Individuals infected with human immunodeficiency virus (HIV) vary greatly in their rate of progression from seroconversion to frank Acquired Immunodeficiency Syndrome. While biological determinants (e.g., characteristics of host and virus) account for much of this variability, it is likely that psychosocial factors can also influence disease progression by affecting immunoregulation and risk behaviors. In a prospective design, this study proposes to examine the hypothesis that life adversity, unsatisfactory social support, maladaptive coping, and dysphoria hasten the progression of HIV-related decline in health in 200 men with known dates of HIV infection (dated seroconverters) from the United States Navy. This group is currently being followed prospectively by repeated medical, neurological, neuropsychological, and psychiatric evaluations through the NIMH-funded San Diego HIV Neurobehavioral Research Center (HNRC). We have simplified our theoretical model, added """"""""loneliness"""""""" as a mediator in the """"""""psychosocial"""""""" domain, refined the analysis of coping (with the help of our consultant, Susan Folkman), and reconceptualized the HIV-related health outcomes with the addition of neurocognitive decline to the criterion variable set. In addition, we have re-thought our data analytic plan, placing more reliance on a modified growth curve approach (as pioneered by our new biomathematics consultant, Ian Abramson). We believe the changes made, plus the addition of strong collaborators in coping and data analysis, have resulted in major strengthening and streamlining of this proposal. We hope reviewers will agree that the opportunity to study psychosocial influences on HIV-related health in a group of dated seroconverters, as part of an already NIMH-funded Center, represents an unusual opportunity to enhance knowledge, and possibly to identify avenues of intervention, for this critical public health problem.
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