Cognitive Behavioral Stress Management (CBSM) can change stressor appraisals and build coping resources; modulate the output of sympathetic nervous system, Hypothalamic Pituitary Adrenal, and Hypothalamic Pituitary Gonadal hormones; and help normalize immunologic status in different HIV+ populations. Recent work suggests that these psychosocial and physiologic changes may influence quality of life and possibly disease course. The proposed 5-year project will directly address these issues in 200 HIV-infected women who are co-infected with Human Papillomavirus (HPV), the putative etiologic virus in cervical carcinoma. We will (a) evaluate the effects of CBSM intervention on quality of life (negative affect, positive growth, fatigue and physical functioning, sexuality) and physical health changes (biopsy-determined squamous fatigue and physical functioning, sexuality) and physical health changes (biopsy-determined squamous intraepithelial lesions [SIL] and opportunistic infections [E.G. herpesvirus outbreaks]; and (b) examine the hypothesized psycho-biological mediators (psychosocial endocrine, and immunologic changes) of intervention effects observed. We will address the psychosocial (quality of life indicators, intervention process measures), virologic (HPV type), immunologic status (natural killer cell cytotoxicity and lymphocyte phenotypes for T-helper-inducer cells [CD3+CD4+, T-suppressor-cytotoxic cells [CD3+CD8+] and natural killer cells [CD3-CD56+]) and health status (SIL incidence and severity, herpes simplex virus) in HIV+HPV+ women at study entry (T1) and then randomize women to either a 10-week CBSM intervention or a one-day CBSM seminar. We will re-assess psychosocial, immunologic and physical health variables after the intervention period (T2) and again at a 6-month (T3) and 12-month (T4) follow-up. We will examine 5 hypothesized CBSM process variables as mediators of its effects on Quality of Life including Cognitive Appraisals, Coping Self-Efficacy, Emotional Processing, Social Support and Physiologic Arousal (using 24- hour urinary catecholamines and cortisol). We will examine 3 hypothesized mediators of physical health changes during the 12-month follow-up including Health Behaviors (medication adherence, health care utilization, smoking, unprotected ex, and substance use). Immunologic Status (NKCC, CD3+CD4+, CD3+CD8+, CD3-CD56+), and Reproductive Hormones (DHEA-S, testosterone, estradiol).
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