5 Tradiciones En Psicologia Social

Review Article

Stress Management and Psychoneuroimmunology in HIV Infection
By Michael H. Antoni, PhD ABSTRACT Does stress management affect psychological and immune functioning in persons with human immunodeficiency virus infections? Stress-management techniques, such as relaxation training and imagery, cognitive restructuring, coping-skills training, and interpersonal-skills training, mayreduce anxiety, depression, and social isolation in HIV-infected persons by lowering physical tension and increasing a sense of control and self-efficacy. A psychoneuroimmunologic model is proposed wherein these psychological changes are hypothesized to be accompanied by an improved ability to regulate neuroendocrine functioning, which in turn may be associated with a partial normalization ofimmune system functions such as lymphocyte proliferation and cytotoxicity, providing more efficient surveillance of latent viruses that may contribute directly to increased HIV replication and generate opportunistic infections or cancer if left unchecked. Such a normalization of stress-associated immune system decrements are hypothesized to forestall or minimize increases in viral load and expressionof clinical symptoms. This model is useful for testing the factors contributing to the health effects of stress-management interventions in HIV-infected persons. In this context, one general research strategy for testing the effects of stress-management interventions is to target them toward the more prevalent psychosocial challenges that HIV-infected people face at various points in the diseaseprocess; enroll an HIV-infected population (eg, HIV-positive homosexual and bisexual men) into a randomized trial; and monitor changes in cognitive, affective, behavioral, and social factors in parallel with hormonal, immunologic, viral, and clinical changes over the course of time. This article will review the major psychoneuroimmunologic findings that have emerged using this paradigm and suggestfuture research directions and clinical applications. CNS Spectrums 2003;8(1):40-51 INTRODUCTION Once an individual is infected with human immunodeficiency virus a period of clinical latency, lasting for a number of years follows the initial sequence of primary infection, viral dissemination, and development of HIV-specific immunity. During the clinically latent period there continues to beincreasing viral load, depletion of T-helper/inducer cells (cluster designation [CD] 4) in peripheral blood and associated loss of “immune repertoire,” and an increasing proportion of HIV-infected lymphoid cells.1 The decline in CD4 cells and related immunologic surveillance functions leaves the infected person susceptible to a number of opportunistic infections and cancers characterizing acquired immunedeficiency syndrome. Some of the more commonly observed infections include pneumocystic carinii pneumonia, cryptococcal meningitis, and candida esophagitis.2 Many other diseases manifest in HIV-infected persons are caused by ubiquitous herpes viruses (eg, cytomegalovirus-associated retinitis is a major cause of blindness in HIV-infected persons). HIV-infected persons are also vulnerable torelatively rare cancers, including Kaposi’s sarcoma and Burkitt’s lymphoma, and cervical carcinoma in women. Interestingly, these cancers are believed to be promoted by fairly common viruses, such as human papillomavirus types, which are associated with cervical neoplasia and squamous cell cervical carcinoma.3,4 In sum, HIV-infected persons are extremely vulnerable to a wide range of pathogens normallycontrolled by the immune system and, with time, these individuals may contract a number of life-threatening clinical conditions. Behavioral-management techniques may help HIV-infected persons cope with the psychosocial aspects of this chronic disease. There is evidence that improving psychological adaptation to HIV may also contribute to physical health outcomes. 5 A major thrust for this...