Is stress associated with CIN progression in HIV-positive women?
Polly Clayden, HIV i-Base
A paper published in May/June’s Psychosomatic Medicine reports findings from a study designed to determine whether “life stress” can be implicated in the progression of cervical intraepithelial neoplasia (CIN).
HIV-positive women are at greater risk from human papillomavirus (HPV) and CIN and they also experience high rates of CIN recurrence and treatment complications. African-American HIV-positive women of low economic status are disproportionately affected by HIV and HPV infections and have high rates of cervical cancer mortality rates. They may be at particularly high risk for CIN progression, recurrence and treatment complications.
Life stress and other psychosocial factors have been implicated in immune decrements in and faster progression to AIDS in both men and women with HIV, and more advanced CIN in HIV-negative women. The purpose of this prospective study was to assess whether life stress was associated with the progression and/or persistence of squamous intraepithelial lesions (SIL), the diagnosis conferred by Papanicolau (PAP) smear in 32 African- and Caribbean- American women coinfected with HIV and HPV after one year follow up.
Inclusion criteria included one abnormal PAP smear in the two years prior to enrolment and CD4 count ≥ 150 cells/mm and exclusion included past or current clinical AIDS (category C), a history of high grade SIL or cervical cancer, hysterectomy or treatment for SIL in the year before enrolment.
The women underwent a psychosocial assessment interview, blood draw, coloscopy and HPV cervical swab at study entry. A 10 item abbreviated version of the life experience survey (LES) was used to measure stressful life events.
Using medical chart review, the investigators then abstracted SIL diagnoses at study entry and after a year of follow up. Hierarchical regression analysis revealed that higher life stress increased the odds of developing progressive/persistent SIL over one year by approximately seven-fold after controlling for biological and behavioural covariants (p=0.001).
The authors conclude that 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”.
Pereira DB, Michael AH, Danielson A et al. Life stress and cervical squamous intraepithelial lesions in women with human papillomavirus and human immunodeficiency virus. Psychosomatic Medicine 65:427-434 (2003)