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Psychological Distress is Associated With Decreased Memory Helper T-cell and B-cell Counts in Pre-AIDS HIV Seropositive Men and Women but Only in Those With Low Viral Load

From the Behavioral Medicine Research Center (B.E.H.) and Department of Medicine (N.G.K., M.A.F.), University of Miami, Miami, Florida; the Department of Psychology (B.E.H., M.M.L., M.H.A., W.G.L., N.S.), University of Miami, Coral Gables, Florida; and the Cousins Center for Psychoneuroimmunology (S.J.M.), University of California, Los Angeles, California.

Address reprint requests to: Barry E. Hurwitz, PhD, Behavioral Medicine Research Center (200 BMRC), University of Miami, c/o VA Medical Center, 1201 NW 16th Street, Miami, FL 33125. Email: BHurwitz{at}miami.edu

Received for publication February 7, 2002; revision received September 11, 2002.

OBJECTIVE: Although some studies have demonstrated the association of psychological distress and diminished immune system function in HIV spectrum disease, other studies have yielded apparently conflicting findings; the lack of consideration of the role of HIV viral burden may be central to this controversy. This study examined whether HIV viral burden moderated the relationship between psychological distress and enumerative and functional immune measures in pre-AIDS HIV spectrum disease.

METHODS: This cross-sectional study used factor analysis to derive a composite measure of psychological distress incorporating measures of dysphoria, anxiety, and perceived stress. Multiple regression analyses used distress as the predictor, immune measures as the outcome variables, with viral load as the moderator variable, while controlling for age, medication use, and HIV symptomatology. Subjects were 148 pre-AIDS, HIV seropositive men and women (89 asymptomatic, 59 symptomatic), aged 18 to 45 years. The main outcome measures were enumerative and functional immune measures.

RESULTS: A model of psychological distress was derived using each of the proposed measures. Findings indicated that high distress was associated with decreased numbers of helper T (memory) cells and B cells, but only at low levels of viral burden after controlling for age, medication use, and HIV-related symptoms.

CONCLUSIONS: These findings highlight the importance of assessing the role of HIV viral burden when examining distress-immunity relationships in HIV-infected individuals. The lack of association in those persons with high viral load suggests that, even before AIDS onset, disease-related processes are disrupting CNS and immune system communication.

Key Words: HIV-1, • psychological stress, • immune system, • viral load, • T lymphocytes, • B lymphocytes.

Abbreviations: AIDS = acquired immunodeficiency syndrome;; BDI = Beck Depression Inventory;; CDC = Centers for Disease Control and Prevention;; cDNA = clonal deoxyribonucleic acid;; EBV = Epstein-Barr virus;; ELISA = enzyme-linked immunosorbent assay;; CD3+CD4+ = helper T4 cells;; CD4+CD45RA-CD29+ = helper T4 cell memory cells;; CD4+CD45RA+CD29+ = transition helper T4 cells between the naive and memory state;; CD4+CD45RA+CD29- = helper T4 naive cells;; CD3+CD8+CD56- = cytotoxic/suppressor T8 cells that are not natural killer cells;; CD8+CD38+HLA/DR+ = cytotoxic-activated T8 cells;; CD8+CD38-HLA/DR+ = noncytotoxic-activated T8 cells;; CD19+ = B cells;; CNS = central nervous system;; C/S = cytotoxic/suppressor cells;; HIV-1 = human immunodeficiency virus type 1;; IES = Impact of Events Scale;; NK or CD3-CD8-CD56+ = natural killer cell that is not a cytotoxic/suppressor T8 cell;; NKCC = natural killer cell cytotoxicity;; PHA = lymphoproliferative response to the plant mitogen, phytohemagglutinin;; POMS = Profile of Mood States;; PSS = Perceived Stress Scale;; RNA = ribonucleic acid;; SCID = structured clinical interview for DSM-III-R.

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