effects. Depression, lethargy and a sense of despair about disease have been shown to weaken the immune system's battle against infections and even to advance the onset of death from cancer.

In AIDS therapy, a major effort has been made to encourage a positive outlook toward health and to treat patients intensively against the long bouts of deep depression that so often accompany the onset of symptoms.

Now, after a five-year study, researchers at the University of California at San Francisco are reporting that HIV-infected gay men with symptoms of chronic depression lose the disease-fighting CD4 cells of their immune systems and thus their potential ability to ward off AIDS-related diseases much more quickly than infected men who are not depressed.

At the same time, however, another group from five university medical centers studying a larger but similar group of gay men with HIV infections came to the opposite conclusion. They found that the clinical course of AIDS in the patients they studied, and the decline in numbers of their protective CD4 cells, were virtually the same whether they showed signs of depression or not.

Both research teams are reporting today in the Journal of the American Medical Association, and both groups agree that treating clinical depression among AIDS patients is an extremely important aspect of their therapy. But their apparently conflicting findings indicate that the true nature of the "mind-body connection" -- whether mental states influence the power of the human immune system -- is likely to remain controversial for a long time to come.

The UCSF research has been headed by Dr. Jeffrey H. Burack, Dr. Donald C. Barrett and Dr. Thomas J. Coates of the university's Center for AIDS Prevention Studies. The other group, headed by Dr. Constantine Lyketsos of Johns Hopkins University, included researchers from medical centers in Chicago, Pittsburgh and Los Angeles.

Both reports used the same standard tests to measure depression in their volunteer subjects, and both studies began with groups of gay men who were already depressed but did not know they were infected with HIV when they were recruited.

Among the 330 HIV-infected men in the UCSF study, the decline in CD4 cells was 38 percent more rapid among the men who were depressed than it was among the men who were not depressed.

In the study of 1,800 HIV-positive men in the study led by the Johns Hopkins group, however, 54 percent of the depressed men and 52 percent of non-depressed men developed full-blown AIDS within eight years -- a difference that was not significant, the researchers said. Nor was there any significant difference in the rate at which the CD4 cells declined in both groups of men, they added.

In a commentary on the two research reports, Dr. Samuel Perry and Dr. Baruch Fishman of Cornell Medical College's psychiatry department found at least one element of reassurance. The studies, they said, show that "most HIV-infected subjects are not depressed and that clinical depression in this population should be seen as a treatable disorder, rather than merely an expected response to having an HIV infection."

Perry and Fishman concluded, however, that in AIDS, "the development of HIV-related symptoms increases the likelihood of depression, but that depressive symptoms do not in themselves increase the progression of HIV disease."

But at UCSF, Coates maintained that there are still other possibilities to account for a significant influence of depression on the immune system.

The apparent difference in the two new studies, he argued, may have been at least partly due to the fact that the men in the UCSF study started off with higher CD4 cell counts than the men in the other study and therefore were probably healthier at the start, Coates said yesterday.

"It may well be that depression has the strongest damaging effect on healthier men who start with healthier immune systems," he said. "At least that's one biological pathway to explain our results. But a behavioral explanation might include the possibility that men who are depressed are more likely to engage in unsafe sex or neglect to take their medications or use more alcohol or drugs.

"These are aspects of the problem that we're now continuing to study, and our results show at the very least that the relation between psychological state and the state of the human immune system in AIDS is well worth pursuing."

Always watch for outdated information. This article first appeared in 1993. This material is designed to support, not replace, the relationship that exists between you and your doctor.

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