Distress, denial, and low adherence to behavioral interventions predict faster disease progression in gay men infected with human immunodeficiency virus

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Abstract
This study examined psychological predictors of 2-year disease progression in gay men after finding out their human immunodeficiency virus (HIV) serostatus. Psychological and immune status of asymptomatic gay men who did not know their HIV serostatus was monitored during the 5 weeks before and after serostatus notification. The men were randomly assigned to an exercise, cognitive-behavioral stress-management intervention, or control group. At 2-year follow-up for the 23 men who turned out to be seropositive, 9 had developed symptoms, including 5 with acquired immune deficiency syndrome—4 of whom died. Distress at diagnosis, denial (5 weeks postdiagnosis minus pre-diagnosis), and low adherence during interventions were significant predictors of 2-year disease progression. Denial and adherence remained significant predictors of disease progression even after controlling for CD4 number at entry. Furthermore, change in denial was significantly correlated with immune status 1 year later; 1-year immune status was significantly correlated with 2-year disease progression. The present study therefore demonstrates significant relations between psychological variables on the one hand and both immune measures and IIIV-1 disease progression on the other. We conclude that distress, denial, and low protocol compliance predict subsequent disease progression.