Difficulty: Intermediate | Prerequisites: Immune system basics, psychoneuroimmunology introduction
This unit covers HIV/AIDS from the health psychology perspective: how the mind and immune system interact (psychoneuroimmunology), who is most at risk and why, and how psychological and personality factors influence disease progression. You should already understand the basics of immune function (T cells, CD4 counts) and the biopsychosocial model. This material connects tightly to the stress and coping content from earlier in the course.
HIV can progress to AIDS over 7-11 years. Psychological factors (depression, optimism, personality traits) influence immune function and disease progression. Women account for half of those infected globally and are 8x more susceptible to transmission. Prevention tools include PrEP and PEP. Social support and certain personality traits (openness, extroversion, conscientiousness) are associated with slower disease progression.
Psychoneuroimmunology (PNI)
The study of how our minds interact with our immune systems. In simple terms, it is the science of how stress, mood, and mental state affect how well your body fights disease.
HIV (human immunodeficiency virus)
The virus that attacks the immune system, specifically CD4 (T) cells. It can go 7-11 years before progressing to AIDS.
AIDS (acquired immunodeficiency syndrome)
Diagnosed when a person has one of 21 AIDS-defining opportunistic infections, or when their CD4 cell count drops to 200 or below (normal range is 600-1500).
CD4 cell count
A measure of immune function. Normal is 600-1500. A count of 200 or below is one criterion for an AIDS diagnosis.
HIV-Associated Neurocognitive Disorders (HAND)
Cognitive changes caused by HIV, ranging from mild to severe. Three types: Asymptomatic Neurocognitive Impairment (ANI), Mild Neurocognitive Disorder (MND), and HIV-Associated Dementia (HAD, which is rare).
PrEP (pre-exposure prophylaxis)
Medication taken by people who do not have HIV but are at high risk of contracting it. Think of it as a preventive shield.
PEP (post-exposure prophylaxis)
Medication taken within 72 hours of possible exposure to HIV. Different from PrEP because it is reactive, not preventive.
Undetectable viral load
When treatment suppresses the virus to levels that cannot be detected by standard tests. People with an undetectable viral load have no risk of sexual transmission.
PNI studies the interplay between the mind and the immune system. Key findings:
Stress management can impact disease progression in people with AIDS
Even acting out a sad scene has been shown to increase immune cells in the bloodstream, demonstrating how directly the mind-body connection operates
HIV can go 7-11 years before progressing to AIDS
AIDS is defined by having one of 21 AIDS-defining opportunistic infections, or a CD4 cell count of 200 or less
Global cases have grown 24% since 2001
Transmitted through body fluids; highest viral loads are found in semen, vaginal fluid, and breast milk
People whose viral load is undetectable have:
No risk of sexual transmission
Less than 1% risk of transmission during childbirth
Reduced risk from sharing syringes
Reduced risk from breastfeeding
PrEP: taken by people who do not have HIV but are at high risk
PEP: taken within 72 hours of possible exposure to HIV
People with HIV/AIDS have 2x higher risk of depression
HIV-Associated Neurocognitive Disorders (HAND) include three types: ANI, MND, and HAD (rare)
Depression is associated with poorer immune system function
Optimism boosts immune function and improves coping
Social support is associated with decreased death from AIDS
Slower disease progression is associated with openness, extroversion, and conscientiousness
Resilience factors:
Social support
Access to care and treatment
Women account for 50% of those infected globally
HIV passes to women 8x more easily than to men
Latin and African American women account for 73% of women diagnosed in the US
Among men, those infected tend to be European Americans
Youth account for 21% of new cases and are the least likely to be virally suppressed or aware of their infection
College students: low rates of testing and condom use, high rates of STDs, low rates of PrEP use
PrEP and PEP are active public health tools, not just exam content. The finding that undetectable viral load eliminates sexual transmission risk ("undetectable = untransmittable" or U=U) has reshaped HIV prevention messaging worldwide. The college student statistics are directly relevant to the student reading these notes: low testing rates, low condom and PrEP use, and high STD rates in university populations.
Students often confuse PrEP and PEP. PrEP is taken before exposure (preventive). PEP is taken after exposure (within 72 hours).
HIV does not equal AIDS. A person can live with HIV for 7-11 years without developing AIDS.
Students sometimes think an undetectable viral load means the virus is gone. It means the virus is suppressed below detectable levels, but the person still has HIV.
Social support is linked to decreased death from AIDS, not just better mood. Students underestimate the physiological impact of support.
Know the CD4 count threshold for AIDS diagnosis (200 or less; normal 600-1500)
PrEP vs. PEP: what each is, who uses it, when
Women 8x more susceptible to HIV transmission than men
Latin and AA women: 73% of women diagnosed in the US
Personality traits linked to slower progression: openness, extroversion, conscientiousness
Youth 21% of new cases, least likely to be virally suppressed
HAND: know the three types (ANI, MND, HAD)
True or False: AIDS is diagnosed when CD4 count drops below 400. (False. The threshold is 200 or less.)
Fill in the blank: HIV can go - years before progressing to AIDS. (7-11 years)
True or False: PEP is taken before potential exposure to HIV. (False. PEP is post-exposure; PrEP is pre-exposure.)
Fill in the blank: HIV passes to women ___x more easily than to men. (8x)
True or False: People with an undetectable viral load can still transmit HIV sexually. (False. Undetectable = untransmittable.)
Q: What is psychoneuroimmunology and what has it found about HIV/AIDS?
A: PNI studies the interplay between the mind and the immune system. Research has found that stress management can impact disease progression in people with AIDS, and that even acting out an emotional scene can increase immune cells in the bloodstream.
Q: Distinguish between PrEP and PEP.
A: PrEP is pre-exposure prophylaxis, taken by people who do not have HIV but are at high risk. PEP is post-exposure prophylaxis, taken within 72 hours of possible exposure.
Q: What personality traits are associated with slower HIV disease progression?
A: Openness, extroversion, and conscientiousness.
Q: Describe the cultural variations in who is most affected by HIV/AIDS.
A: Women account for 50% of infections globally and are 8x more susceptible. Latin and African American women account for 73% of US female diagnoses. Among men, those infected tend to be European Americans. Youth account for 21% of new cases and are least likely to be virally suppressed.
Q: What are the three types of HIV-Associated Neurocognitive Disorders?
A: Asymptomatic Neurocognitive Impairment (ANI), Mild Neurocognitive Disorder (MND), and HIV-Associated Dementia (HAD, which is rare).
Psychoneuroimmunology connects directly to the cancer unit (stress and NK cells). Depression as a factor in immune function recurs across cancer, heart disease, and HIV/AIDS. The cultural disparities (who is at risk, who gets tested, who gets treated) mirror those in every other disease unit. Adherence issues from the patient-provider communication notes apply directly to antiretroviral therapy.
HIV, AIDS, psychoneuroimmunology, PNI, CD4 cell count, T cells, HAND, ANI, MND, HAD, PrEP, PEP, undetectable viral load, U=U, viral transmission, social support, depression and immune function, resilience, cultural disparities, women and HIV, college students and HIV, health psychology, PSY 320, Michigan State University