Psychobiological Processes and Health in HIV/AIDS

说明(申请人提供)：尽管艾滋病毒/艾滋病的治疗最近取得了进展，但病程仍有相当大的变异性，这可能是心理社会和心理生物过程造成的。这笔赠款要求提供资金，以确定心理社会因素(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。这项研究包括一个已经跟踪了3.5年的艾滋病毒阳性样本：这项提议将增加与现有队列和新的生物措施相当的新对象，并将总共随访5至8年。在进入试验时，受试者的CD4计数在150到500之间，他们从未出现过严重的艾滋病症状(C类)。这项研究的特殊优势使这个队列有能力提供新的信息，超过了迄今为止研究的其他队列，包括(1)我们的样本有不同的群体(28%的女性；36%的非裔美国人；30%的西班牙裔)。(2)整个研究都是在有蛋白酶抑制剂可用的时间内进行的，这使得坚持等问题变得至关重要。将增加抗逆转录病毒水平和基因分型，以确保遵守措施的准确性，并衡量耐药性的发展。(3)我们已经能够量化一些相对未被探索的变量，如医患关系、灵性和情绪处理。(4)我们是最早能够预测病毒载量的研究之一。(5)我们包括了几种可以作为疾病进展的预测和中介进行研究的生物学指标。虽然我们有强有力的横断面和纵向数据表明，心理社会变量与CD4和病毒载量的变化有关(控制相关变量)，但目前的长期纵向设计应该允许我们将这些心理社会变量与严重艾滋病症状和死亡率的发展联系起来。这些分析证实，我们已经确定了适当的变量来扩大对心理生物学联系的探索。拟议研究的主要优点是，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；以及(B)将重要的心理社会变量(例如压力、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.