Article Summaries for October 2022 Psychosomatic Medicine, Volume 84, Issue 8

This special issue of Psychosomatic Medicine addresses the intersection of HIV with mental health in the modern era of antiretroviral therapy (ART). People with HIV (PWH) receiving effective ART often continue to display residual immune system dysregulations that may amplify the risk for neurological and psychiatric comorbidities thereby adversely affecting their mental health. In addition, PWH commonly experience stigma and other psychosocial stressors that are linked to neuroendocrine stress responses, potentiate residual immune system dysregulation, and alter other biobehavioral processes relevant to health outcomes. In an introductory article, Guest Editors Adam Carrico, Leah Rubin, and Robert Paul provide an outline of the themes covered in this special issue “Biobehavioral and Neurobehavioral Processes in the HIV–Mental Health Interaction.”

Pages 859–862; https://doi.org/10.1097/PSY.0000000000001134

The neural dynamics underlying cardiac interoceptive awareness and its relationship to depressive symptom severity were investigated by Roger McIntosh et al. in a diverse sample of postmenopausal women with and without HIV. Hypoactivity of the anterior insula has previously been reported in individuals with major depression. In contrast, the results in this study indicated higher activation in this region when participants were tasked with attending to their heartbeat while ignoring a distracting tone. These findings support an active-interference model for risk of depression.

Pages 863–873; https://doi.org/10.1097/PSY.0000000000001136

Early life trauma (ELT) and HIV infection are associated with social processing deficits. Rubin et al. examined secondary data to find that social processing difficulties and higher oxytocin (OT) levels were more common in people living with HIV (PWH) who were exposed to ELT compared to ELT-unexposed PWH. An OT/C-reactive protein (CRP) factor moderated ELT-performance associations, indicating a potential role of inflammation-related processes. A myeloid migration (MM) factor was associated with reduced social processing accuracy regardless of ELT. Interventions that target OT/CRP and MM factors may alter social processing for PWH including ELT-exposed individuals.

Pages 874–884; https://doi.org/10.1097/PSY.0000000000001124

People with HIV (PWH) disproportionately experience depression, which increases their risk for poor viral control, cognitive impairment, and death, and affects the rate at which they seek medical care. Little is known about the biological contributions to the development of depressive symptoms in PWH. Shortell et al. demonstrated an association between the peptide hormone oxytocin and total depressive symptoms in a sample consisting predominately of Black PWH.

Pages 885–892; http://doi.org/10.1097/PSY.0000000000001122

Alterations in glucocorticoid receptor (GCR) function may be a risk factor for cognitive dysfunction among older people with HIV. Rubin et al. compared the associations among GCR functional metrics and cognitive performance in women with HIV younger than 40 years of age or older than 50 to the results from HIV-uninfected women. The results suggest that HIV-serostatus and age may modify the influence of the GCR, potentially through epigenetic modification of target genes.

Pages 893–903; https://doi.org/10.1097/PSY.0000000000001126

People living with HIV (PWH) often experience high levels of psychological distress and disease burden, but little is known about how “stress” affects brain and neurobehavioral outcomes in PWH. Elissa Charney McIntosh et al. examined how cumulative lifetime chronic stressor exposure is related to cognition and brain integrity. As hypothesized, greater lifetime chronic stressor exposure was related to worse global cognitive function, processing speed, and executive functioning, and smaller prefrontal cortex (PFC) volume. HIV status did not moderate any of these associations. Results showed that the association between lifetime chronic stressor exposure with processing speed was accounted for by PFC volume.

Pages 904–913; https://doi.org/10.1097/PSY.0000000000001125

Research on the impact of psychological interventions on biological indicators of HIV disease is limited. Nakimuli-Mpungu et al. documented effects of group support psychotherapy (GSP) compared to group HIV education (GHE) on depression, antiretroviral therapy (ART) adherence, and viral load suppression. GSP resulted in a reduction in depression and improvements in ART adherence as well as improved viral suppression. Adding depression treatment with GSP to routine HIV care may be beneficial to achieve optimal HIV treatment outcomes in settings where the HIV epidemic persists.

Pages 914–923; https://doi.org/10.1097/PSY.0000000000001128

The association between HIV/AIDS and suicidality is not well understood. Tsai et al. investigated the predictive value of HIV/AIDS for incident suicidality by conducting a systematic review of articles published between 2010 and 2021. Pooled rates of suicidal ideation, attempted suicide, and deaths by suicide in 43 studies were 22.3%, 9.6%, and 1.7%, respectively. Significant risk factors for suicidal ideation were substance use disorder, depression, low quality of life, low social support, undisclosed HIV status, living alone, absence of memory problems, family history of suicide, and stage III of HIV. These factors could be used in risk stratification and tailored interventions.

Pages 924–939; https://doi.org/10.1097/PSY.0000000000001127

Wändell et al. studied the frequency of health care visits, types of clinics visited, registered diagnoses, and psychopharmacotherapy in individuals before and after a new diagnosis of HIV compared with sex-, age-, and socioeconomic status-matched HIV-negative controls. Before newly diagnosed HIV, people living with HIV (PWH) had the same level of psychiatric diagnoses as their controls, except for higher substance use disorder. Psychiatric problems were more common in PWH whose HIV was newly diagnosed than in the controls, especially in men.

Pages 940–948; https://doi.org/10.1097/PSY.0000000000001121

Ghanooni et al. examined the direct associations of sexual minority stress processes with DNA methylation-derived markers of cellular aging and soluble markers of inflammation in sexual minority men (i.e., gay, bisexual, and other men who have sex with men) living with HIV who use methamphetamine. Greater sexual minority stress was directly associated with a faster epigenetic clock, shorter telomere length, and fewer naive CD4+ and CD8+ T-cells.

Pages 949–956; https://doi.org/10.1097/PSY.0000000000001123

The links between pain, mood, and inflammation was investigated by Derry-Vick et al. among older adults with HIV. Participants with greater depressive symptoms and those with higher cytokine levels had worse pain. Poorer physical function was observed among those with worse pain. Exploratory mediation analyses suggested that links between depressive symptoms and lower physical function were partially due to pain, warranting longitudinal investigations. The findings underscore the importance of multidisciplinary approaches to pain management in HIV care.

Pages 957–965; https://doi.org/10.1097/PSY.0000000000001119

Simian immunodeficiency virus (SIV) infection of macaques is a model that recapitulates many aspects of HIV pathogenesis, including the effects of external factors such as environmental stressors. In a retrospective study, Castell et al. investigated the impact of single housing vs. social housing as a model of psychosocial stress during acute infection. Singly housed monkeys showed decreases in circulating monocyte subsets and platelet activation, which are consistent with innate immune suppression during viral infection and may lead to worse clinical outcomes.

Pages 966–975; https://doi.org/10.1097/PSY.0000000000001132

Paul et al. examined individual differences in CD4/CD8 T-cell ratio trajectories and associated risk profiles from acute HIV infection (AHI) through 144 weeks of antiretroviral therapy (ART) using a data-driven approach. Early HIV disease dynamics predicted unfavorable CD4/CD8 T-cell ratio outcomes after ART. CD4+ and CD8+ T-cell trajectories contributed to inversion risk and corresponded to specific viral, immune, and psychological profiles during AHI. These findings highlight the importance of investigating adjunctive strategies to achieve immune normalization.

Pages 976–983; https://doi.org/10.1097/PSY.0000000000001129

In a comprehensive review integrating findings from 163 articles, Carrico et al. propose a microbiome-gut-brain axis model to promote high-impact psychoneuroimmunology (PNI) research relevant to people with HIV (PWH) in the antiretroviral therapy (ART) era. To optimize health outcomes, PNI studies that examine the relevance of gut microbiota, tryptophan catabolism, residual immune dysregulation, and herpesvirus co-infections (e.g., cytomegalovirus) as key biological drivers of psychiatric and neurological comorbidities in PWH (i.e., body to mind) are important. Evidence also supports the adverse consequences of psychological factors on biological processes relevant to disease progression in PWH (i.e., mind to body). These bi-directional pathways are essential to guide the development of biobehavioral treatments for depression and other psychiatric and neurological comorbidities relevant to mental health in PWH.

Pages 984–994; https://doi.org/10.1097/PSY.0000000000001133

This Special Issue of Psychosomatic Medicine was initiated under the editorship of Willem J. Kop, who is now Editor-in-Chief Emeritus of Psychosomatic Medicine. He collaborated with the Guest Editors in managing the review and editing of the papers in this issue. He also edited the article summaries.

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