RESUMEN
OBJECTIVE: Human immunodeficiency virus (HIV)-infected women are at risk for cervical intraepithelial neoplasia (CIN) and cancer due to impaired immunosurveillance over human papillomavirus (HPV) infection. Life stress has been implicated in immune decrements in HIV-infected individuals and therefore may contribute to CIN progression over time. The purpose of this study was to determine whether life stress was associated with progression and/or persistence of squamous intraepithelial lesions (SIL), the cytologic diagnosis conferred by Papanicolaou smear, after 1-year follow-up among women co-infected with HIV and HPV. METHOD: Thirty-two HIV-infected African-American and Caribbean-American women underwent a psychosocial interview, blood draw, colposcopy, and HPV cervical swab at study entry. Using medical chart review, we then abstracted SIL diagnoses at study entry and after 1-year follow-up. RESULTS: Hierarchical logistic regression analysis revealed that higher life stress increased the odds of developing progressive/persistent SIL over 1 year by approximately seven-fold after covarying relevant biological and behavioral control variables. CONCLUSIONS: These findings suggest that life stress may constitute an independent risk factor for SIL progression and/or persistence in HIV-infected women. Stress management interventions may decrease risk for SIL progression/persistence in women living with HIV.
Asunto(s)
Infecciones por VIH/complicaciones , Vigilancia Inmunológica , Papillomaviridae , Infecciones por Papillomavirus/complicaciones , Estrés Psicológico/complicaciones , Infecciones Tumorales por Virus/complicaciones , Displasia del Cuello del Útero/etiología , Neoplasias del Cuello Uterino/etiología , Negro o Afroamericano/psicología , Pruebas Inmunológicas de Citotoxicidad , Progresión de la Enfermedad , Femenino , Florida/epidemiología , Grupos Focales , Infecciones por VIH/inmunología , Infecciones por VIH/psicología , Humanos , Huésped Inmunocomprometido , Acontecimientos que Cambian la Vida , Subgrupos Linfocitarios , Recurrencia Local de Neoplasia , Infecciones por Papillomavirus/inmunología , Infecciones por Papillomavirus/psicología , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología , Complicaciones Infecciosas del Embarazo/psicología , Estudios Prospectivos , Psiconeuroinmunología , Factores de Riesgo , Factores Socioeconómicos , Estrés Psicológico/inmunología , Infecciones Tumorales por Virus/inmunología , Infecciones Tumorales por Virus/psicología , Neoplasias del Cuello Uterino/epidemiología , Neoplasias del Cuello Uterino/inmunología , Neoplasias del Cuello Uterino/psicología , Indias Occidentales/etnología , Displasia del Cuello del Útero/epidemiología , Displasia del Cuello del Útero/psicologíaRESUMEN
OBJECTIVE: This study examines whether stressful negative life events and pessimism were associated with lower natural killer cell cytotoxicity (NKCC) and T cytotoxic/suppressor cell (CD8+CD3+) percentage in black women co-infected with human immunodeficiency virus Type 1 (HIV-1) and human papillomavirus (HPV), a viral initiator of cervical cancer. METHOD: Psychosocial interviews, immunological evaluations, and cervical swabs for HPV detection and subtyping were conducted on 36 HIV+ African-American, Haitian, and Caribbean women. RESULTS: Greater pessimism was related to lower NKCC and cytotoxic/suppressor cells after controlling for presence/absence of HPV Types 16 or 18, behavioral/lifestyle factors, and subjective impact of negative life events. CONCLUSIONS: A pessimistic attitude may be associated with immune decrements, and possibly poorer control over HPV infection and increased risk for future promotion of cervical dysplasia to invasive cervical cancer in HIV+ minority women co-infected with HPV.