Increases in a marker of immune system reconstitution are predated by decreases in 24-h urinary cortisol output and depressed mood during a 10-week stress management intervention in symptomatic HIV-infected men

J Psychosom Res. 2005 Jan;58(1):3-13. doi: 10.1016/j.jpsychores.2004.05.010.


Background: Stress management interventions reduce distress symptoms and hypothalamic-pituitary-adrenal (HPA) axis hormones such as cortisol, which has been related to a down-regulation of immune system components relevant to the human immunodeficiency virus (HIV) infection. We previously showed that HIV+ men assigned to a 10-week cognitive behavioral stress management (CBSM) intervention showed more CD4+CD45RA+CD29+ lymphocytes, an indicator of immune system reconstitution, at a 6- to 12-month follow-up compared with controls. Here, we tested whether reductions in urinary cortisol output and depressed mood during the 10-week CBSM intervention period mediated its effects on this immune system reconstitution marker at follow-up.

Methods: Twenty-five HIV-infected men randomized to either a 10-week CBSM intervention or a wait-list control provided 24-h urine samples and psychological responses pre- to postintervention, which were related to changes in immune status over a 6- to 12-month follow-up period.

Results: Greater reductions in cortisol output and depressed mood during CBSM appeared to mediate the effects of this intervention on this indicator of immune system reconstitution over the 6- to 12-month follow-up period. Changes in mood were maintained over the follow-up period, although these did not add explanatory information beyond the cortisol and mood changes that were observed during the 10-week intervention period. These findings were not explained by the changes in medications or health behaviors during follow-up.

Conclusion: A time-limited CBSM intervention may affect the rate of immune system reconstitution in HIV-infected men by modifying the stress of symptomatic disease. This intervention may work by decreasing depressed mood and normalizing HPA axis functioning.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Biomarkers
  • CD3 Complex / immunology*
  • CD4 Antigens / immunology*
  • Cognitive Behavioral Therapy / methods*
  • Depression* / etiology
  • Depression* / immunology
  • Depression* / urine
  • Follow-Up Studies
  • HIV Seropositivity / psychology*
  • Humans
  • Hydrocortisone / metabolism
  • Hydrocortisone / urine*
  • Hypothalamo-Hypophyseal System / metabolism
  • Integrin beta1 / immunology*
  • Leukocyte Common Antigens / immunology*
  • Male
  • Middle Aged
  • Monitoring, Ambulatory
  • Pituitary-Adrenal System / metabolism
  • Stress, Psychological / etiology*
  • Stress, Psychological / therapy*


  • Biomarkers
  • CD3 Complex
  • CD4 Antigens
  • Integrin beta1
  • Leukocyte Common Antigens
  • Hydrocortisone