The Impact of Stress on Immune Health

RICHARD S. FERRI PHD, ANP, ACRN, FAAN

Prior to September 11, people living with HIV/AIDS already experienced higher levels of stress and anxiety than the general population did. However, feelings of worry, anxiety, nervousness, inability to sleep, eat, and generally take pleasure from life have dramatically increased in American society since the terrorist attacks, and this has impacted people living with HIV/AIDS.

Stress is a physical, chemical, or emotional factor that causes bodily or mental tension and may be a factor in disease progression. Physical and chemical factors that can cause stress include trauma, infections, toxins, illnesses, and injuries of any sort. Emotional causes of stress and tension are numerous and varied. While many people associate the term stress with psychological stress, scientists use this term to denote any force that impairs the stability and balance of bodily functions.
People living with HIV disease have additional stressors such as social stress related to being a member of a highly stigmatized group. Also, stress in HIV disease is related to the stage of disease, concerns about treatment adherence, the presence of any illness or symptoms, and chronic worry about disease progression.
Some anti-HIV medications, such as the non-nucleoside reverse transcriptase inhibitor, efavirenz (Sustiva"), may also cause depression. Although very rare, serious psychiatric symptoms from this medication including severe depression, suicide attempts, aggressive behavior, delusions, paranoia, and psychosis-like symptoms may develop. Generally, these problems tend to occur more often in patients with a history of mental illness

In addition, many people living with HIV disease have other diagnoses that increase stress such as hepatitis C, rectal or uterine cancer, and pre-existing psychosocial issues.

The impact of stress and anxiety is both psychological and physiological. The latter can result in a chronic stress state that can elevate body levels of the stress hormone cortisol, which is also known to suppress the immune response. Elevated cortisol levels have also been identified with a more rapid trajectory to progression to AIDS. In essence, high levels of stress are known to negatively affect the functioning of the immune system.

Treatment strategies include relaxation techniques, stress management plans, social support networks, and counseling in addition to use of stress-reducing medications. Some additional interventions include behavior therapy to modify and gain control over unwanted behavior. Individuals learn to cope with difficult situations, often through controlled exposure to them. A sense of control over life is the main goal.

Cognitive therapy is used to change unproductive or harmful thought patterns. Separation of realistic from unrealistic thoughts is taught to the individual. As with behavior therapy, the individual is actively involved and has sense of control over their life.

Most anxiety disorders have at least some biological component and often respond to medication. Medication, particularly antidepressants, can be very useful in treating anxiety disorders and is often used in combination with talk therapy. Antidepressants and anxiolytics (anti anxiety medications) are often used to ease symptoms so that other therapy can move forward. Medication may be a short-term intervention, or it may be required for a lengthy period of time, depending on the patient.

Treatment is often complicated by the fact that people may have more than one anxiety disorder, or suffer from depression or substance abuse. Treatment must be tailored to the individual.

Dr. Ferri received his Masters of Science in PrimaryHealth Care Nursing, Adult Nurse Practitioner, from Simmons College and Ph.D. in Adult Education and Development from Columbia Pacific University, and a master of science in adult educationand human resource development from Fordham University in New York. He is certified as an AIDS Certified Registered Nurse (ACRN) and has served the elected positions of president and national director for the Association of Nurses in AIDS Care (ANAC) the HIV/AIDS Nursing Certification Board (HANCB) from 19992000. He currently practices in an independent consulting firm in the areas of HIV/STD clinical management and lends his expertise to continuing medical and nursing education program development, editing, writing, and scripting for multi disciplinary audiences, workshops/seminars in HIV/STD management, mens health issues, gay and lesbian issues (domestic violence, breast cancer, prostate disease), and adolescent health care.

Dr. Ferri has co-authored eight textbooks and written more than 40 articles in such journals as RN, Nursing Spectrum, The American Journal of Nursing, The Journal of the Association of Nurses in AIDS Care, and Advance for Nurse Practitioners. He is on the editorial board/review panel of several professional journals, he has presented at more than 35 national symposia and workshops. Dr. Ferri is a Distinguished Lecturer in HIV/AIDS Nursing for the ANAC. He is a clinical expert in HIV nursing for the International Council of Nurses, and is a Fellow of the American Academy of Nursing. In November of 2000, he was awarded the ANAC Lifetime achievement award for this contributions to AIDS care.