PSYCHONEUROIMMUNOLOGICAL ASPECTS OF DISEASE PROGRESSION AMONG WOMEN WITH HUMAN PAPILLOMAVIRUS-ASSOCIATED CERVICAL DYSPLASIA AND HUMAN-IMMUNODEFICIENCY-VIRUS TYPE-1 COINFECTION

Objective: Psychosocial associations have been observed with level of cervical dysplasia or ''pre-cancer'' and invasive cervical cancer [related to human papillomavirus (HPV) infection]. Psychoneuroimmunological relationships have been observed in human immunodeficiency virus type 1 (HIV-1) infection, which is being described in an increasing number of women' Our objective was to review these relationships regarding effects that might be expected in HIV-1 and HPV co-infected women. Method: This review was based on a Medline literature search supplemented by a manual search of selected journals unrepresented in that database. Results: Relationships of psychosocial factors and level of cervical dysplasia were similarly observed with reference to immunological and health status in asymptomatic and early symptomatic HIV-1 infected homosexual men, suggesting that a potentiating effect may occur in HIV-1 and HPV co-infected women. Consistency of relationships across studies appeared to be enhanced by the use of a biopsychosocial model integrating the effects of life stressors, social support and coping style as well as psychiatric disorders. Conclusions: Research is indicated on the relationships between psychosocial factors, immunological status and clinical health status in this group of women. Because of the high prevalence of psychosocial risk factors for chronic psychological distress in these women and the known immunological and health status decrements occurring with progression of these two infections, a clinical screening program based on the biopsychosocial model is recommended as a means of secondary prevention. If effective in generating treatment referrals, such a program would likely improve quality of life and could aid in the determination of relationships with immunological and health status as well.