Objective
Most previous longitudinal studies demonstrating relationships between psychosocial variables and human immunodeficiency virus (HIV) disease progression utilized samples of gay men accrued before the era of highly active antiretroviral treatment (HAART), without including viral load (VL) as an indicator of disease progression or assessing the impact of medication adherence. This study sought to determine whether psychosocial variables would predict both CD4 and VL changes in a diverse sample assessed entirely during the era of HAART and accounting for adherence effects.

/pdf/psychosocial-factors-predict-cd4-and-viral-load-change-in-2ti06rlngs.pdf

Psychosocial factors predict CD4 and viral load change in men and women with human immunodeficiency virus in the era of highly active antiretroviral treatment.

Background. The primary aim of this study is to examine prospectively the association of stressful life events, social support, depressive symptoms, anger, serum cortisol and lymphocyte subsets with changes in multiple measures of human immunodeficiency virus (HIV) disease progression.Methods. Ninety-six HIV-infected gay men without symptoms or anti-retroviral medication use at baseline were studied every 6 months for up to 9 years. Disease progression was defined in three ways using the Centers for Disease Control (CDC) classifications (e.g. AIDS, clinical AIDS condition and mortality). Cox regression models with time-dependent covariates were used, adjusting for control variables (e.g. race, age, baseline, CD4 T cells and viral load, number of anti-retroviral medications).Results. Higher cumulative average stressful life events and lower cumulative average social support predicted faster progression to both the CDC AIDS classification and a clinical AIDS condition. Higher anger scores and CD8 T cells were associated with faster progression to AIDS, and depressive symptoms were associated with faster development of an AIDS clinical condition. Higher levels of serum cortisol predicted all three measures of disease progression.Conclusions. These results suggest that stressful life events, dysphoric mood and limited social support are associated with more rapid clinical progression in HIV infection, with serum cortisol also exerting an independent effect on disease progression.

Progression to AIDS, a clinical AIDS condition and mortality: psychosocial and physiological predictors.

Medical students in their 1st year (N=71) were assessed prior to starting training and at year's end. Coping styles reported at baseline were strongly related to coping styles at the end of the year. Students' physical health and psychological well-being declined over the course of the year. The greater the students' use of both problem-focused coping and approach emotion-focused coping, the less their physical health deteriorated. Psychological well-being at year's end was more strongly related to baseline functioning, and coping style did not predict change. This study demonstrated the utility of measuring coping style and the predictive ability of coping on physical health in a healthy sample.

Coping style as a predictor of health and well-being across the first year of medical school.

The mammalian response to stress involves the release of soluble products from the sympathetic nervous system and the hypothalamic-pituitary-adrenal axis. Cells of the immune system respond to many of the hormones, neurotransmitters, and neuropeptides through specific receptors. The function of the immune system is critical in the mammalian response to infectious disease. A growing body of evidence identifies stress as a cofactor in infectious disease susceptibility and outcomes. It has been suggested that effects of stress on the immune system may mediate the relationship between stress and infectious disease. This article reviews recent psychoneuroimmunology literature exploring the effects of stress on the pathogenesis of, and immune response to, infectious disease in mammals.

Psychoneuroimmunology: stress effects on pathogenesis and immunity during infection.

As the life expectancy of people living with HIV infection has increased (through recent advances in antiretroviral therapy), clinicians have been more likely to encounter neuropsychiatric manifestations of the disease. Some patients present with cognitive deficits due to an HIV-triggered neurotoxic cascade in the central nervous system. However, more patients present with a depressive spectrum disorder during the course of their illness, the underlying pathogenesis of which is not as well understood. This category of psychiatric disorders presents diagnostic challenges because of the many neurovegetative confounding factors that are present in association with HIV illness. As quality of life becomes a more central consideration in the management of this chronic illness, better awareness of these neuropsychiatric manifestations is paramount. This article reviews these clinical issues and the available psychopharmacologic treatment options.

/pdf/neuropsychiatric-manifestations-of-hiv-infection-and-aids-1hh9hzxqgx.pdf

Neuropsychiatric manifestations of HIV infection and AIDS

Psychosocial factors and clinical evolution in HIV-1 infection: A longitudinal study

In-hospital cost-effectiveness analysis of open versus staged fenestrated/branched endovascular elective repair of thoracoabdominal aneurysms.

OBJECTIVE
To provide an updated systematic review and meta-analysis with meta-regression of safety and efficacy of fenestrated/branched endovascular repair of thoracoabdominal aortic aneurysms (TAAAs) compared with open repair.


SUMMARY BACKGROUND DATA
Endovascular repair of TAAAs may be a promising alternative to open surgery by reducing invasiveness and expanding the eligible population, but evidence remains limited.


METHODS
We applied PRISMA to retrieve, quantitatively pool, and critically evaluate the efficacy and safety (including 30-day mortality, reintervention, spinal cord injury, SCI, and renal injury) of both approaches. Original studies were retrieved from PubMed, Embase and Cochrane Library until 20 April 2022, excluding papers reporting less than 10 patients. Pooled proportions and means were determined using a random-effects model. Heterogeneity between studies was evaluated with I2 statistics.


RESULTS
Sixty-four studies met the pre-defined inclusion criteria. Endovascular cohort patients were older and had higher rates of comorbidities. Endovascular repair was associated with similar proportions of mortality (0.07, 95% confidence interval, CI, 0.06-0.08) compared with open repair (0.09, 95%CI 0.08-0.12; P-value=0.22), higher proportions of reintervention (0.19, 95%CI 0.13-0.26, vs. 0.06, 95%CI 0.04-0.10; P-value<0.01), similar proportions of transient SCI (0.07, 95%CI 0.05-0.09, vs. 0.06, 95%CI 0.05-0.08; P-value=0.28), lower proportions of permanent SCI (0.04, 95%CI 0.03-0.05, vs. 0.06, 95%CI 0.05-0.07; P-value<0.01) and renal injury (0.08, 95%CI 0.06-0.10, vs. 0.13, 95%CI 0.09-0.17; P-value=0.02). Results were affected by high heterogeneity and potential publication bias.


CONCLUSIONS
Despite these limitations and the lack of randomised trials, this meta-analysis suggests that endovascular TAAA repair could be a safer alternative to the open approach.

Efficacy and Safety of Endovascular Fenestrated and Branched Grafts vs open Surgery in Thoracoabdominal Aortic Aneurysm Repair: An Updated Systematic Review, Meta-analysis and Meta-regression.

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Psychosocial factors and clinical evolution in HIV-1 infection: A longitudinal study

In-hospital cost-effectiveness analysis of open versus staged fenestrated/branched endovascular elective repair of thoracoabdominal aneurysms.

Efficacy and Safety of Endovascular Fenestrated and Branched Grafts vs open Surgery in Thoracoabdominal Aortic Aneurysm Repair: An Updated Systematic Review, Meta-analysis and Meta-regression.