Depressive symptoms and cervical neoplasia in HIV+ low-income minority women with human papillomavirus infection.

BACKGROUND: Prior work has related elevated life stress to greater risk of cervical neoplasia in women with human immunodeficiency virus (HIV) and human papillomavirus (HPV). PURPOSE: This study investigated associations between depressive symptoms and cervical neoplasia in HIV+ HPV+ women. Participants were 58 HIV+ HPV+ women. METHOD: Participants underwent colposcopy, including HPV screening, Papanicolaou smear, and cervical biopsy to determine study eligibility. Eligible participants completed the Beck Depression Inventory (BDI) and the Center for Epidemiologic Studies-Depression (CES-D) scale. RESULTS: Presence and severity of clinically significant depressive symptomatology were associated with cervical neoplasia. Hierarchical logistic regression analysis revealed that women with greater depressive symptoms had marginally greater odds of presenting with cervical neoplasia (BDI: OR = 1.16, p = 0.092; CES-D: OR = 1.15, p = 0.067. Women with greater somatic depressive symptoms, specifically, had significantly greater odds of presenting with cervical neoplasia (BDI: OR = 1.86, p = 0.027; CES-D: OR = 1.56, p = 0.017). CONCLUSION: These findings suggest that screening HIV+ women for somatic depression may help identify those at risk for cervical neoplasia. Future depression research with medical populations should discern somatic depressive symptoms from disease symptoms, as they may have important value in independently predicting health outcomes.

Stress management effects on perceived stress and cervical neoplasia in low-income HIV-infected women.

OBJECTIVE: Risk for developing cervical neoplastic disease is greatly increased in women infected with oncogenic sexually transmitted human papillomaviruses (HPVs) and who have lowered cellular immunity due to coinfection with human immunodeficiency virus (HIV) infection. The majority of these individuals are low-income minority women. Factors associated with promotion of HPV to cervical neoplasia in HIV-infected populations include degree of immunosuppression as well as behavioral factors such as tobacco smoking and psychological stress. This study examined the effects of a cognitive behavioral stress management (CBSM) intervention on life stress and cervical neoplasia in HIV+ minority women. METHODS: Participants were 39 HIV+ African-American, Caribbean, and Hispanic women with a recent history of an abnormal Papanicolaou smear. Participants underwent colposcopic examination, psychosocial interview, and peripheral venous blood draw at study entry and 9 months after being randomly assigned to either a 10-week CBSM group intervention (n=21) or a 1-day CBSM workshop (n=18). RESULTS: Women assigned to the 10-week group-based CBSM intervention reported decreased perceived life stress and had significantly lower odds of cervical neoplasia over a 9-month follow-up. CBSM effects on life stress and neoplasia appeared independent of presence of neoplasia at study entry, HPV type, CD4+CD3+ cell count, HIV viral load, and substance use. Furthermore, CBSM intervention effects on cervical neoplasia were especially pronounced among women with residual life stress at follow-up. CONCLUSION: These findings suggest that stress management decreases perceived life stress and may decrease the odds of cervical neoplasia in women with HIV and a history of abnormal Papanicolaou smears. Although preliminary, these findings suggest the utility of stress management as a cancer prevention strategy in this high-risk population.

Inhibited interpersonal coping style predicts poorer adherence to scheduled clinic visits in human immunodeficiency virus infected women at risk for cervical cancer.

BACKGROUND: One of the most common gynecologic conditions among HIV+ women is cervical dysplasia, the precancerous phase of cervical cancer. Therefore, adherence to gynecology visits may be among the most important health care practices for HIV+ women. However, no research has evaluated the psychosocial factors associated with health care practices among HIV+ women at risk for cervical cancer. PURPOSE: This study examined the relationship between inhibited interpersonal coping style and adherence to primary care and obstetrics/gynecology visits in HIV+ women with Human Papillomavirus (HPV) infection. METHODS: Twenty-eight HIV-1 seropositive Black, non-Hispanic women underwent a psychosocial interview, blood draw, and gynecologic examination. The Millon Behavioral Health Inventory was used to assess coping style. Medical chart review was used to assess adherence to scheduled special immunology clinic visits for 24 months following study entry. RESULTS: Results suggested that greater inhibited coping style significantly predicted greater nonadherence to clinic visits during 1-year (beta = .45, p = .04) and 2-year (beta = .58, p = .02) follow-up, even after controlling for the possible confounding effects of recent depressed mood on adherence. Social support satisfaction did not mediate the relationship between inhibited coping style and nonadherence. CONCLUSIONS: These findings suggest that interpersonal coping style assessment may be a useful tool in predicting adherence in HIV+ women with HPV. Future research should assess the effect of psychosocial interventions on coping style, adherence, and cervical dysplasia in HIV+ women with HPV.

Life stress and cervical squamous intraepithelial lesions in women with human papillomavirus and human immunodeficiency virus.

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.

Stress as a predictor of symptomatic genital herpes virus recurrence in women with human immunodeficiency virus.

OBJECTIVE: Genital herpes (Herpes Simplex Virus Type 2, HSV-2) is a significant public health problem for HIV+ women, who have high rates of HSV-2 seropositivity and elevated risk for HSV-2 associated morbidity and mortality. Life stress has been identified as a co-factor in genital herpes recurrence. However, no research has evaluated the relationship between stress and genital herpes recurrences in HIV+ women. The purpose of this study was to determine whether stress was associated with symptomatic genital herpes recurrences in women seropositive for HIV and HSV-2. METHODS: Thirty-four HIV-infected African-American and Caribbean-American women underwent a psychosocial interview, blood draw and gynecologic examination to assess gynecologic symptoms (including genital herpes) at study entry. Life stress was measured using a 10-item modified version of the Life Experiences Survey (LES). Genital herpes recurrence over 1-year follow-up was abstracted using medical chart review. RESULTS: Using hierarchical linear regression analysis, life stress at study entry was significantly associated with number of genital herpes recurrences during 1-year follow-up (beta=.38, P=.03) after controlling for HIV disease variables and relevant behavioral factors. Recent life stress, in particular, was highly predictive of genital herpes recurrence during follow-up (beta=.57, P=.002). The relationship between life stress and genital herpes recurrence persisted after controlling for HSV-2 viral reactivation (i.e., HSV-2 IgG titers) at study entry. CONCLUSION: These findings suggest that stress may be a significant predictor of genital herpes recurrence in women with HIV and HSV-2. Stress management interventions may buffer HSV-related morbidity and mortality in women with HIV.