HIV/AIDS Treatment Outcomes Influenced by Psychosocial Issues

A researcher from University of North Carolina at Chapel Hill has revealed that psychosocial factors such as stress, depression and trauma may influence treatment outcomes of people infected with HIV/AIDS.

According to Jane Leserman, Ph.D., sociologist, professor of psychiatry in the UNC School of Medicine, long-term studies have shown that HIV and AIDS patients with chronic depression and trauma are about twice as likely to die from AIDS-related causes.

"A huge amount of research has been done in our field around these psychosocial influences, yet we felt not all medical professionals working with HIV-infected persons were aware of this body of knowledge," said Leserman.

HIV patients face depression, anxiety, and stressful and traumatic life events in epidemic proportions.

Leserman made a reference of a study in men and women being treated in infectious disease clinics in the southeastern United States. The researchers 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.

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 behaviourally through changes in such behaviours as non-adherence to medications.

He said that asking about past trauma, current stress, depression and coping need to become routine aspects of a multidisciplinary and comprehensive approach to HIV treatment.

"Asking about past trauma and current life issues brings a fuller, truer focus on the patient and should be a routine practice in any multi-disciplinary and comprehensive approach to HIV treatment," he 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.

"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," he added.

Such inquiries could have a positive impact on patient care if they lead to appropriate referrals for psychological and behavioural treatment for the patients.

"In these populations with high psychosocial disturbance, there is also a documented higher proportion of risky behaviors - such as lack of adherence to treatment - that translates into a higher likelihood of developing drug resistance."

"Patients developing drug resistance become harder to treat and more likely to pass on a resistant strain of the virus," he said.

However, Leserman said more studies are required to investigate the biological and behavioural mediators of the relationship between psychosocial issues and the immune system, and the types of interventions that could lessen the negative health impact of chronic depression and trauma.

The report appears in current issue of the journal Psychosomatic Medicine.

Source-ANI
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