M. Antoni

Emotional repression, stress disclosure responses, and Epstein-Barr viral capsid antigen titers

&NA; Based on the theory of psychosomatic inhibition, we hypothesized that subjects who abstained from disclosing emotional material on a laboratory task would have poorer control of latent Epstein‐Barr virus (as evidenced by high titers for the viral capsid antigen), and similarly, those subjects with psychometrically derived repressive interpersonal styles would show the highest Epstein‐Barr viral capsid antigen titers (EBV‐VCA). Eighty first‐year undergraduates completed a personality inventory and were asked to write an essay/letter for 30 minutes about a stressful event that had happened in their life. Blood was collected from each subject immediately after writing. Essays were scored for degree of emotional disclosure according to the ratio of emotional‐to‐total words used. Degree of disclosure was found to be associated with impaired control of latent EBV (high antibody titers to the EBV‐VCA) controlling for medication use, recent sleep loss, physical activity, lean body mass, caloric intake, and alcohol and recreational drug use. Further, individual differences in interpersonal style (characterized by emotional suppression) related to this immunologic marker in a similar fashion, and these two factors interacted in determining EBV‐VCA titers. That is, Repressors who were either high or low disclosers had high levels of antibody titer to EBV‐VCA, whereas only those Sensitizers who did not disclose had high antibody titers to EBV‐VCA. In addition to supporting the hypothesis that emotional repression is associated with some aspects of host‐virus interaction, the present findings highlight the importance of obtaining behavioral and psychometric assessments in psychoimmunologic investigations of this abstract affective construct (i.e., repression).

Changes in immune and psychological measures as a function of anticipation and reaction to news of HIV-1 antibody status

&NA; We assessed changes in psychological and immunological functioning during 5‐week periods preceding and following notification of serostatus among gay males taking the HIV‐1 antibody test. Forty‐six asymptomatic homosexual men between the ages of 18 and 40 yrs were recruited from a gay mens organization and through advertisements in a local newspaper. Measures of cell‐mediated immunity (lymphocyte phenotypic markers, mitogen responsivity, and natural killer cell cytotoxicity) and psychological functioning (state anxiety, intrusive thoughts, and avoidant behaviors) were obtained at baseline, five weeks later and 72 hr before serostatus notification, and 1 week, 3 weeks and 5 weeks postnotification. Results suggested a dissociation between psychological and immunological phenomena among seropositives wherein lymphocyte proliferative responses to the mitogens phytohemagglutinin (PHA) and pokeweed mitogen (PWM) remained unchanged in the face of significant increases in state anxiety and intrusive thoughts following serostatus notification. These findings suggested that asymptomatic HIV‐1 infected individuals, even at the earliest stages of infection, may be unable to mount an immune response to potent psychosocial stressors (i.e., serostatus notification), due perhaps, to the fact that the viral contribution to immune functioning overrides any influence of environmental stimuli. Among the seronegative subjects studied, blastogenic responses to PHA and PWM were depressed at baseline (relative to a group of age and gender‐matched controls who were not undergoing HIV‐1 antibody testing) but PHA values returned to normal values 5 weeks later. Natural killer (NK) cell cytotoxicity and CD4+CD45R+ inducer cell counts appeared to parallel these changes in seronegatives. Seropositives did display fluctuations in NK cell cytotoxicity that were similar to those noted for seronegatives. Correlational analyses suggested that individual differences in anxiety responses at the time of notification of seropositivity predicted subsequent (1‐week lag) declines in NK cell cytotoxicity but not other functional markers. Although most seropositives displayed clinical levels of anxiety, intrusive thoughts and avoidant responses during the week of serostatus notification, these measures returned to their initial nonclinical baseline levels within 5 weeks after notification in both the seropositive and seronegative groups.

Psychosocial modulation of antibody to Epstein-Barr viral capsid antigen and human herpesvirus type-6 in HIV-1-infected and at-risk gay men.

&NA; We investigated the effects of two behavioral interventions—aerobic exercise and cognitive behavioral stress management (CBSM)—on Epstein‐Barr virus viral capsid antigen (EBV‐VCA) and human herpesvirus type‐6 (HHV‐6) antibody modulation in 65 asymptomatic gay men measured at several time points in the 5 weeks preceding and following notification of their human immunodeficiency virus‐type 1 (HIV‐1) serostatus. After accounting for potential immunomodulatory confounds, we found that HIV‐1 seropositive men had higher EBV‐VCA antibody titers than those diagnosed as seronegative at every time point during the study; however, no significant differences were found with respect to HHV‐6. Among HIV‐1 seropositive and seronegative subjects, respectively, those randomized to either behavioral intervention had significant decreases in both EBV‐VCA and HHV‐6 antibody titers over the course of the intervention as compared with assessment‐only controls (of HIV‐1 seropositive and seronegative status) whose antibody titers did not significantly change and which remained consistently higher than either serostatus‐matched intervention group over subsequent time points, independent of total immunoglobulin G levels and degree of polyclonal B cell activation. In attempting to explain serostatus differences in EBV and HHV‐6 values, it was found that HIV‐1 seropositive men had significantly lower CD4 cells, CD4:CD8 ratio, and blastogenic response to phytohemagglutinin (PHA), as well as significantly higher CD8 cells at baseline. No significant differences were found between the HIV‐1 seropositive and seronegative men with respect to anxiety and depression at baseline. Since the greatest changes in EBV and HHV‐6 occurred between baseline and week 10, we correlated changes in immune (CD4, CD8, CD4:CD8 ratio, PHA stimulation) and distress‐related markers (state depression and anxiety) with EBV and HHV‐6 change scores over this time period. No significant correlations were found between any of these immune‐ or distress‐related variable and the antibody change scores suggesting that the mechanisms by which EBV and HHV‐6 antibodies are being modulated by these interventions possibly involve other, yet to be determined, immune, neuroendocrine, and/or psychologic variables.

Personality, quality of life and HAART adherence among men and women living with HIV/AIDS

Very few studies have documented relations between personality traits and quality of life among individuals living with human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS). Some have shown that poor perceived quality of life as determined by a sense of purpose may be associated with inadequate adherence to highly active antiretroviral treatment (HAART) in this population. Although adequate HAART adherence is critical to achieve the full therapeutic effects of newly and highly effective regimens, very little is known of how both personality factors and HIV-specific quality of life may impact adherence to these medication regimens. This study evaluated relations among personality traits, quality of life and HAART adherence among 116 men and women living with HIV/AIDS. Results showed that personality traits such as neuroticism were significantly associated with poorer quality of life, whereas conscientiousness and extraversion were associated with better quality of life. In contrast, personality traits were not directly related to HAART adherence. Both higher overall functioning and lower medication worries scores were significantly associated with HAART adherence. Findings suggest that personality traits are associated with HIV-specific quality of life on the one hand, and that HIV-specific quality of life is related to HAART adherence on the other. Future studies assessing the efficacy of psychosocial interventions in improving quality of life and HAART adherence should consider the role of personality traits in promoting better quality of life.

Active confrontational coping predicts decreased clinical progression over a one-year period in HIV-infected homosexual men

The association between stressful life events, psychiatric symptoms, coping, and social support and HIV disease progression one year later were studied in 51 HIV-infected asymptomatic and early symptomatic homosexual men. Dependent variables were CD4 counts and clinical progression. No associations between the psychosocial parameters and CD4 counts were found. Active confrontation with HIV infection as a coping strategy was predictive of decreased clinical progression at one year follow-up, after taking into account baseline biomedical and behavioral variables. These results show that active coping strategies may have an effect on disease progression, possibly mediated by greater compliance with medical treatments or by psychoneuroimmunological mechanisms.

Cognitive-behavioral and experiential group psychotherapy for Hiv-infected homosexual men: a comparative study.

&NA; The knowledge of being infected with the human immunodeficiency virus type 1 (HIV‐1) brings about psychological distress and social problems including anxiety, depression, and social isolation. Participating in psychosocial intervention programs can help to reduce these problems. To date, however, very little is known about the efficacy of different intervention strategies. We implemented a study with a randomized experimental design to investigate the effectiveness of a cognitive‐behavioral group psychotherapy (CBT) and an experiential group psychotherapy (ET) program for 39 asymptomatic HIV‐infected homosexual men. Both therapies consisted of 17 sessions over a 15‐week period. The major finding of this study was that psychosocial intervention, independent of the therapeutic orientation, decreased distress significantly, as compared with a waiting‐list control group (WCG). There were no significant changes in the intervention groups as compared with the WCG in coping styles, social support, and emotional expression. Finally, CBT and ET did not differ in their effects on psychological distress or on the other psychosocial variables measured in this study.

The impact of improved self-efficacy on HIV viral load and distress in culturally diverse women living with AIDS: the SMART/EST women's project

The purpose of the present study was to determine whether changes in self-efficacy over time would be related to changes in disease progression markers (CD4, viral load) in a sample of women with AIDS. A self-efficacy measure was developed and two sub-scales emerged via factor analysis of 391 HIV-positive women: AIDS Self-efficacy and Cognitive Behavioral Skills Self-efficacy. Subsequently, the sub-scales and an additional adherence self-efficacy item were given to 56 HIV-positive women who were measured at two time points three months apart. Half of these women were randomly assigned to a CB intervention and half to a low intensity comparison condition. Increases in AIDS Self-efficacy over the three-month period were significantly related to increases in CD4 and decreases in viral load. Similarly, increases in Cognitive Behavioral Skills Self-efficacy were significantly related to decreases in distress over time. Findings were maintained within the intervention group alone. Interestingly, increases in cognitive behavioral skills self-efficacy and increases in the self-efficacy adherence item were also significantly related to decreases in viral load. Implications of the findings and suggestions for future research are discussed.

Psychological and neuroendocrine measures related to functional immune changes in anticipation of HIV-1 serostatus notification

&NA; Our previous work indicated that gay males ultimately found to be seronegative showed impaired lymphocyte proliferative responses to phytohemagglutinin (PHA) and pokeweed mitogen (PWM) upon entering a study in which they would be notified of their human immunodeficiency virus‐Type 1 (HIV‐1) antibody status. To examine the degree to which alterations in various neuroendocrine and psychological markers might be related to this phenomenon we measured plasma cortisol, beta‐endorphin, denial coping strategies, intrusive thoughts related to AIDS risk, and several affective distress markers in 46 HIV‐1 seronegative subjects at each of the timepoints previously studied. Results indicated that cortisol levels were elevated at study entry and decreased across the subsequent five‐week period—mirroring the changes in mitogen responsivity across these timepoints. Analyses of individual differences showed that higher baseline cortisol and lower denial coping scores predicted lower PHA values at baseline. Persisting intrusive thoughts about risk of HIV‐1 infectivity (after seronegativity notification) were consistently associated with higher plasma cortisol levels. Finally, beta‐endorphin levels did not change significantly across the 10‐week observation period, were not associated with psychological variables, and were inconsistently associated with immune functioning.

Psychosocial group intervention and the rate of decline of immunological parameters in asymptomatic HIV-infected homosexual men

The aim of the study was to determine changes in the rate of decline of immunological parameters after psychosocial group intervention. Subjects were 26 asymptomatic HIV-infected homosexual men who participated in a cognitive-behavioral group therapy (CBT; n = 14), or an experiential group therapy program (ET; n = 12), both of 15 weeks duration. The outcome measures were changes in the decline of CD4 cell counts, and T cell proliferative responses to anti-CD3 monoclonal antibodies from preintervention to 24 months postintervention. No differences in the rate of decline of CD4 cells or T cell responses between the CBT and ET condition were found, and there were no significant changes in CD4 cell count from pre- to postintervention. However, those subjects who showed larger decreases in distress showed a smaller decline in CD4 cell counts. While the rate of decline in T cell responses was significantly less after both interventions, a similar positive change in T cell responses was found in a comparison group of 149 HIV-infected men with similar demographic, psychosocial and immunological characteristics who did not participate in one of the interventions. We conclude that the psychosocial intervention programs tested here did not cause changes in CD4 cell decline or T cell responses and that decreases in distress were related to increases in CD4 cell counts.

The effects of surgical stress and psychological stress on the immune function of operative cancer patients

Abstract Surgical resection of solid tumors provides a major opportunity for cure in many patients, but unfortunately can also increase the risk of metastases by spilling of tumor cells into the circulation. Moreover, surgery has been shown to result in immunological changes including an impaired natural killer cell cytotoxicity (NKCC). This immunosuppression can be. intensified by supportive cares such as anaesthesia and pen-operative blood transfusion. Additionally, psychological stress induced by cancer diagnosis and surgery can also impair immune function. These immunosuppressive factors may potentially provide a “fertile soil” for the outgrowth of circulating tumor cells. This review will focus on the influence of surgery and related methods such as bloodtransfusion and anaesthesia and on the detrimental effects psychological stress on the critical components in the hosts natural and acquired immune responses to tumor cells.