Distress, denial, and low adherence to behavioral interventions predict faster disease progression in gay men infected with human immunodeficiency virus

  • Gail Ironson
  • Andrea Friedman
  • Nancy Klimas
  • Michael Antoni
  • Mary Ann Fletcher
  • Arthur LaPerriere
  • John Simoneau
  • Neil Schneiderman

Abstract

This study examined psychological predictors of 2-year disease progression in gay men after finding out their human immunodeficiency virus (HIV) serostatus. Psychological and immune status of asymptomatic gay men who did not know their HIV serostatus was monitored during the 5 weeks before and after serostatus notification. The men were randomly assigned to an exercise, cognitive-behavioral stress-management intervention, or control group. At 2-year follow-up for the 23 men who turned out to be seropositive, 9 had developed symptoms, including 5 with acquired immune deficiency syndrome—4 of whom died. Distress at diagnosis, denial (5 weeks postdiagnosis minus pre-diagnosis), and low adherence during interventions were significant predictors of 2-year disease progression. Denial and adherence remained significant predictors of disease progression even after controlling for CD4 number at entry. Furthermore, change in denial was significantly correlated with immune status 1 year later; 1-year immune status was significantly correlated with 2-year disease progression. The present study therefore demonstrates significant relations between psychological variables on the one hand and both immune measures and IIIV-1 disease progression on the other. We conclude that distress, denial, and low protocol compliance predict subsequent disease progression.

Key words

acquired immune deficiency syndrome (AIDS) human immunodeficiency virus (HIV) disease progression distress immunity denial coping adherence healt 

References

  1. Antoni, M. H., Baggett, L., Ironson, G., IaPerriere, A., August, S., Klimas, N. G., Schneider-man, N., & Fletcher, M. A. (1991). Cognitive-behavioral stress management intervention buffers distress responses and immunological changes following notification of HIV-1 anti-body seropositivity. Journal of Consulting and Clinical Psychology, 59, 906–915.PubMedCrossRefGoogle Scholar
  2. Antoni, M. H., Goodkin, K., Goldstein, V., LaPcrriere, A., Ironson, G., & Fletcher, M. A. (1991). Coping responses to HIV-1 serostatus notification predict short-term affective distress and one-year immunologic status in HIV-1 seronegative and seropositive gay men [Abstract]. Psychosomatic Medicine, 53, 227.Google Scholar
  3. Antoni, M. H., Ironson, G., Helder, L., Lutgendorf, S., Friedman, A., LaPerriere, A., Fletcher, M., & Schneiderman, N. (1992, April). Stress management intervention reduces social isolation and maladaptive coping behaviors in gay men adjusting to an HIV+ diagnosis. Paper presented at the scientific meeting of the Society of Behavioral Medicine, New York.Google Scholar
  4. Burack, J. H., Stall, R. D., Barrett, D. C., & Coates, T. J. (1992, June). Depression predicts accelerated CD4 decline among gay men in San Francisco. Paper presented at the International Conference on AIDS, Amsterdam.Google Scholar
  5. Carver, C. S., Scheier, M. F., & Weintraub, J. K. (1989). Assessing coping strategies: A theoretically based approach. Journal of Personality and Social Psychology, 56, 267–283.PubMedCrossRefGoogle Scholar
  6. Centers for Disease Control. (1987). Revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. Journal of the American Medical Association, 269, 729–730.Google Scholar
  7. Cohen, S., Tyrrell, D., & Smith, A. P. (1991), Psychological stress and susceptibility to the common cold. New England Journal of Medicine, 8, 606–612.Google Scholar
  8. Costa, P., & McCrae, R. (1983). Personality in adulthood: A six-year longitudinal study of self-reports and spouse ratings on the NEO Personality Inventory. Journal of Personality and Social Psychology, 54, 853–863.CrossRefGoogle Scholar
  9. Digman, J. (1990). Personality structure: Emergence of the five-factor model. Annual Review of Psychology, 41, 417–440.Google Scholar
  10. Digman, J. M., & Inouye, J. (1986). Further specification of the five robust factors of personality. Journal of Personality and Social Psychology, 50, 116–123.CrossRefGoogle Scholar
  11. Esterling, B., Anloni, M. H., Kumar, M., & Schneiderman, N. (1990). Emotional repression, stress disclosure responses, and Epstein Ban viral capsid antigen tilers. Psychosomatic Medicine, 52, 397–410.PubMedGoogle Scholar
  12. Esterling, B., Antoni, M. H., Schneiderman, N., Carver, C., LaPcrriere, A., Ironson, G., Klimas, N., & Fletcher, M. A. (1992). Psychosocial modulation of antibody to Epstein-Barr viral capsid antigen and human herpes virus Type 6 in HIV-1 infected and at-risk gay men. Psychosomatic Medicine, 54, 354–371.PubMedGoogle Scholar
  13. Fahey, J. I., Taylor, J. M., Detels, R., Hofmann, B., Melmed, R., Nishanian, P., & Giorgi, J. V. (1990). The prognostic value of cellular and serologic markers in infection with human immunodeficiency virus Type I. New England Journal of Medicine, 322, 166–172.PubMedGoogle Scholar
  14. Fawzy, F., Cousins, N., Fawzy, N., Kemeny, M., Elashoff, R., & Morton, D. (1990). A structured psychiatric intervention for cancer patients: I. Changes over time in methods of coping and affective disturbance. Archives of General Psychiatry, 47, 720–725.PubMedGoogle Scholar
  15. Felten, B., Revenson, T., & Hinrichsen, G. (1984). Stress and coping in the explanation of psychological adjustment among chronically ill adults. Social Science and Medicine, 18, 889–989CrossRefGoogle Scholar
  16. Fletcher, M. A., Donegan, E., Stevens, C. E., Schiff, E. R., Dietrich, S. I., Hassett, J., Parker, J., Operskalski, E. A., Moslcy, J., & Transfusion Safely Study Group. (1991). Lymphocyte phenotypes among anti-HTLV-l/II positive donors and recipients. Journal of AIDS, 4, 628–632.Google Scholar
  17. Fletcher, M. A., Klimas, N., Morgan, R., & Gjersel, G. (1992). Lymphocyte proliferation assays. In N. Rose & J. Fahey (Eds.), Manual of clinical laboratory immunology (4th ed., pp. 213–219). American Society of Microbiology.Google Scholar
  18. Gentry, W. D., Foster, S., & Haney, T. (1972). Denial as a determinant of anxiety and perceived health status in the corollary care unit. Psychosomatic Medicine, 34, 39–44.PubMedGoogle Scholar
  19. Glaser, R., Kiccolt-Glaser, J. K., Bonneau, R. H., Malarkey, W., & Hughes, J. (1992). Stress-induced modulation of the immune response to recombinant hepatitis B vaccine. Psychosomatic Medicine, 54, 22–27.PubMedGoogle Scholar
  20. Hackett, T. P., Cassem, N. H., & Wishnie, H. A. (1968). The coronary care unit: An appraisal of its psychologic hazards. New England Journal of Medicine, 279, 1365–1370.PubMedCrossRefGoogle Scholar
  21. Horowítz, M., Wilner, N., & Alvarez, W. (1979). Impact of Event Scale: A measure of subjective stress. Psychosomatic Medicine, 41, 209–218.PubMedGoogle Scholar
  22. Ironson, G., LaPerriere, A., Antoni, M. H., O’Hearn, P., Schneiderman, N., Klimas, N., & Fletcher, M. A. (1990). Changes in immune and psychological measures as a function of anticipation and reaction to news of HIV-1 antibody status. Psychosomatic Medicine, 52, 247–270.PubMedGoogle Scholar
  23. Keet, I. P., Lee, F, K., van Grievsen, G. J., Lange, J. M., Nahmias, A., & Coutinho, R. A. (1990). Herpes simplex virus Type 2 and other genital ulcerative infections as a risk factor for HIV-1 acquisition. Genitourinary Medicine, 66, 330–333.PubMedGoogle Scholar
  24. Kessler, R., Foster, C., Joseph, J., Ostrow, D., Wortman, C., Phair, J., & Chmiel, J. (1991). Stressful life events and symptom onset in HIV infection. American Journal of Psychiatry, 148, 733–738.PubMedGoogle Scholar
  25. Kiecoll-Glaser, J., Fisher, L., Ogrocki, P., Stout, J. C., Speicher, C. D., & Glaser, R. (1987). Marital quality, marital disruption, and immune function. Psychosomatic Medicine, 49, 13–34.Google Scholar
  26. Kiecolt-Glaser, J. K., Garner, W., Speicher, C. E., Penn, G., & Glaser, R. (1984). Psychosocial modifiers of immunocompetence in medical students. Psychosomatic Medicine, 46, 7–14.PubMedGoogle Scholar
  27. Kiecolt-Glaser, J. K., & Glaser, R. (1991). Stress and immune function in humans. In R. Ader, D. Felten, & N. Cohen (Eds.), Psychoneuroimmunology (2nd ed., pp. 849–867). San Diego: Academic.Google Scholar
  28. Kiecolt-Glaser, J., Glaser, R., Strain, E., Stout, J., Tarr, K., Holliday, J., & Speicher, C. (1986). Modulation of cellular immunity in medical students. Journal of Behavioral Medicine, 9, 5–21.PubMedCrossRefGoogle Scholar
  29. Kiecolt-Glaser, J. K., Kennedy, S., Malkoff, S., Fisher, L., Speicher, C. E., & Glaser, R. (1988). Marital discord and immunity in males. Psychosomatic Medicine, 50, 213–229.PubMedGoogle Scholar
  30. LaPerriere, A. R., Antoni, M. H., Schnciderman, N., Ironson, G., Klimas, N. G., Caralis, P., & Fletcher, M. A. (1990). Exercise intervention attenuates emotional distress and natural killer cell decrements following notification of positive serologic status for HIV-l. Biofeedback and Self Regulation, 15, 229–242.PubMedCrossRefGoogle Scholar
  31. Lazarus, R, S., & Cohen, F. (1973). Active coping processes, coping dispositions, and recovery from surgery. Psychosomatic Medicine, 35, 375–389.PubMedGoogle Scholar
  32. McNair, D., Lorr, M., & Droppleman, L., (1981). EITS manual for the Profile of Mood States. San Diego: Educational and Industrial Testing Service.Google Scholar
  33. Namir, S., Wolcott, D. L., Fawzy, F. J., & Alumbaugh, M. J. (1987). Coping with AIDS: Psychological and health implications (Special issue: Acquired immune deficiency syndrome]. Journal of Applied Social Psychology, 17, 309–328.CrossRefGoogle Scholar
  34. Page, J. B., Lai- S.H., Chitwood, D., Smith, P. J., Klimas, N., & Fletcher, M. A. (1990). HTLV-I/II seroposilivity and mortality due to AIDS in HIV-1 seropositive IV drug users. Lancet, 335, 1439–1441.PubMedCrossRefGoogle Scholar
  35. Perry, S., Fishman, B., Jacobsberg, L., & Frances, A. (1992). Relationships over 1 year between lymphocyte subsets and psychosocial variables among adults with infection by human immunodeficiency virus. Archives of General Psychiatry, 49, 396–401.PubMedGoogle Scholar
  36. Rabkin, J. G., Williams, J. B. W., Remien, R. H., Goetz, R. R., Kertzner, R., & Gorman, J. M. (1991). Depression, lymphocyte subsets, and human immunodeficiency virus symptoms on two occasions in HIV-positive homosexual men. Archives of General Psychiatry, 48, 111–119.PubMedGoogle Scholar
  37. Sarason, I. G., Johnson, J. H., & Siegel, J. M. (1978). Assessing the impact of life changes: Development or the Life Expericnces Survey. Journal of Consulting and Clinical Psychology, 46, 932–946.PubMedCrossRefGoogle Scholar
  38. Schellekens, P., Roos, M., De Wolf, R., Lang, J., & Miedema, F. (1990). Low T-cell responsiveness to activation via CD3/TCR is a prognostic marker for AIDS in HIV-1-infected men. Journal of Clinical Immunology, 10, 121–127.PubMedCrossRefGoogle Scholar
  39. Solomon, G. F., Kemeny, M. E., & Temoshok, L. (1991). Psychoneuroimmunological aspects of human immunodeficiency virus infection. In R. Ader, D. L. Fellen, & N. Cohen (Eds.), PsychoneuToimmunology (2nd ed., pp, 1081–1113). San Diego: AcademicGoogle Scholar
  40. Spielberger, C., Gorsuch, R., & Lushene, R. (1970). State-Trait Anxiety Inventory manual. Palo Alto, CA: Consulting Psychologists Press.Google Scholar
  41. Stanton, A. L., & Snider, P. R. (in press). Coping with breast cancer diagnosis: A prospective study. Health Psychology.Google Scholar
  42. Stern, M. J., Pascale, I., & Ackerman, A. (1977). Life adjustment post myocardial infarction. Archives of Internal Medicine, 137, 1680–1685.PubMedCrossRefGoogle Scholar

Copyright information

© International Society of Behavioral Medicine 1994

Authors and Affiliations

  • Gail Ironson
    • 1
    • 2
  • Andrea Friedman
    • 1
    • 2
  • Nancy Klimas
    • 1
    • 2
  • Michael Antoni
    • 1
    • 2
  • Mary Ann Fletcher
    • 1
    • 2
  • Arthur LaPerriere
    • 1
    • 2
  • John Simoneau
    • 1
    • 2
  • Neil Schneiderman
    • 1
    • 2
  1. 1.Departments of Psychology, Psychiatry, and MedicineUniversity of MiamiMiami and Coral GablesUSA
  2. 2.Miami Veterans Administration Medical CenteramiUSA

Personalised recommendations