Elucidating Biopsychosocial Mediators of HIV Progression

描述（由申请人提供）：HIV进展的显著个体差异表明与心理神经免疫学（PNI）机制有关。研究人员先前和初步的研究已经证明了适应不良的C型应对方式（情感上缺乏表达，不认识自己的需求或感受）与HIV进展之间的纵向关系;以及C型应对与HIV特异性β趋化因子的低产量之间的横截面关系，这些趋化因子是CCR 5 HIV辅助受体的配体，并与有效的HIV抑制活性相关。本研究的目的是在一项纵向研究中检验以下假设：较高水平的C型应对通过HIV特异性β-趋化因子产生的失调促进HIV进展。将在基线时对至少100名HIV感染者进行生物心理社会评估（从N = 200开始，以解决预期的损耗，并在6、12、18、24和36个月时进行心理社会测量，包括C型应对;压力和反应的心理生理测量; β-趋化因子和细胞因子的实验室测量，有证据或理论依据表明其与HIV进展相关;和临床变量，包括CD 4细胞计数、HIV-1 RNA（病毒载量，VL）。在48个月时确定仅评估的医疗状况。多变量分析将检查这些措施的贡献及其相互作用，以阐明HIV进展的潜在介质，控制基线临床状态和抗逆转录病毒治疗。我们的目标是了解和描述如何观察到的生物心理社会因素之间的关系和相互作用可能有助于艾滋病毒的进展，通过这样的“宏观介质”的失调，在稳态控制，这已被证明或假设与艾滋病毒的进展。

DESCRIPTION (provided by applicant): Significant individual differences in HIV progression suggest that psychoneuroimmunological (PNI) mechanisms are implicated. Previous and preliminary studies by the investigators have demonstrated a longitudinal relationship between the maladaptive Type C coping style (emotionally inexpressive, not recognizing own needs or feelings) and HIV progression; and a cross-sectional relationship between Type C coping and lower production of HIV-specific beta chemokines, which are ligands for the CCR5 HIV coreceptor, and associated with potent HIV inhibitory activity. The purpose of the proposed study is to test within a single longitudinal study the hypothesis that higher levels of Type C coping contribute to HIV progression through dysregulation of HIV -specific beta-chemokine production. Biopsychosocial assessments of at least 100 HIV-infected participants will be conducted at baseline (starting with N = 200 to address expected attrition, and at 6, 12, 18, 24, and 36 months on psychosocial measures, including Type C coping; psychophysiological measures of stress and reactivity; laboratory measures of beta-chemokines and cytokines for which there is evidence or theoretical rationale for their relevance to HIV progression; and clinical variables including CD4 cell count, HIV-1 RNA (viral load, VL). Medical status only assessed will be determined at 48 months. Multivariate analyses will examine the contribution of these measures and their interactions to elucidate potential mediators of HIV progression, controlling for baseline clinical status and antiretroviral therapy. The goal is to understand and delineate how observed relationships and interactions among biopsychosocial factors may contribute to HIV progression through such "macro-mediators" as deregulation in homeostatic control, which have been demonstrated or hypothesized to be related to HIV progression.