A primary mechanism for the high incidence of oral disease in HIV-infected people is a reduction in innate and specific oral immunity, which has been shown to be associated with increased perceived stress and stress hormone levels. Salivary immunoglobulin A (IgA) and antibacterial agents, such as lysozyme and lactoferrin, which protect the oral mucosa, are significantly decreased in persons with HIV. Further, increased salivary cortisol is a common finding associated with HIV infection and is thought to reduce immunity, increase HIV viral replication, and contribute to the pathogenesis of AIDS. Based on Psychoneuroimmunology (PNI) theory, the increase in salivary cortisol and reductions in salivary IgA, lysozyme, and lactoferrin may result from the well-described increase in emotional distress that is reported by HIV-positive individuals. This model suggests that greater perceived stress increases stress hormone release and, in turn, suppresses immune function. Further, impoverished and minority populations appear to be disproportionately affected by stress-related conditions. The proposed research is based on the hypothesis that stress-related endocrine changes mediate oral immunosuppression in HIV+ individuals. Human and animal studies indicate that acupuncture (ACU) can reduce stress hormone levels and stimulate immune function. It follows that ACU may be useful therapeutically for reduction of stress, reduction of HIV-associated immunosuppression, and enhanced oral health. However, well-controlled studies examining the effects of stress-reduction ACU treatments on salivary cortisol, IgA, lysozyme, and lactoferrin in HIV+ individuals have not been tested. Our previous research indicates that ACU delivered in a group setting can provide relief for a number of HIV-related symptoms and offer a cost-effective method of administration that can be performed in a variety of community settings. The goal of the study proposed in this application is to determine the efficacy of a standardized stress-reduction ACU regimen, administered in a group setting, in reducing the oral immunosuppression that is associated with high levels of perceived stress and anxiety in an HIV-infected minority population. Further, we will examine the effect of ACU on the stress hormone-related mechanisms for these oral conditions.
The specific aims i nclude 1) testing the effects of ACU on perceived stress of HIV-infected African Americans, 2) testing the effects of ACU on the concentrations of salivary hormonal and immune factors of HIV-infected African Americans, and 3) assessing the role of hormonal and immune factors in the relationship between perceived stress and salivary hormonal and immune factors of HIV-infected African Americans.
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