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From the Departments of Psychology (S.C., M.A., D.C., G.I., M.K., A.H., N.S.), Psychiatry and Behavioral Sciences (M.A., G.I., M.K., N.S.), Medicine (M.A.F., N.K., N.S.), and Biomedical Engineering (N.S.), University of Miami, Miami, FL; and the Department of Psychology (S.L.), University of Iowa, Iowa City, IA.
Address reprint requests to: Michael H. Antoni, PhD, Department of Psychology, University of Miami, Merrick 212, Coral Gables, FL 33124-2070. Email: mantoni{at}umiami.ir.miami.edu
OBJECTIVE: Coinfection with herpes simplex virus type 2 (HSV-2) is common in individuals infected with human immunodeficiency virus (HIV) and may have health implications. This study examined the effect of a 10-week cognitive behavioral stress management (CBSM) intervention on immunoglobulin G (IgG) antibody titers to HSV-2 in a group of mildly symptomatic HIV-infected gay men and the degree to which these effects were mediated by psychosocial and endocrine changes during the 10-week period.
METHODS: Sixty-two HIV+ gay men were randomly assigned to either a 10-week CBSM intervention (N = 41) or a wait-list control condition (N = 21). Anxious mood, social support, cortisol/dehydroepiandrosterone sulfate (DHEA-S) ratio levels, and HSV-2 IgG antibody titers were assessed at baseline and after the 10-week period. CBSM participants also recorded their stress levels before and after at-home relaxation practice.
RESULTS: HSV-2 IgG titers were significantly reduced in the CBSM participants but remained unchanged in the control group after the 10-week intervention period. Increases in one type of social support, perceived receipt of guidance, during the 10 weeks was associated with and partially mediated the effect of the intervention on HSV-2 IgG. Similarly, decreases in cortisol/DHEA-S ratio levels were associated with decreases in HSV-2 IgG, and lower mean stress levels achieved after home relaxation practice were associated with greater decreases in HSV-2 IgG among CBSM participants.
CONCLUSIONS: These findings suggest that behavioral and psychosocial changes occurring during CBSM interventions, including relaxation, enhanced social support, and adrenal hormone reductions, may help to explain the effects of this form of stress management on immune indices such as HSV-2 antibody titers.
Key Words: herpes simplex virus • human immunodeficiency virus, • neuroendocrine • relaxation, • social support • stress management.
Abbreviations: ANOVA = analysis of variance; BMI = body mass index; CBSM = cognitive behavioral stress management; CDC = Centers for Disease Control and Prevention; DHEA = dehydroepiandrosterone; DHEA-S = dehydroepiandrosterone sulfate; DSM-III-R = Diagnostic and Statistical Manual of Mental Disorders, third edition revised; HIV = human immunodeficiency virus; HSV-2 = herpes simplex virus type 2; IgG = immunoglobulin G; MMSE = Mini-Mental State Examination; POMS = Profile of Mood States; SCID-II = Structured Clinical Interview for DSM-II; SCID-NP-HIV = Structured Clinical Interview for DSM-III-R–nonpatient version for HIV studies; SIGH-AD = Structured Interview Guide for the Hamilton Anxiety and Depression Scales; SPS = Social Provisions Scale; TMD = total mood disturbance.
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