Abstract
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.
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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.
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Ironson, G., Balbin, E., Stieren, E. et al. Perceived Stress and Norepinephrine Predict the Effectiveness of Response to Protease Inhibitors in HIV. Int. J. Behav. Med. 15, 221–226 (2008). https://doi.org/10.1080/10705500802219606
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DOI: https://doi.org/10.1080/10705500802219606