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International Journal of Behavioral Medicine

, Volume 24, Issue 2, pp 294–304 | Cite as

Psychological Distress Mediates the Effect of Alexithymia on 2-Year Change in HIV Viral Load

  • Roger C. McIntoshEmail author
  • Gail Ironson
  • Michael Antoni
  • Betty Lai
  • Mahendra Kumar
  • Mary Ann Fletcher
  • Neil Schneiderman
Article

Abstract

Purpose

Individuals with trait alexithymia (AL) display poor cognitive assimilation of thoughts, feelings, and emotions. This may result in the persistence of stress, anxiety, and depressive disorders. The cumulative effect of this psychological distress is also linked clinical markers of human immunodeficiency virus (HIV) disease progression. This study examines the indirect effect of AL on HIV viral load as a function of baseline levels and change in psychological distress.

Methods

N = 123 HIV positive adults aged 37.9 ± 9.2 years provided blood samples for HIV-1 viral RNA and CD4 T lymphocytes along with self-reported stress, anxiety, and depression every 6 months for 2 years. A second-order conditional latent growth model was used to represent baseline and 2-year change in cumulative levels of psychological distress and to test the indirect effect of baseline levels of trait AL on change in HIV-1 viral load through this latent measure.

Results

AL was associated with baseline and latent change in psychological distress. Furthermore, baseline psychological distress predicted 2-year change in HIV-1 viral RNA after controlling for viral load at baseline. Altogether, trait AL had a significant indirect effect on change in viral load (β = 0.16, p = 0.03) as a function of baseline levels of distress.

Conclusion

Identification and communication of thoughts, feelings, and emotions are important for long-term psychological adaptation in HIV. Greater psychological distress, in turn, allows for persistence of peripheral viral replication.

Keywords

Human immunodeficiency virus Alexithymia Anxiety Stress Depression Latent growth modeling 

Notes

Compliance with Ethical Standards

Funding

This study was funded by the National Institutes of Mental Health (T32 MH018917 and R01 MH53791, G. Ironson, PI).

Conflict of Interest

Roger McIntosh declares that he has no conflict of interest. Gail Ironson declares that she has no conflict of interest. Michael Antoni declares that he has no conflict of interest. Betty Lai declares that she has no conflict of interest. Mahendra Kumar declares that he has no conflict of interest. Mary Ann Fletcher declares that she has no conflict of interest. Neil Schneiderman declares that he has no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Goetz RR, Remien RH. Axis I psychiatric symptoms associated with HIV infection and personality disorder. Am J Psychiatry. 1995;1(52):551.Google Scholar
  2. 2.
    Bing EG, Burnam MA, Longshore D, Fleishman JA, Sherbourne CD, London AS, et al. Psychiatric disorders and drug use among human immunodeficiency virus–infected adults in the United States. Arch Gen Psychiatry. 2001;58(8):721–8.PubMedCrossRefGoogle Scholar
  3. 3.
    Asch SM, Kilbourne AM, Gifford AL, Burnam MA, Turner B, Shapiro MF, et al. Underdiagnosis of depression in HIV. J Gen Intern Med. 2003;18(6):450–60.PubMedPubMedCentralCrossRefGoogle Scholar
  4. 4.
    Israelski D, Prentiss D, Lubega S, Balmas G, Garcia P, Muhammad M, et al. Psychiatric co-morbidity in vulnerable populations receiving primary care for HIV/AIDS. AIDS Care. 2007;19(2):220–5.PubMedCrossRefGoogle Scholar
  5. 5.
    Rabkin JG. HIV and depression: 2008 review and update. Curr HIV/AIDS Rep. 2008;5(4):163–71.PubMedCrossRefGoogle Scholar
  6. 6.
    Ironson GH, O’Cleirigh C, Schneiderman N, Weiss A, Costa Jr PT. Personality and HIV disease progression: role of NEO-PI-R openness, extraversion, and profiles of engagement. Psychosom Med. 2008;70(2):245.PubMedPubMedCentralCrossRefGoogle Scholar
  7. 7.
    John OP, Gross JJ. Healthy and unhealthy emotion regulation: personality processes, individual differences, and life span development. J Pers. 2004;72(6):1301–34.PubMedCrossRefGoogle Scholar
  8. 8.
    Gross JJ, Muñoz RF. Emotion regulation and mental health. Clin Psychol Sci Pract. 1995;2(2):151–64.CrossRefGoogle Scholar
  9. 9.
    Taylor GJ, Bagby RM, Luminet O. Assessment of alexithymia: self-report and observer-rated measures. The Handbook of Emotional Intelligence. 2000;301–19.Google Scholar
  10. 10.
    Taylor GJ, Bagby RM, Ryan DP, Parker JD, Doody KF, Keefe P. Criterion validity of the Toronto Alexithymia Scale. Psychosom Med. 1988;50(5):500–9.PubMedCrossRefGoogle Scholar
  11. 11.
    Lumley MA, Stettner L, Wehmer F. How are alexithymia and physical illness linked? A review and critique of pathways. J Psychosom Res. 1996;41(6):505–18.PubMedCrossRefGoogle Scholar
  12. 12.
    Parruti G, Vadini F, Sozio F, Mazzott E, Ursini T, Polill E, et al. Psychological factors, including alexithymia, in the prediction of cardiovascular risk in HIV infected patients: results of a cohort study. PLoS ONE. 2013;8(1):e54555.PubMedPubMedCentralCrossRefGoogle Scholar
  13. 13.
    McIntosh RC, Ironson G, Antoni M, Kumar M, Fletcher MA, Schneiderman N. Alexithymia is linked to neurocognitive, psychological, neuroendocrine, and immune dysfunction in persons living with HIV. Brain Behav Immun. 2014;36:165–75.PubMedCrossRefGoogle Scholar
  14. 14.
    Hintikka J, Honkalampi K, Lehtonen J, Viinamäki H. Are alexithymia and depression distinct or overlapping constructs? A study in a general population. Compr Psychiatry. 2001;42(3):234–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Berthoz S, Consoli S, Perez-Diaz F, Jouvent R. Alexithymia and anxiety: compounded relationships? A psychometric study. Eur Psychiatry. 1999;14(7):372–8.PubMedCrossRefGoogle Scholar
  16. 16.
    Parker JD, Bagby RM, Taylor GJ. Alexithymia and depression: distinct or overlapping constructs? Compr Psychiatry. 1991;32(5):387–94.PubMedCrossRefGoogle Scholar
  17. 17.
    Honkalampi K, Saarinen P, Hintikka J, Virtanen V, Viinamäki H. Factors associated with alexithymia in patients suffering from depression. Psychother Psychosom. 1999;68(5):270–5.PubMedCrossRefGoogle Scholar
  18. 18.
    Marchesi C, Brusamonti E, Maggini C. Are alexithymia, depression, and anxiety distinct constructs in affective disorders? J Psychosom Res. 2000;49(1):43–9.PubMedCrossRefGoogle Scholar
  19. 19.
    Picardi A, Toni A, Caroppo E. Stability of alexithymia and its relationships with the ‘big five’ factors, temperament, character, and attachment style. Psychother Psychosom. 2005;74(6):371–8.PubMedCrossRefGoogle Scholar
  20. 20.
    Luminet O, Rokbani L, Ogez D, Jadoulle V. An evaluation of the absolute and relative stability of alexithymia in women with breast cancer. J Psychosom Res. 2007;62(6):641–8.PubMedCrossRefGoogle Scholar
  21. 21.
    Tolmunen T, Heliste M, Lehto SM, Hintikka J, Honkalampi K, Kauhanen J. Stability of alexithymia in the general population: an 11-year follow-up. Compr Psychiatry. 2011;52(5):536–41.PubMedCrossRefGoogle Scholar
  22. 22.
    Spek V, Nyklíček I, Cuijpers P, Pop V. Alexithymia and cognitive behaviour therapy outcome for subthreshold depression. Acta Psychiatr Scand. 2008;118(2):164–7.PubMedCrossRefGoogle Scholar
  23. 23.
    De Gucht V, Heiser W. Alexithymia and somatisation: a quantitative review of the literature. J Psychosom Res. 2003;54(5):425–34.PubMedCrossRefGoogle Scholar
  24. 24.
    Lumley MA, Tomakowsky J, Torosian T. The relationship of alexithymia to subjective and biomedical measures of disease. Psychosomatics. 1997;38(5):497–502.PubMedCrossRefGoogle Scholar
  25. 25.
    Martin JB, Pihl R. Influence of alexithymic characteristics on physiological and subjective stress responses in normal individuals. Psychother Psychosom. 1986;45(2):66–77.PubMedCrossRefGoogle Scholar
  26. 26.
    Newton TL, Contrada RJ. Alexithymia and repression: contrasting emotion-focused coping styles. Psychosom Med. 1994;56(5):457–62.PubMedCrossRefGoogle Scholar
  27. 27.
    Martínez-Sánchez F, Ortiz-Soria B, Ato-García M. Subjective and autonomic stress responses in alexithymia. Psicothema. 2001;13(1):57–62.Google Scholar
  28. 28.
    Kohn PM, Gurevich M, Pickering DI, Macdonald JE. Alexithymia, reactivity, and the adverse impact of hassles-based stress. Personal Individ Differ. 1994;16(6):805–12.CrossRefGoogle Scholar
  29. 29.
    Martin JB, Pihl R. The stress-alexithymia hypothesis: theoretical and empirical considerations. Psychother Psychosom. 1985;43(4):169–76.PubMedCrossRefGoogle Scholar
  30. 30.
    Lumley MA. Alexithymia, emotional disclosure, and health: a program of research. J Pers. 2004;72(6):1271–300.PubMedCrossRefGoogle Scholar
  31. 31.
    Evans DL, Leserman J, Perkins DO, Stern RA, Murphy C, Zheng B, et al. Severe life stress as a predictor of early disease progression in HIV infection. Am J Psychiatr. 1997;154(5):630–4.PubMedCrossRefGoogle Scholar
  32. 32.
    Leserman J, Petitto JM, Perkins DO, Folds JD, Golden RN, Evans DL. Severe stress, depressive symptoms, and changes in lymphocyte subsets in human immunodeficiency virus–infected men: a 2-year follow-up study. Arch Gen Psychiatry. 1997;54(3):279.PubMedCrossRefGoogle Scholar
  33. 33.
    Leserman J, Jackson ED, Petitto JM, Golden RN, Silva SG, Perkins DO, et al. Progression to AIDS: the effects of stress, depressive symptoms, and social support. Psychosom Med. 1999;61(3):397–406.PubMedCrossRefGoogle Scholar
  34. 34.
    Zorrilla EP, McKay JR, Luborsky L, Schmidt K. Relation of stressors and depressive symptoms to clinical progression of viral illness. Am J Psychiatry. 1996.Google Scholar
  35. 35.
    Kemeny ME, Dean L. Effects of AIDS-related bereavement of HIV progression among New York City gay men. AIDS Educ Prev. 1995.Google Scholar
  36. 36.
    Solano L, Costa M, Salvati S, Coda R, Aiuti F, Mezzaroma I, et al. Psychosocial factors and clinical evolution in HIV-1 infection: a longitudinal study. J Psychosom Res. 1993;37(1):39–51.PubMedCrossRefGoogle Scholar
  37. 37.
    Ironson G, Friedman A, Klimas N, Antoni M, Fletcher MA, LaPerriere A, et al. Distress, denial, and low adherence to behavioral interventions predict faster disease progression in gay men infected with human immunodeficiency virus. Int J Behav Med. 1994;1(1):90–105.PubMedCrossRefGoogle Scholar
  38. 38.
    Kimerling R, Armistead L, Forehand R. Victimization experiences and HIV infection in women: associations with serostatus, psychological symptoms, and health status. J Trauma Stress. 1999;12(1):41–58.PubMedCrossRefGoogle Scholar
  39. 39.
    Leserman J, Petitto J, Gu H, Gaynes B, Barroso J, Golden R, et al. Progression to AIDS, a clinical AIDS condition and mortality: psychosocial and physiological predictors. Psychol Med. 2002;32(6):1059–73.PubMedCrossRefGoogle Scholar
  40. 40.
    Leserman J. HIV disease progression: depression, stress, and possible mechanisms. Biol Psychiatry. 2003;54(3):295–306.PubMedCrossRefGoogle Scholar
  41. 41.
    Leserman J. Role of depression, stress, and trauma in HIV disease progression. Psychosom Med. 2008;70(5):539–45.PubMedCrossRefGoogle Scholar
  42. 42.
    Chida Y, Vedhara K. Adverse psychosocial factors predict poorer prognosis in HIV disease: a meta-analytic review of prospective investigations. Brain Behav Immun. 2009;23(4):434–45.PubMedCrossRefGoogle Scholar
  43. 43.
    McIntosh RC, Ironson G, Antoni M, Kumar M, Fletcher MA, Schneiderman N. Alexithymia is linked to neurocognitive, psychological, neuroendocrine, and immune dysfunction in persons living with HIV. Brain Behav Immun. 2013.Google Scholar
  44. 44.
    Motivala SJ, Hurwitz BE, Llabre MM, Klimas NG, Fletcher MA, Antoni MH, et al. Psychological distress is associated with decreased memory helper T-cell and B-cell counts in pre-AIDS HIV seropositive men and women but only in those with low viral load. Psychosom Med. 2003;65(4):627–35.PubMedCrossRefGoogle Scholar
  45. 45.
    Greeson JM, Hurwitz BE, Llabre MM, Schneiderman N, Penedo FJ, Klimas NG. Psychological distress, killer lymphocytes and disease severity in HIV/AIDS. Brain Behav Immun. 2008;22(6):901–11.PubMedCrossRefGoogle Scholar
  46. 46.
    McIntosh RC, Hurwitz BE, Antoni M, Gonzalez A, Seay J, Schneiderman N. The ABCs of trait anger, psychological distress, and disease severity in HIV. Ann Behav Med. 2014;49(3):420–33.CrossRefGoogle Scholar
  47. 47.
    Li F, Duncan TE, Duncan SC, Acock A. Latent growth modeling of longitudinal data: a finite growth mixture modeling approach. Struct Equ Model. 2001;8(4):493–530.CrossRefGoogle Scholar
  48. 48.
    Hancock GR, Kuo W-L, Lawrence FR. An illustration of second-order latent growth models. Struct Equ Model. 2001;8(3):470–89.CrossRefGoogle Scholar
  49. 49.
    Sayer AG, Cumsille PE. Second-order latent growth models. 2001.Google Scholar
  50. 50.
    Ironson G, O’Cleirigh C, Fletcher MA, Laurenceau JP, Balbin E, Klimas N, et al. Psychosocial factors predict CD4 and viral load change in men and women with human immunodeficiency virus in the era of highly active antiretroviral treatment. Psychosom Med. 2005;67(6):1013–21.PubMedPubMedCentralCrossRefGoogle Scholar
  51. 51.
    Ironson G, Balbin E, Stuetzle R, Fletcher MA, O’Cleirigh C, Laurenceau J, et al. Dispositional optimism and the mechanisms by which it predicts slower disease progression in HIV: proactive behavior, avoidant coping, and depression. Int J Behav Med. 2005;12(2):86–97.PubMedPubMedCentralCrossRefGoogle Scholar
  52. 52.
    Ironson G, Balbin E, Stieren E, Detz K, Fletcher MA, Schneiderman N, et al. Perceived stress and norepinephrine predict the effectiveness of response to protease inhibitors in HIV. Int J Behav Med. 2008;15(3):221–6.PubMedPubMedCentralCrossRefGoogle Scholar
  53. 53.
    Taylor GJ, Ryan D, Bagby RM. Toward the development of a new self-report alexithymia scale. Psychother Psychosom. 1985;44(4):191–9.PubMedCrossRefGoogle Scholar
  54. 54.
    Beck AT, Ward C, Mendelson M. Beck Depression Inventory (BDI). Arch Gen Psychiatry. 1961;4(6):561–71.PubMedCrossRefGoogle Scholar
  55. 55.
    Spielberger CD. State‐trait anxiety inventory: Wiley Online Library. 2010.Google Scholar
  56. 56.
    Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24(4):385–96.PubMedCrossRefGoogle Scholar
  57. 57.
    Chesney MA, Ickovics J, Chambers D, Gifford A, Neidig J, Zwickl B, et al. Self-reported adherence to antiretroviral medications among participants in HIV clinical trials: the AACTG adherence instruments. AIDS Care. 2000;12(3):255–66.PubMedCrossRefGoogle Scholar
  58. 58.
    Reynolds NR, Sun J, Nagaraja HN, Gifford AL, Wu AW, Chesney MA. Optimizing measurement of self-reported adherence with the ACTG adherence questionnaire: a cross-protocol analysis. J Acquir Immune Defic Syndr. 2007;46(4):402–9.PubMedCrossRefGoogle Scholar
  59. 59.
    Markus KA. Principles and practice of structural equation modeling by Rex B. Kline. Struct Equ Model Multidiscip J. 2012;19(3):509–12.CrossRefGoogle Scholar
  60. 60.
    Muthen L, Muthen B. MPlus 4.1. Los Angeles: Muthen & Muthen; 2006.Google Scholar
  61. 61.
    McArdle JJ. Structural factor analysis experiments with incomplete data. Multivar Behav Res. 1994;29(4):409–54.CrossRefGoogle Scholar
  62. 62.
    Hu L, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct Equ Model Multidiscip J. 1999;6(1):1–55.CrossRefGoogle Scholar
  63. 63.
    Baron RM, Kenny DA. The moderator–mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol. 1986;51(6):1173.PubMedCrossRefGoogle Scholar
  64. 64.
    Sobel ME. Asymptotic confidence intervals for indirect effects in structural equation models. Sociol Methodol. 1982;13(1982):290–312.CrossRefGoogle Scholar
  65. 65.
    Ironson G, Hayward H. Do positive psychosocial factors predict disease progression in HIV-1? A review of the evidence. Psychosom Med. 2008;70(5):546–54.PubMedPubMedCentralCrossRefGoogle Scholar
  66. 66.
    Milam JE, Richardson JL, Marks G, Kemper CA, Mccutchan AJ. The roles of dispositional optimism and pessimism in HIV disease progression. Psychol Health. 2004;19(2):167–81.CrossRefGoogle Scholar
  67. 67.
    Carrico AW, Riley ED, Johnson MO, Charlebois ED, Neilands TB, Remien RH, et al. Psychiatric risk factors for HIV disease progression: the role of inconsistent patterns of anti-retroviral therapy utilization. J Acquir Immune Defic Syndr. 2011;56(2):146. 1999.PubMedPubMedCentralCrossRefGoogle Scholar
  68. 68.
    O’Cleirigh C, Ironson G, Weiss A, Costa Jr PT. Conscientiousness predicts disease progression (CD4 number and viral load) in people living with HIV. Health Psychol. 2007;26(4):473.PubMedCrossRefGoogle Scholar
  69. 69.
    Penedo FJ, Gonzalez JS, Dahn JR, Antoni M, Malow R, Costa P, et al. Personality, quality of life and HAART adherence among men and women living with HIV/AIDS. J Psychosom Res. 2003;54(3):271–8.PubMedCrossRefGoogle Scholar
  70. 70.
    Temoshok LR, Waldstein SR, Wald RL, Garzino-Demo A, Synowski SJ, Sun L, et al. Type C coping, alexithymia, and heart rate reactivity are associated independently and differentially with specific immune mechanisms linked to HIV progression. Brain Behav Immun. 2008;22(5):781–92.PubMedCrossRefGoogle Scholar
  71. 71.
    Semple SJ, Patterson TL, Temoshok LR, McCutchan JA, Straits-Troster K, Chandler JA, et al. Identification of psychobiological stressors among HIV-positive women. Women Health. 2003;20(4):15–36.CrossRefGoogle Scholar
  72. 72.
    Thompson SC, Nanni C, Levine A. The stressors and stress of being HIV-positive. AIDS Care. 1996;8(1):5–14.PubMedCrossRefGoogle Scholar
  73. 73.
    Peterson JL, Folkman S, Bakeman R. Stress, coping, HIV status, psychosocial resources, and depressive mood in African American gay, bisexual, and heterosexual men. Am J Community Psychol. 1996;24(4):461–87.PubMedCrossRefGoogle Scholar
  74. 74.
    McIntosh RC, Rosselli M. Stress and coping in women living with HIV: a meta-analytic review. AIDS Behav. 2012;16(8):2144–59.PubMedCrossRefGoogle Scholar
  75. 75.
    Moskowitz JT, Hult JR, Bussolari C, Acree M. What works in coping with HIV? A meta-analysis with implications for coping with serious illness. Psychol Bull. 2009;135(1):121.PubMedCrossRefGoogle Scholar
  76. 76.
    Kopnisky KL, Stoff DM, Rausch DM. Workshop report: the effects of psychological variables on the progression of HIV-1 disease. Brain Behav Immun. 2004;18(3):246–61.PubMedCrossRefGoogle Scholar
  77. 77.
    Antoni MH. Stress, coping, and health in HIV/AIDS. The Oxford Handbook of Stress, Health, and Coping. 2010:428.Google Scholar
  78. 78.
    Cardena E. The domain of dissociation. 1994.Google Scholar
  79. 79.
    Lipsanen T, Saarijärvi S, Lauerma H. Exploring the relations between depression, somatization, dissociation and alexithymia—overlapping or independent constructs? Psychopathology. 2004;37(4):200–6.PubMedCrossRefGoogle Scholar
  80. 80.
    Grabe H-J, Rainermann S, Spitzer C, Gänsicke M, Freyberger H. The relationship between dimensions of alexithymia and dissociation. Psychother Psychosom. 2000;69(3):128–31.PubMedCrossRefGoogle Scholar
  81. 81.
    Guilbaud O, Corcos M, Hjalmarsson L, Loas G, Jeammet P. Is there a psychoneuroimmunological pathway between alexithymia and immunity? Immune and physiological correlates of alexithymia. Biomed Pharmacother. 2003;57(7):292–5.PubMedCrossRefGoogle Scholar
  82. 82.
    Bruni R, Serino F, Galluzzo S, Coppolino G, Cacciapaglia F, Vadacca M, et al. Alexithymia and neuroendocrine-immune response in patients with autoimmune diseases. Ann N Y Acad Sci. 2006;1069(1):208–11.PubMedCrossRefGoogle Scholar
  83. 83.
    Bossu P, Salani F, Cacciari C, Picchetto L, Cao M, Bizzoni F, et al. Disease outcome, alexithymia and depression are differently associated with serum IL-18 levels in acute stroke. Curr Neurovasc Res. 2009;6(3):163–70.PubMedCrossRefGoogle Scholar
  84. 84.
    Corcos M, Guilbaud O, Paterniti S, Curt F, Hjalmarsson L, Moussa M, et al. Correlation between serum levels of interleukin-4 and alexithymia scores in healthy female subjects: preliminary findings. Psychoneuroendocrinology. 2004;29(5):686–91.PubMedCrossRefGoogle Scholar
  85. 85.
    Guilbaud O, Curt F, Perrin C, Chaouat G, Berthoz S, Dugré-Le Bigre C, et al. Decreased immune response in alexithymic women: a cross-sectional study. Biomed Pharmacother. 2009;63(4):297–304.PubMedCrossRefGoogle Scholar
  86. 86.
    Uher T. Alexithymia and immune dysregulation: a critical review. Act Nerv Super. 2010;52(1):40–4.CrossRefGoogle Scholar
  87. 87.
    Spitzer C, Brandl S, Rose H-J, Nauck M, Freyberger HJ. Gender-specific association of alexithymia and norepinephrine/cortisol ratios. A preliminary report. J Psychosom Res. 2005;59(2):73–6.PubMedCrossRefGoogle Scholar
  88. 88.
    Henry JP, Haviland MG, Cummings MA, Anderson DL, Nelson JC, MacMurray JP, et al. Shared neuroendocrine patterns of post-traumatic stress disorder and alexithymia. Psychosom Med. 1992;54(4):407–15.PubMedCrossRefGoogle Scholar
  89. 89.
    Härtwig EA, Aust S, Heuser I. HPA system activity in alexithymia: a cortisol awakening response study. Psychoneuroendocrinology. 2013;38(10):2121–6.CrossRefGoogle Scholar
  90. 90.
    Connor RI, Ho DD. Human immunodeficiency virus type 1 variants with increased replicative capacity develop during the asymptomatic stage before disease progression. J Virol. 1994;68(7):4400–8.PubMedPubMedCentralGoogle Scholar
  91. 91.
    Wei X, Ghosh SK, Taylor ME, Johnson VA, Emini EA, Deutsch P, et al. Viral dynamics in human immunodeficiency virus type 1 infection. Nature. 1995;373(6510):117–22.PubMedCrossRefGoogle Scholar
  92. 92.
    Ho DD, Neumann AU, Perelson AS, Chen W, Leonard JM, Markowitz M. Rapid turnover of plasma virions and CD4 lymphocytes in HIV-1 infection. Nature. 1995;373(6510):123–6.PubMedCrossRefGoogle Scholar
  93. 93.
    Connor RI, Mohri H, Cao Y, Ho DD. Increased viral burden and cytopathicity correlate temporally with CD4+ T-lymphocyte decline and clinical progression in human immunodeficiency virus type 1-infected individuals. J Virol. 1993;67(4):1772–7.PubMedPubMedCentralGoogle Scholar
  94. 94.
    Leserman J, Petitto JM, Golden RN, Gaynes BN, Gu H, Perkins DO, et al. Impact of stressful life events, depression, social support, coping, and cortisol on progression to AIDS. Am J Psychiatr. 2000;157(8):1221–8.PubMedCrossRefGoogle Scholar
  95. 95.
    Cole SW, Korin YD, Fahey JL, Zack JA. Norepinephrine accelerates HIV replication via protein kinase A-dependent effects on cytokine production. J Immunol. 1998;161(2):610–6.PubMedGoogle Scholar
  96. 96.
    Cole SW. Psychosocial influences on HIV-1 disease progression: neural, endocrine, and virologic mechanisms. Psychosom Med. 2008;70(5):562–8.PubMedCrossRefGoogle Scholar
  97. 97.
    Cole SW, Naliboff BD, Kemeny ME, Griswold MP, Fahey JL, Zack JA. Impaired response to HAART in HIV-infected individuals with high autonomic nervous system activity. Proc Natl Acad Sci. 2001;98(22):12695–700.PubMedPubMedCentralCrossRefGoogle Scholar
  98. 98.
    Singh N, Squier C, Sivek C, Wagener MM, Victor LY. Psychological stress and depression in older patients with intravenous drug use and human immunodeficiency virus infection: implications for intervention. Int J STD AIDS. 1997;8(4):251–5.PubMedCrossRefGoogle Scholar
  99. 99.
    LeBlanc AJ. Aging with HIV/AIDS. Handbook of Sociology of Aging: Springer; 2011, p. 495–512.Google Scholar
  100. 100.
    Ironson G, O’cleirigh C, Kumar M, Kaplan L, Balbin E, Kelsch C, et al. Psychosocial and neurohormonal predictors of HIV disease progression (CD4 cells and viral load): a 4 year prospective study. AIDS Behav. 2015;19(8):1388–97.PubMedPubMedCentralCrossRefGoogle Scholar
  101. 101.
    Lumley MA, Tojek TM, Macklem DJ. Effects of written emotional disclosure among repressive and alexithymic people. 2002.Google Scholar
  102. 102.
    Frisina PG, Borod JC, Lepore SJ. A meta-analysis of the effects of written emotional disclosure on the health outcomes of clinical populations. J Nerv Ment Dis. 2004;192(9):629–34.PubMedCrossRefGoogle Scholar
  103. 103.
    O’Cleirigh C, Ironson G, Antoni M, Fletcher MA, McGuffey L, Balbin E, et al. Emotional expression and depth processing of trauma and their relation to long-term survival in patients with HIV/AIDS. J Psychosom Res. 2003;54(3):225–35.PubMedCrossRefGoogle Scholar
  104. 104.
    O’Cleirigh C, Ironson G, Fletcher MA, Schneiderman N. Written emotional disclosure and processing of trauma are associated with protected health status and immunity in people living with HIV/AIDS. Br J Health Psychol. 2008;13(1):81–4.PubMedPubMedCentralCrossRefGoogle Scholar
  105. 105.
    McIntosh RC, Ironson G, Antoni M, Fletcher MA, Schneiderman N. Alexithymia, assertiveness and psychosocial functioning in HIV: implications for medication adherence and disease severity. AIDS Behav. 2015;1–14.Google Scholar
  106. 106.
    Carpenter KM, Addis ME. Alexithymia, gender, and responses to depressive symptoms. Sex Roles. 2000;43(9–10):629–44.CrossRefGoogle Scholar
  107. 107.
    Levant RF, Hall RJ, Williams CM, Hasan NT. Gender differences in alexithymia. Psychol Men Masculinity. 2009;10(3):190.CrossRefGoogle Scholar
  108. 108.
    Kokkonen P, Karvonen JT, Veijola J, Läksy K, Jokelainen J, Järvelin M-R, et al. Prevalence and sociodemographic correlates of alexithymia in a population sample of young adults. Compr Psychiatry. 2001;42(6):471–6.PubMedCrossRefGoogle Scholar
  109. 109.
    Mattila AK, Salminen JK, Nummi T, Joukamaa M. Age is strongly associated with alexithymia in the general population. J Psychosom Res. 2006;61(5):629–35.PubMedCrossRefGoogle Scholar
  110. 110.
    Bangsberg DR, Perry S, Charlebois ED, Clark RA, Roberston M, Zolopa AR, et al. Non-adherence to highly active antiretroviral therapy predicts progression to AIDS. AIDS. 2001;15(9):1181–3.PubMedCrossRefGoogle Scholar
  111. 111.
    Bangsberg DR, Hecht FM, Charlebois ED, Zolopa AR, Holodniy M, Sheiner L, et al. Adherence to protease inhibitors, HIV-1 viral load, and development of drug resistance in an indigent population. AIDS. 2000;14(4):357–66.PubMedCrossRefGoogle Scholar
  112. 112.
    Mannheimer S, Friedland G, Matts J, Child C, Chesney M. The consistency of adherence to antiretroviral therapy predicts biologic outcomes for human immunodeficiency virus–infected persons in clinical trials. Clin Infect Dis. 2002;34(8):1115–21.PubMedCrossRefGoogle Scholar
  113. 113.
    Pillai R, Nair BS, Watson RR. AIDS, drugs of abuse and the immune system: a complex immunotoxicological network. Arch Toxicol. 1991;65(8):609–17.PubMedCrossRefGoogle Scholar
  114. 114.
    Giannini AJ. Alexithymia, affective disorders and substance abuse: possible cross-relationships. Psychol Rep. 1996;78(3c):1389–90.PubMedCrossRefGoogle Scholar
  115. 115.
    Haviland MG, Hendryx MS, Shaw DG, Henry JP. Alexithymia in women and men hospitalized for psychoactive substance dependence. Compr Psychiatry. 1994;35(2):124–8.PubMedCrossRefGoogle Scholar
  116. 116.
    Lane RD, Weihs KL, Herring A, Hishaw A, Smith R. Affective agnosia: expansion of the alexithymia construct and a new opportunity to integrate and extend Freud’s legacy. Neurosci Biobehav Rev. 2015;55:594–611.PubMedCrossRefGoogle Scholar
  117. 117.
    Ricciardi L, Demartini B, Fotopoulou A, Edwards MJ. Alexithymia in neurological disease: a review. J Neuropsychiatry Clin Neurosci. 2015:appi. neuropsych. 14070169.Google Scholar
  118. 118.
    Lutgendorf SK, Antoni MH, Ironson G, Starr K, Costello N, Zuckerman M, et al. Changes in cognitive coping skills and social support during cognitive behavioral stress management intervention and distress outcomes in symptomatic human immunodeficiency virus (HIV)-seropositive gay men. Psychosom Med. 1998;60(2):204–14.PubMedCrossRefGoogle Scholar
  119. 119.
    Antoni M, Cruess D, Wagner S, Lutgendorf S, Kumar M, Ironson G, et al. Cognitive behavioral stress management effects on anxiety, 24-hour urinary catecholamine output, and T-cytotoxic/suppressor cells over time among symptomatic HIV-infected gay men. J Consult Clin Psychol. 2000;68:31–45.PubMedCrossRefGoogle Scholar
  120. 120.
    Antoni MH, Cruess S, Cruess DG, Kumar M, Lutgendorf S, Ironson G, et al. Cognitive-behavioral stress management reduces distress and 24-hour urinary free cortisol output among symptomatic HIV-infected gay men. Ann Behav Med. 2000;22(1):29–37.PubMedCrossRefGoogle Scholar
  121. 121.
    Antoni MH, Carrico AW, Durán RE, Spitzer S, Penedo F, Ironson G, et al. Randomized clinical trial of cognitive behavioral stress management on human immunodeficiency virus viral load in gay men treated with highly active antiretroviral therapy. Psychosom Med. 2006;68(1):143–51.PubMedCrossRefGoogle Scholar
  122. 122.
    Antoni MH, Pereira DB, Marion I, Ennis N, Andrasik MP, Rose R, et al. Stress management effects on perceived stress and cervical neoplasia in low-income HIV-infected women. J Psychosom Res. 2008;65(4):389–401.PubMedPubMedCentralCrossRefGoogle Scholar
  123. 123.
    Antoni MH, Cruess DG, Klimas N, Carrico AW, Maher K, Cruess S, et al. Increases in a marker of immune system reconstitution are predated by decreases in 24-h urinary cortisol output and depressed mood during a 10-week stress management intervention in symptomatic HIV-infected men. J Psychosom Res. 2005;58(1):3–13.PubMedCrossRefGoogle Scholar
  124. 124.
    Antoni MH, Cruess DG, Klimas N, Maher K, Cruess S, Kumar M, et al. Stress management and immune system reconstitution in symptomatic HIV-infected gay men over time: effects on transitional naïve T cells (CD4+ CD45RA+ CD29+). Am J Psychiatr. 2002;159(1):143–5.PubMedCrossRefGoogle Scholar

Copyright information

© International Society of Behavioral Medicine 2016

Authors and Affiliations

  • Roger C. McIntosh
    • 1
    Email author
  • Gail Ironson
    • 1
  • Michael Antoni
    • 1
  • Betty Lai
    • 2
  • Mahendra Kumar
    • 3
  • Mary Ann Fletcher
    • 4
  • Neil Schneiderman
    • 1
  1. 1.Department of Health PsychologyUniversity of MiamiMiamiUSA
  2. 2.School of Public HealthGeorgia State UniversityAtlantaUSA
  3. 3.Departments of Psychiatry and Behavioral SciencesUniversity of Miami Miller School of MedicineMiamiUSA
  4. 4.Department of Clinical Immunology, Institute of Neuro Immune MedicineNova Southeastern UniversityDavieUSA

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