By Melanie Fridl Ross

GAINESVILLE, Fla.---Stress can accelerate the progression of the early stages of HIV disease, report researchers from the University of Florida and the University of North Carolina at Chapel Hill. In fact, for every severe stress a patient reported in a six-month period, the risk of early disease progression doubled. And among those tracked for at least two years, higher severe life stress increased the odds of developing HIV disease progression nearly fourfold, researchers wrote in the June issue of the American Journal of Psychiatry. While other studies have suggested stress and depression can alter the body's ability to fight off illness, few have rigorously examined the role of emotional factors in the onset and course of immune-based diseases such as cancer and AIDS, says Dr. John M. Petitto, associate professor of psychiatry, neuroscience and pharmacology at UF's College of Medicine and the UF Brain Institute. "This study provides among the first evidence that severe life stress increases the likelihood and severity of early HIV disease progression," Petitto said. Researchers studied 93 homosexual men, ages 18 to 51, who tested positive for HIV but showed no symptoms of the disease when they entered the trial. They were recruited from rural and urban areas of North Carolina through state health departments, advertisements in gay publications and gay organizations, and word of mouth. To be eligible for the study, they could have no previous intravenous drug use as a risk factor for HIV, could not drink heavily or use recreational drugs and could not be taking medications affecting the immune system, such as antibiotics. Participants, who were studied up to 42 months, were asked about more than 100 possible stresses at six-month intervals, including death of a mate, arrest, trouble with a boss, chronic financial difficulties or breakup of a love relationship. Researchers then assigned a "degree of threat" to the stress; in other words, the unpleasantness and uncertainty most people would experience given the same circumstances. For example, the long-term stress associated with the breakup of a committed relationship was based on the length of time the two were together, whether the patient lived with the person, whether the patient had control over the decision and other extenuating circumstances. In addition, to eliminate the chance that the stress of worsening disease might have influenced disease progression, researchers excluded disease-related stresses such as the onset of symptoms of AIDS-related complex, job loss due to dementia or a mate leaving because the disease worsened. The study showed that only severe stress had an influence; levels of stress common to everyday living did not seem to play a role in disease progression, Petitto said. Because HIV progresses at varying rates among patients, showing that stress can influence the course of illness could have implications for treatment, he said. "If we are able to identify factors that account for this disparity, that information could someday have implications for the treatment of HIV-infected individuals," Petitto said. "Further studies are required to shed light on the potential immune or other biological factors that may underlie the relationship between stress and disease progression."

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