TY - JOUR
T1 - Perceived stress and norepinephrine predict the effectiveness of response to protease inhibitors in HIV
AU - Ironson, Gail
AU - Balbin, Elizabeth
AU - Stieren, Emily
AU - Detz, Kelly
AU - Fletcher, Mary Ann
AU - Schneiderman, Neil
AU - Kumar, Mahendra
N1 - Funding Information:
This research was funded by NIH (R01MH53791 and R01MH066697). Principal investigator: Gail Ironson and T32MH18917. Thanks go to Nathaniel Ezra Kieval for technical help with preparing the manuscript.
PY - 2008/7
Y1 - 2008/7
N2 - Background: In vitro evidence has suggested that increasing levels of norepinephrine (NE) can accelerate HIV replication; however, the importance in a clinical setting has not been tested. Purpose: The purpose of this study was to determine if perceived stress as well as the stress hormones NE and cortisol would predict the response to starting a new protease inhibitor (PI) prospectively. Method: Perceived stress, urinary cortisol and norepinephrine, CD4 and viral load (VL) were measured in people with HIV before starting a new PI and six months later (an average of three months after starting the new PI) in order to determine CD4 and VL response to the PI. Results: Higher perceived stress significantly predicted lower effectiveness of the new PI in increasing CD4 and decreasing VL controlling for age, duration of new PI, baseline CD4/VL, sexually transmitted diseases (STDs), and gender/ethnic risk groups. Higher norepinephrine, but not cortisol, predicted worse VL response to PIs and, in fact, mediated the relationship between perceived stress and change in VL. Conclusion: Perceived stress and high norepinephrine levels are prospectively associated with a poorer response to starting a new PI. Assessing stress and norepinephrine levels in patients starting on antiretroviral medications might be clinically useful.
AB - Background: In vitro evidence has suggested that increasing levels of norepinephrine (NE) can accelerate HIV replication; however, the importance in a clinical setting has not been tested. Purpose: The purpose of this study was to determine if perceived stress as well as the stress hormones NE and cortisol would predict the response to starting a new protease inhibitor (PI) prospectively. Method: Perceived stress, urinary cortisol and norepinephrine, CD4 and viral load (VL) were measured in people with HIV before starting a new PI and six months later (an average of three months after starting the new PI) in order to determine CD4 and VL response to the PI. Results: Higher perceived stress significantly predicted lower effectiveness of the new PI in increasing CD4 and decreasing VL controlling for age, duration of new PI, baseline CD4/VL, sexually transmitted diseases (STDs), and gender/ethnic risk groups. Higher norepinephrine, but not cortisol, predicted worse VL response to PIs and, in fact, mediated the relationship between perceived stress and change in VL. Conclusion: Perceived stress and high norepinephrine levels are prospectively associated with a poorer response to starting a new PI. Assessing stress and norepinephrine levels in patients starting on antiretroviral medications might be clinically useful.
KW - Cortisol
KW - HAART
KW - HIV
KW - Norepinephrine
KW - Protease inhibitors
KW - Stress
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U2 - 10.1080/10705500802219606
DO - 10.1080/10705500802219606
M3 - Article
C2 - 18696316
AN - SCOPUS:49449085615
VL - 15
SP - 221
EP - 226
JO - International Journal of Behavioral Medicine
JF - International Journal of Behavioral Medicine
SN - 1070-5503
IS - 3
ER -