United Press International - August 1, 2000
Joyce Frieden, UPI Science News

"We all kind of believe that denial is not helpful, but it's difficult to demonstrate that scientifically," said Jane Leserman, the study's lead investigator. "The message of the study is that we shouldn't focus just on the biological aspects of HIV infection. We should also think about referring our patients who seem to be coping by means of denial to behavioral stress management programs or support groups to get that psychological care."

Leserman, who is research associate professor at the University of North Carolina, in Chapel Hill, said there was one biological finding from study: Patients whose illness progressed faster also had higher levels of a stress hormone known as cortisol in their blood. Some AIDS researchers have theorized that cortisol may trigger the destruction of the cells that fight HIV, thereby helping the virus reproduce itself. "Our study gives credence to the idea that cortisol may be a player in this illness."

She said the study was unique because researchers knew from the beginning how much of the AIDS virus the patients had in their bodies, and accounted for that during their research.

"One difficult thing about HIV studies is that we often don't know when people were infected. By [measuring their HIV levels], we had some assessment of where they were in their disease course."

Although some of the patients who were in denial of their illness may not have taken as good care of themselves, that does not fully account for the faster disease progression, Leserman said. "We did [account for] whether the patients smoked, exercised, or had alcohol or drug abuse, but that didn't explain things away. But we may not have had very good measures of all the health habits people engage in."

Margaret Chesney, professor of medicine at the University of California, San Francisco, said it's likely that the patients in denial were not taking as good care of themselves. "They likely weren't engaging in the range of behaviors that's important, like the need for more sleep or paying attention to opportunistic infections. If their way of coping is denial, it limits their ability to manage their disease proactively."

Whether or not these patients have worse health habits than other HIV patients, the message is still the same, she said: "What we need to do is create ways in which care is supportive of people, so they become actively involved in their care. We need to make care easily available to people early in their condition, when prevention of complications is still possible."

The perils of denying an illness can be a lesson to all patients, not just those with HIV, said Chesney, who is also a senior fellow at the Center for the Advancement of Health in Washington. "One of the strategies for dealing with a problem is to pretend it's not there. Many of us do that; women will know they have lumps and not go in and have them looked at. One way to deal with it is to play Scarlett O'Hara and worry about it tomorrow. But it didn't work for these patients, and it won't work for anyone else, either."
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