The overall goal of our biopsychosocial HIV research program is to identify factors associated with mediators of HIV progression, in order to incorporate these into interventions intended to influence more positive HIV clinical outcomes. In a baseline sample of 200 largely African-American HIV-positive individuals attending an inner-city HIV primary care clinic, we have indeed demonstrated that hypothesized emotional dysregulation (high Type C coping, alexithymia), as well as dysregulated physiological responses to stress (heart rate and blood pressure overreactivity to and slow recovery from experimental emotional stressors) are associated both concurrently and predictively (baseline to 24-month follow-up) with reciprocal immune factors which either amplify the immune activation that is central to HIV progression (IL-6) or which inhibit HIV entry through the CCR5 co-receptor (the beta-chemokines MIP-1α/β) (Temoshok et al., Brain Behavior & Immunity, 2008, 2009).
We now report on cytokine/chemokine, as well as clinical status results at 36-month follow-up of 125 individuals available for analysis. Cytokine/chemokine results are expressed as a stimulation index: HIV p24 (PHA and Candida) antigen-stimulated production of IL-6, and MIP-1α/β, compared to spontaneous production. Using generalized estimating equations to make longitudinal predictions, based on a linear model, and controlling for age, CD4+ count at baseline, medications, and time of measurement, we found the same relationships as previously reported, suggesting a chronic pattern that influences HIV disease progression, as indicated by CD4+ cell count: (1) higher baseline alexithymia scores, and heart rate/blood pressure overreactivty and under-recovery following experimental emotional stress tasks were significantly inversely associated with the MIP-1α stimulation index and with lower CD4+ cell count at follow-up; (2) baseline maladaptive Type C coping was associated with significantly higher IL-6 production at 36 months, as well as lower CD4+ cell count. These findings contribute to the growing evidence we are applying to developing a “natural” biopsychosocial anti-HIV intervention.