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HIV: ON LIVING-THE MIND-BODY CONNECTION

Your attitude toward life might in fact be related to your health. A field of research studies the intricate connections between mental state, the brain, and the immune system. The field goes by two impossible names: one is neuroimmunomodulation, the other is psychoneuroimmunology.
Specifically, stress seems to affect the immune system’s ability to respond to infection. Several studies selected people under certain kinds of stresses: people whose spouses had died, people with severe depression, medical students at examination time, people under such extreme physical stresses as marathon running or dieting to the point of malnutrition. Their blood was analyzed for changes in immune response, that is, for changes in certain cells of the immune system: T cells, B cells, and white blood cells called natural killer cells.
Different studies measured immune response differently. In some studies, researchers counted the numbers of T and B cells in the blood. In others, researchers treated people’s T cells with a chemical that stimulates reproduction, then counted the numbers of new T cells. In still others, researchers added natural killer cells to foreign cells, then measured the number of foreign cells not killed.
Regardless of which measure of immune response was studied, most researchers found that people under stress have immune responses that are somewhat lower than the immune systems of people not under stress. In other words, people under stress have fewer of certain immune system cells, or they have cells that reproduce less successfully, or they have cells that respond ineffectively to foreign cells.
The converse is also true: not only do people under stress have lower immune responses, but people with positive attitudes seem to have better immune responses. Some studies, done specifically on people with HIV infection, found that those who describe themselves as vigorous and self-expressive, who have ways of venting their emotions, and who exercise regularly have better immune responses. The level of T cell reproduction and the response of the natural killer cells—the same measures of immune response that had been lower with stressed people—were higher.
Other researchers have suggested theories of how stress might affect immune response. In other words, all these theories suggest how a person’s mental state and the immune system might be linked. When people are under stress, their adrenal glands release hormones called
glucocorticoids (the medications cortisone and prednisone are examples of glucocorticoids). In the immune system, glucocorticoids inhibit the release of chemicals called interferon and interleukin-2, which immune cells use to fight off fungi, bacteria, and viruses. In the bloodstream, glucocorticoids also decrease, temporarily at least, the number of certain T cells called T4 or CD4 cells, the same cells that HIV preferentially infects. And in experiments in the laboratory, another hormone the adrenal gland releases under stress, called adrenaline or epinephrine, seems to suppress reproduction of CD4 cells. In any case, because HIV specifically infects CD4 cells, anything that suppresses CD4 cells might make matters worse for someone trying to combat HIV infection.
It is hard to draw conclusions from any of these studies. The experiments with CD4 cells were done on animals or in laboratory dishes and not on living humans. The studies on humans measured different aspects of the immune system’s response, they did not exclude people who were not eating and sleeping, they measured stress differently, and the stresses themselves were different and of different magnitudes.
Most importantly, many of the changes measured were small, and no one knows whether small changes in immune response are clinically important—that is, whether they actually increase the chances of getting sick. In general, take the research with a grain of salt: this field is only a few years old; it connects psychology, the brain, and the immune system; and all three systems are extraordinarily complex and not yet understood.
In spite of the studies’ inconclusiveness, however, the sense in this new field is that people who are more emotionally stable may be less vulnerable to disease. When sick, they seem to do better, become less severely sick, stay alive longer.
The fact is, to people facing HIV infection, whether the research turns out to be right or wrong is irrelevant. If a positive mental state does affect the immune system, so much the better. If it does not, nothing is lost. A positive outlook makes your life more pleasant. The only trap is the possibility that people who do get sicker might blame themselves for not having worked hard enough. In view of the studies’ inconclusiveness, blaming yourself is both unrealistic and unnecessary.
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HIV: ON LIVING-THE MIND-BODY CONNECTIONYour attitude toward life might in fact be related to your health. A field of research studies the intricate connections between mental state, the brain, and the immune system. The field goes by two impossible names: one is neuroimmunomodulation, the other is psychoneuroimmunology.     Specifically, stress seems to affect the immune system’s ability to respond to infection. Several studies selected people under certain kinds of stresses: people whose spouses had died, people with severe depression, medical students at examination time, people under such extreme physical stresses as marathon running or dieting to the point of malnutrition. Their blood was analyzed for changes in immune response, that is, for changes in certain cells of the immune system: T cells, B cells, and white blood cells called natural killer cells.     Different studies measured immune response differently. In some studies, researchers counted the numbers of T and B cells in the blood. In others, researchers treated people’s T cells with a chemical that stimulates reproduction, then counted the numbers of new T cells. In still others, researchers added natural killer cells to foreign cells, then measured the number of foreign cells not killed.     Regardless of which measure of immune response was studied, most researchers found that people under stress have immune responses that are somewhat lower than the immune systems of people not under stress. In other words, people under stress have fewer of certain immune system cells, or they have cells that reproduce less successfully, or they have cells that respond ineffectively to foreign cells.     The converse is also true: not only do people under stress have lower immune responses, but people with positive attitudes seem to have better immune responses. Some studies, done specifically on people with HIV infection, found that those who describe themselves as vigorous and self-expressive, who have ways of venting their emotions, and who exercise regularly have better immune responses. The level of T cell reproduction and the response of the natural killer cells—the same measures of immune response that had been lower with stressed people—were higher.     Other researchers have suggested theories of how stress might affect immune response. In other words, all these theories suggest how a person’s mental state and the immune system might be linked. When people are under stress, their adrenal glands release hormones called glucocorticoids (the medications cortisone and prednisone are examples of glucocorticoids). In the immune system, glucocorticoids inhibit the release of chemicals called interferon and interleukin-2, which immune cells use to fight off fungi, bacteria, and viruses. In the bloodstream, glucocorticoids also decrease, temporarily at least, the number of certain T cells called T4 or CD4 cells, the same cells that HIV preferentially infects. And in experiments in the laboratory, another hormone the adrenal gland releases under stress, called adrenaline or epinephrine, seems to suppress reproduction of CD4 cells. In any case, because HIV specifically infects CD4 cells, anything that suppresses CD4 cells might make matters worse for someone trying to combat HIV infection.     It is hard to draw conclusions from any of these studies. The experiments with CD4 cells were done on animals or in laboratory dishes and not on living humans. The studies on humans measured different aspects of the immune system’s response, they did not exclude people who were not eating and sleeping, they measured stress differently, and the stresses themselves were different and of different magnitudes.     Most importantly, many of the changes measured were small, and no one knows whether small changes in immune response are clinically important—that is, whether they actually increase the chances of getting sick. In general, take the research with a grain of salt: this field is only a few years old; it connects psychology, the brain, and the immune system; and all three systems are extraordinarily complex and not yet understood.     In spite of the studies’ inconclusiveness, however, the sense in this new field is that people who are more emotionally stable may be less vulnerable to disease. When sick, they seem to do better, become less severely sick, stay alive longer.     The fact is, to people facing HIV infection, whether the research turns out to be right or wrong is irrelevant. If a positive mental state does affect the immune system, so much the better. If it does not, nothing is lost. A positive outlook makes your life more pleasant. The only trap is the possibility that people who do get sicker might blame themselves for not having worked hard enough. In view of the studies’ inconclusiveness, blaming yourself is both unrealistic and unnecessary.*248\191\2*

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