Stress management effects on psychological, endocrinological, and immune functioning in men with HIV infection: Empirical support for a psychoneuroimmunological model

We present a psychoneuroimmunologic (PNI) model for Human immunodeficiency Virus (HIV) infection, describe a 10-week group-based cognitive behavioral stress management (CBSM) intervention and summarize research demonstrating the effects of this intervention on mood, neuroendocrine (Hypothalamic Pituitary Adrenal [HPA], Hypothalamic Pituitary Gonadal [HPG] and Sympathetic Nervous System [SNS] hormones) and immune system status (lymphocyte subsets, antiviral immune function) in HIV-infected persons. This work demonstrates that changes in relaxation skills, cognitive coping strategies and social support may mediate the mood effects of CBSM, and that these mood changes may mediate adrenal hormone regulation indicated by reductions in 24-h urinary cortisol (with reduced depressed mood) and norepinephrine (with reduced anxiety) and increases in serum DHEA-S and testosterone levels (with reduced depressed mood). Results also suggest that CBSM-related changes in production of these hormones may explain, in part, the effects of this intervention on short-term changes in IgG antibody titers to herpesviruses (with increased DHEA-S-to-cortisol ratio), and longer-term changes in lymphocyte subpopulations such as CD8 suppressor/ cytotoxic cells (with reductions in urinary noradrenaline output) and transitional naive CD4 cells (with reductions in urinary cortisol output). Thus a multi-modal CBSM intervention is associated with alterations in mood, neuroendocrine functioning and immunologic status that may have health implications for HIV infection.