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Life Stress and Cervical Squamous Intraepithelial Lesions in Women With Human Papillomavirus and Human Immunodeficiency Virus

From the Department of Psychology (D.B.P., M.H.A., A.D., C.S.C., R.E.F.D., G.I., N.K.), University of Miami, Coral Gables, Florida; and Department of Obstetrics and Gynecology (D.B.P., T.S., J.E-P., M.J.O.), Department of Psychiatry (M.H.A., G.I.), and Departments of Microbiology and Immunology (N.K.), University of Miami School of Medicine, Miami, Florida.

Address reprint requests to: Deidre Byrnes Pereira, PhD, Department of Clinical and Health Psychology, University of Florida, P.O. Box 100165, 101 S. Newell Dr., Room 3137, Gainesville, FL 32610-0165. Email: dpereira{at}hp.ufl.edu

OBJECTIVE: Human immunodeficiency virus (HIV)-infected women are at risk for cervical intraepithelial neoplasia (CIN) and cancer due to impaired immunosurveillance over human papillomavirus (HPV) infection. Life stress has been implicated in immune decrements in HIV-infected individuals and therefore may contribute to CIN progression over time. The purpose of this study was to determine whether life stress was associated with progression and/or persistence of squamous intraepithelial lesions (SIL), the cytologic diagnosis conferred by Papanicolaou smear, after 1-year follow-up among women co-infected with HIV and HPV.

METHOD: Thirty-two HIV-infected African-American and Caribbean-American women underwent a psychosocial interview, blood draw, colposcopy, and HPV cervical swab at study entry. Using medical chart review, we then abstracted SIL diagnoses at study entry and after 1-year follow-up.

RESULTS: Hierarchical logistic regression analysis revealed that higher life stress increased the odds of developing progressive/persistent SIL over 1 year by approximately seven-fold after covarying relevant biological and behavioral control variables.

CONCLUSIONS: These findings suggest that life stress may constitute an independent risk factor for SIL progression and/or persistence in HIV-infected women. Stress management interventions may decrease risk for SIL progression/persistence in women living with HIV.

Key Words: HIV, • squamous intraepithelial lesions (SIL), • human papillomavirus (HPV), • stress, • psychoneuroimmunology (PNI), • women.

Abbreviations: AIDS = acquired immune deficiency syndrome;; CI = confidence interval;; CIN = cervical intraepithelial neoplasia;; HAART = highly active antiretroviral therapy;; HGSIL = high-grade SIL;; HIV = human immunodeficiency virus;; HPV = human papillomavirus;; LES = Life Experiences Survey;; LGSIL = low-grade SIL;; NKCC = natural killer cell cytotoxicity;; SIL = squamous intraepithelial lesions.

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