Psychoimmunology of Health and Long Term Survival with AIDS
Principal Investigator: Gail Ironson, Ph.D., M.D.
In order to determine factors that may be protective of health, this study proposes to compare three groups on psychologic and immunologic measures: (1) long-term survivors of AIDS; (2) HIV positive people who have low CD4 counts (<100) and are clinically asymptomatic (no CDC 1993 category B or C symptoms); and (3) HIV positive people who are matched to group two) for age, gender, ethnic group, route of infection and use of anti-retroviral medication, but who are symptomatic. Study I compares the three groups cross-sectionally on psychologic and immunologic factors: Study II follows group 2 (the asymptomatic low CD4 group) longitudinally for three years and relates psychological and immunological variables to the development of morbidity and mortality.
Major psychological variables to be assessed through interview and questionnaire include coping style, life involvement, emotional expression, assertiveness, social support, negative beliefs (self-efficacy, optimism, fatalism), distress, and approach to health care (doctor-patient relationship, taking responsibility for health, keeping up with medical information, etc.). Comparison of immunologic profiles among the three groups (and longitudinally within the asymptomatic low CD4 group) will test the hypothesis of whether people who stay relatively healthy are higher on particular immune measures (such as higher natural killer cell cytotoxicity, relative preservation of cytokines representing TH1 (vs. TH2) shift of cells, relative preservation of the naive (vs. memory) CD4 cell subsets, cytotoxic CD8 cell subset, response to PHA mitogen, etc., that may possibly compensate for the overall loss in CD4 cells.
The study will be done at two sites: University of Miami and University of California at Los Angeles to ensure our finding adequate numbers of the unusual people who comprise groups 1 and 2.