Psychosocial issues affect HIV/AIDS treatment outcomes: UNC ...(rticles addressing five overarching them...),Health

• Depression, anxiety, and stressful and traumatic life events occur in epidemic proportions in HIV-infected persons.

• These psychosocial factors (e.g., depression, trauma and coping with stress) have consistent and clinically relevant influences on HIV disease progression.

• The effects of psychosocial factors may be mediated biologically through changes in the sympathetic nervous system, "stress hormones" and the immune system, as well as behaviorally through changes in such behaviors as non-adherence to medications.

• Interventions to address depression, stress and coping may help to ameliorate some of the negative health and behavioral effects associated with poor psychological functioning.

• Asking about past trauma, current stress, depression and coping need to become routine aspects of a multidisciplinary and comprehensive approach to HIV treatment.

Recent large, long-term studies show that HIV and AIDS patients with chronic depression and trauma are about twice as likely to die from AIDS-related causes, Leserman said.

"No one argues about the importance of following the numbers immune cell counts and levels of the virus in the blood nor should they," Leserman said. "But there is substantial and consistent evidence that depression, stressful life events and trauma account for some of the variability in HIV disease course. That can't be ignored."

Leserman cited the clinical significance of addressing the psychosocial issues that exist in epidemic proportions in HIV-infected populations. One study of men and women being treated in infectious disease clinics in the southeastern United States found that more than 70 percent of those patients had suffered at least two major lifetime traumas about half had been sexually and/or physically abused.

"Asking about past trauma and current life issues brings a fuller, truer foc
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