TreatmentUpdate79 - Vol. 7, No. 9; July 1997
Sean Hosein

In North American popular culture it is commonly accepted that stress can affect the immune system and may be involved in the development of cancer and AIDS. In one study, researchers found that stress increased the chance of breast cancer recurring. In another, doctors found that women with breast cancer who were in a support group and who also received chemotherapy lived longer than other women with breast cancer who received the same chemotherapy but did not get psychosocial support. Several research teams studying the impact of "stress or depression" on the course of HIV infection using different methods, found that these factors had no effect. Now a team of American researchers has documented the impact of severe stress on the development of AIDS.

Study Details

The doctors only enrolled 93 symptom-free HIV-infected male subjects, 80% of whom were white and had at least a high school education. Subjects over the age of 51 were excluded as were those with serious illness (not necessarily due to HIV), injection and non-injection drug users, people with a history of alcoholism and those using antihistamines. Interviews to find out about the stress in the lives of subjects were done every six months, as were assessments by psychiatrists. A sophisticated set of questions was developed by this research team to analyse the stress experienced by subjects. Researchers focused their questions on "stressful life events". They also made sure that stress caused by worsening health was not included in the data.

Results

Over a period of 3.5 years, 38% of the subjects developed symptoms of HIV infection. According to the researchers, "the more severe the life stress experienced, the greater the risk of [developing symptoms]." This risk was statistically significant, that is; not likely due to chance. Indeed, for every severe life stress in each of the 6 month intervals, the risk of developing symptoms of HIV infection doubled.

The research team did not find that depression accelerated the decline of subjects' health, nor did they identify any interaction between stress and depression. It should be noted, however, that researchers were only interested in events that happened before the appearance of symptoms. So depression, at least in this study, could still affect someone's health later in the course of their illness.

This study is important because it documents, for the first time, the link between severe life-stress and an increased rate of development of symptoms of HIV infection. Exactly what this link is is not clear, but we know that connections between the brain and the immune system exist which enable these different parts of the body to influence each other.

Surviving

One conclusion that can be drawn from this and other studies (such as the one mentioned earlier on breast cancer) is that people with severe illnesses need psychosocial support to help them manage. This support may take different forms, depending on each person's needs, including:

* support groups

* individual counselling

* stress reduction behaviours/exercises

* anti-anxiety drugs

* antidepressants.

REFERENCES:

1. Evans DL, Leserman J, Perkins DO, et al. Severe life stress as a predictor of early disease progression in HIV infection. American Journal of Psychiatry 1997;154(5):630-634.

2. Black PH. Central nervous system-immune system interactions: psychoneuroendocrinology of stress and its immune consequences. Antimicrobial Agents and Chemotherapy 1994;38(1):1-6.

3. Black PH. Immune system-central nervous system interactions: Effect and immunomodulatory consequences of immune system mediators on the brain. Antimicrobial Agents and Chemotherapy 1994;38(1):7-12.

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Copyright © 1997 - TreatmentUpdate. Reproduced with permission. Reproduction of this article (other than one copy for personal reference) must be cleared through the Editor, The Canadian AIDS Treatment Information Exchange, 555 Richmond St. West, Suite 505, Box 1104, Toronto, ON, M5V 3B1 • Phone: 416-203-7122 • Toll Free: 1-800-263-1638 • Fax: 416-203-8284  http://www.catie.ca