Psychobiological Processes and Health in HIV/AIDS

描述（由申请人提供）：尽管最近在艾滋病毒/艾滋病的治疗方面取得了进展，但在疾病过程中仍有很大的可变性，这可能是由社会心理和心理生物学过程造成的。该赠款要求提供资金，以确定社会心理（压力、应对和相关变量）和生物因素（皮质醇、细胞毒性T淋巴细胞和NK#）对艾滋病毒/艾滋病疾病进展和死亡率的影响。该研究包括一个已随访3.5年的HIV阳性样本：该建议将增加与现有队列相当的新受试者和新的生物测量，并将随访时间延长5至8年。在入组时，我们的受试者CD4计数在150到500之间，并且他们从未有过严重的艾滋病症状（C类）。该研究的特殊优势使该队列能够比迄今为止研究的其他队列提供新的信息，包括：(1)我们的样本具有多样化的群体（28%的女性；36%的非洲裔美国人；30%的西班牙裔）。(2)整个研究是在蛋白酶抑制剂可用期间进行的，这使得诸如依从性等问题至关重要。将增加抗逆转录病毒水平和基因分型，以确保依从性措施的准确性并衡量耐药性的发展。(3)我们已经能够量化一些相对未开发的变量，如医患关系、精神和情绪处理。(4)我们是最早能够预测病毒载量的研究之一。(5)我们纳入了几种生物学指标，可以作为疾病进展的预测因子和媒介进行研究。虽然我们有强有力的横断面和纵向数据表明，社会心理变量与CD4和病毒载量变化有关（控制相关变量），但目前的长期纵向设计应使我们能够将这些社会心理变量与严重艾滋病症状的发展和死亡率联系起来。这些分析证实，我们已经确定了适当的变量，以扩大对心理生物学联系的探索。拟议研究的主要优势在于，它将使我们能够：(a)预测关键疾病终点（例如C类症状）和死亡率；(b)将重要的社会心理变量（如压力、抑郁应对、依从性、医患关系）与生物过程和疾病终点联系起来。

DESCRIPTION (provided by applicant): Despite the recent advances in the treatment for HIV/AIDS there remains a significant amount of variability in disease course that may be accounted for by psychosocial and psychobiological processes. This grant requests funding to determine the impact of both psychosocial (stress, coping and related variables) and biological factors (cortisol, Cytotoxic T lymphocytes, and NK#) on disease progression and mortality in HIV/AIDS. The study includes an HIV positive sample that has been followed for 3.5 years: This proposal would add new subjects comparable to the existing cohort and new biological measures and extend follow-up for 5 to 8 years total. At entry our subjects' CD4 counts were between 150 and 500, and they had never had serious AIDS symptoms (Category C). Particular strengths of the study that give this cohort the ability to contribute new information above other cohorts studied to date include (1) Our sample has diverse groups (28% women; 36% African American; 30% Hispanic). (2) The entire study has been conducted during the time protease inhibitors have been available, which makes issues such as adherence of paramount importance. Antiretroviral levels and genotyping will be added to ensure accuracy of adherence measures and to measure the development of resistance. (3) We have been able to quantify some relatively unexplored variables such as the doctor-patient relationship, spirituality, and emotional processing. (4) We are one of the first studies to be able to predict viral load. (5) We include several biological measures that could be investigated as both predictors and as mediators of disease progression. While we have strong cross sectional and longitudinal data showing that psychosocial variables are related to CD4 and viral load changes (controlling for relevant variables), the current long-term longitudinal design should allow us to relate these psychosocial variables to the development of serious AIDS symptoms and mortality. These analyses confirm that we have identified appropriate variables for expanding explorations of psychobiological links. Major strengths of the proposed study are that it will allow us to: (a) predict critical disease end points (e.g. Category C symptoms) and mortality; and (b) relate important psychosocial variables (e.g. stress, depression coping, adherence, doctor-patient relationship) to biological processes and disease endpoints.