Psychoneuroimmunology

and
Immune-Related Disorders
OUTLINE
• Psychoneuroimmunology (textbook)
• HIV Infection and AIDS
• Cancer
• Arthritis (textbook)
• Type I Diabetes (textbook)
 HIV INFECTION AND AIDS

• Begun in central Africa, perhaps in the early 1970s.

• It spread rapidly throughout Zaire, Uganda, and other central African
nations.
• A high rate of extramarital sex, a lack of condom use, use of the same
needles, and a high rate of gonorrhea facilitated the spread of the
AIDS virus in the heterosexual population.
• Currently AIDS is the sixth leading cause of death worldwide (World
Health Organization, May 2014).
Global HIV statistics
• There were an estimated 38.4 million [33.9–43.8 million] people living with HIV
at the end of 2021, two thirds of whom (25.6 million) are in the WHO African
Region.
• 1.5 million [1.1 million–2.0 million] people became newly infected with HIV in
2021.
• 650 000 [510 000–860 000] people died from AIDS-related illnesses in 2021.
• 28.7 million people were accessing antiretroviral therapy in 2021.
• 84.2 million [64.0 million–113.0 million] people have become infected with HIV
since the start of the epidemic.
• 40.1 million [33.6 million–48.6million] people have died from AIDS-related
illnesses since the start of the epidemic.

https://www.unaids.org/en/resources/fact-sheet
https://www.who.int/news-room/fact-sheets/detail/hiv-aids
 How We Get AIDS: Cases by Mode of
Transmission (World, 2008; U.S., 2010)
Adults and children estimated to be living with HIV, 2014
(Source: World Health Organization, 2016)
How is HIV transmitted?

• Among drug users, needle sharing leads to the exchange of bodily fluids,
thereby spreading the virus.

• Among men who have sex with men, exchange of the virus has been tied
to sexual practices, especially anal-receptive sex involving the exchange of
semen without a condom.

• In the heterosexual population, vaginal intercourse is associated with the

transmission of AIDS, with women more at risk than men.

• The likelihood of developing AIDS increases with the number of sexual

partners, and with the number of anonymous sexual partners.
How HIV Infection Progresses?
• Following transmission, HIV grows very rapidly within the first few weeks
of infection and spreads throughout the body.
• Early symptoms are mild, with swollen glands and mild, flu like
symptoms predominating.
• After 3–6 weeks, the infection may decrease, leading to a long
asymptomatic period, during which viral growth is slow and gradual.

• Some of the more common opportunistic infections that result from the
impaired immune system include pneumonia and unusual cancers, such
as Kaposi’s sarcoma or non-Hodgkin’s lymphoma.
• HIV also begin to show abnormalities in their neuroendocrine and
cardiovascular responses to stress.
• Chronic diarrhea, skeletal pain, and blindness are later complications.
• Early symptoms of central nervous system impairment are similar to those of depression and include:
forgetfulness,
inability to concentrate,
psychomotor retardation,
decreased alertness,
apathy,
withdrawal,
diminished interest in work,
loss of sexual desire.

• In more advanced stages, patients may experience:

confusion,
disorientation,
seizures,
profound dementia,
coma.
A- The Psychosocial Impact of HIV Infection
• Depression especially for people with little social support, who feel stigmatized by their
sexual preference or race.
- Depression can reduce receptivity to interventions, as well as lowering quality of life.
- Depression may also prompt self-medication through alcohol, and drug use, which in
turn can increase the likelihood of risky sexual behavior.

• Over the long term, most people cope with HIV infection make positive changes in their
health behaviors almost immediately after diagnosis:
changing diet in a healthier direction,
getting more exercise,
quitting or reducing smoking,
reducing or eliminating drug use.

• They also use various CAM.

1- Disclosure
• Not disclosing HIV status or simply lying about risk factors, such as the
number of partners one has had, is a major barrier to controlling the
spread of HIV infection.
• Those less likely to disclose their HIV+ status to sex partners also are
less likely to use condoms during intercourse.
• People with strong social support networks are more likely to disclose
and are, in turn, more likely to receive social support.
2- Women and HIV
• In general, many women with HIV infection:
- have no partners,
- may not hold jobs,
- depend on social services and Medical aid to survive,
- have problems with drugs,
- have experienced trauma from sexual or physical abuse,
- may suffer from discrimination due to race or ethnicity.

• Low-income women who are HIV+ especially experience stress related to

family issues and depression. Suicide attempts are not uncommon.
• Many women are able to find meaning in their lives, often prompted by the
shock of testing positive.
B- Interventions to Reduce the Spread of HIV Infection
• Interventions to reduce risk-related behavior, targeting specifically at-
risk groups (adolescents, homosexuals, low-income women,
minorities):
- getting tested,
- refraining from high-risk sex,
- using a condom,
- not sharing needles.
1- Education
• Most interventions begin by educating the target population about:
- risky activity,
- information about HIV infection and modes of transmission,
- transmission of HIV to infants (only about 15–30 percent of infants
born to HIV+ mothers will be seropositive, and treatment can reduce
that incidence to 4–8 percent).
How successful are educational
interventions?
• Education was an effective means of
secondary prevention for HIV+
individuals, reducing behaviors that
might infect others.
• However, it was not an effective
primary prevention strategy for
uninfected people (Weinhardt, Carey,
Johnson, & Bickman, 1999; Albarracín
et al., 2003).
2- Targeting Sexual Activity
• People who have had a large number of partners (especially anonymous
partners), who have not used condoms in the past, and who meet their partners
in bars or through the Internet may continue to expose themselves to risk,
perhaps because those behaviors are well integrated into their sexual style.

• Sexual encounters, particularly with a new partner, are often rushed, nonverbal,
and passionate, conditions not very conducive to a rational discussion of safe-sex
practices.

• Sexual compulsivity is an issue among sexually active gay men.

• Young women engage in unsafe sex is the coercive sexual behavior of their young
male partners.
• In a major review of behavioral interventions conducted with adolescents,
gay and bisexual men, inner-city women, college students, and mentally ill
adults—all groups at significant risk for AIDS— interventions oriented toward
reducing their sexual activity and enhancing their abilities to negotiate
condom use with partners reduced risk-related behavior (Kalichman, Carey,
& Johnson, 1996; Widman, Noar, Choukas-Bradley, & Francis, 2014).

• Even brief but intensive interventions addressing:

risk factors,
motivation,
self-efficacy,
social support,
sexual negotiation skills,
may have beneficial effects.
3- HIV Prevention Programs
• Prevention programs have been developed for U.S. public schools to
warn adolescents about the risks of unprotected sexual intercourse
and to help instill safe-sex practices.

• Intervention that supports norms favoring more long-term

relationships or decreasing the number of short-term sexual
relationships an individual has is a reasonable approach to prevention
+ condom negotiation skills.
4- Cognitive-Behavioral Interventions
• Stress management interventions improve quality of life and mental
health.
• CBT oriented to health behaviors  smoking, excessive alcohol use, and
drug use commonly compromise health and adherence among people who
are HIV seropositive.

5- Targeting Adherence
Homeless people, IV drug users, and alcoholics show poor adherence rates.
Those who adhere to ART, are more likely to have social support, low levels
of depression, and a sense of self-efficacy.
• Adherence to ART is affected by motivational training.

• Having the right information, the motivation to adhere, and skills to do

so significantly improves adherence to treatment.

• Interventions that enhance social support and text messaging have also
shown some success in improving adherence.
6- Targeting IV Drug Use
• Targeted toward both reducing contact with infected needles and
changing sexual activity.
• Information about AIDS transmission, needle exchange programs, and
instruction on how to sterilize needles can reduce risky injection
practices among IV drug users.
C- Coping with HIV+ Status and AIDS
• They are more likely to have a history of traumas and co-existing
mental health problems, such as anxiety disorders, depression, and
substance abuse disorders  lack of coping skills.

• Issue or challenge of employment  interventions may be needed to

help those who can return to work do so.

• People with HIV must continually cope with the fear, prejudice, and
stigma that they encounter from the general community, which can
increase psychological distress.
Coping Skills
• Coping effectiveness training is helpful in managing the psychological
distress that can be associated with HIV+ status.
• Positive affect promotes good HIV care and adherence to ART  making
positive affect an important target for coping interventions.
• Written disclosure is a successful coping intervention.

Social support
Gay men infected with HIV who have emotional, practical, and informational
support are less depressed, and men with strong partner support are less
likely to practice risky sex.
 Intervention programs that include male partners and those that focus on
building and maintaining relationship skills.
D- Psychosocial Factors That Affect the Course of HIV Infection
• Depression is an important target for intervention, not only to improve
quality of life but also because depression predicts non-adherence.

• Negative beliefs about the self and the future and negative
expectations about the course of illness can lead to an accelerated
course of disease.

• Depression, stress, and trauma all adversely affect disease progression.

• Psychological inhibition may promote a more rapid course of illness.

• Optimism, active coping, extraversion,
conscientiousness, and spirituality all
predict slower disease progression.

• Positive affect lowers the risk of AIDS

mortality.
 CANCER

• Cancer is second causes of death in

the United States and most
developed countries (Centers for
Disease Control and Prevention, April
2016).
Leading Sites of New Cancer Cases and Deaths, 2012 Estimates
(Source: American Cancer Society, 2012a)
A- Who Gets Cancer? A Complex Profile
Genetic factors.
Lifestyle (e.g. eating pattern). Common among people who are chronically
malnourished and among those who consume high levels of fats, certain food
additives (such as nitrates), and alcohol.
Infectious agents are implicated in some cancers (e.g. the human
papillomavirus (HPV) is the main cause of cervical cancer).
Ethnicity - Latino men and women have the lowest lung cancer rates, but
Latina women show one of the highest rates of invasive cancers of the cervix.
Breast cancer is extremely common among northern European women and is
relatively rare among Asians.
SES.
Marital status - Married people, especially married men, develop fewer
cancers than single people. Exception prostate or cervical cancer, to which
married people are somewhat more vulnerable than single people.
• Research is beginning to focus on
interactions among risk factors that
may contribute to particular cancers.
For example, women who are
sedentary and significantly overweight
have a higher risk of pancreatic cancer
if their diets are also high in starchy
foods such as potatoes and rice
(Michaud et al., 2002).
B- Psychosocial Factors and Cancer

Stress and Cancer

Does stress cause cancer?

• Although stress generally has not been linked to the onset of cancer, a
particular type of stress—lack or loss of social support— may affect the onset
and course of cancer.
• The absence of close family ties in childhood and early childhood adversity
predicts some cancers.
• The absence of a current social support network has also been tied to a
worsening course of illness.
• Experiencing major social stressors such as divorce, infidelity, marital
quarreling, and financial stress increases risk for cervical cancer.
C- Psychosocial Issues and Cancer
• Intermittent and long-term depression are the most common
difficulties experienced as a result of cancer.

• Depression, pain, and fatigue often cooccur among cancer patients,

and this complex of symptoms may be caused or aggravated by stress
hormones.

• Problems appear to be greatest among people who have a history of

life stressors, a diagnosis of PTSD, or a lack of social support.