If one is angry about being diagnosed with the HIV virus, can that hamper his or her immune system? If bitter about how one was infected, is that person at higher risk of infecting others in retaliation? And, if people forgive themselves and/or others for contracting the disease, does that make them stronger, help them live longer and help halt the progressive spread of AIDS?

The Institute of Human Virology, a first-of-its-kind center with epidemiologists, basic researchers and physicians working side-by-side under one roof to hasten the progress of scientific discovery, has kicked off a two-year study looking at the effects psychological and spiritual attitudes may have on the immune systems of patients with HIV -- and the preventive role they may play in the transmission of the virus that causes AIDS.

"Rapidly accumulating research demonstrates a strong correlation between psychosocial and spiritual influences and immunological, biochemical and disease outcomes," says Dr. Lydia Temoshok, prinicipal investigator of the IHV study and Professor of Psychiatry at the University of Maryland School of Medicine. "But there have been few scientific studies with empirical data to prove these theories. This will be one of the first to systematically test these approaches and document their benefit, perhaps not only to HIV/AIDS patients, but to the general public as well."

The Institute of Human Virology is a center of the University of Maryland Biotechnology Institute and is affiliated with University of Maryland Medicine.

Two hundred HIV-positive patients will be enrolled in the IHV study, which is designed to better assess the relationship between psychological and spiritual attitudes -- specifically forgiveness -- and HIV health outcomes.

"HIV/AIDS as an intrinsically immunologic disease provides perhaps the quintessential paradigm for studying the impact of forgiveness on immunologic parameters and health outcomes," Dr. Temoshok adds.

The status of HIV/AIDS can be readily monitored through routine blood work conducted through the Institute's HIV clinic, the Evelyn Jordan Center. Stored blood samples from each participant will be examined to study progression of the disease -- or lack thereof -- in correlation with reported spiritual attitudes and coping tendencies. Measured throughout the study will be the patient's CD4 cell count, chemokine production and plasma HIV RNA levels.

The Institute of Human Virology's clinical team will oversee the medical components of the study. The IHV study also will examine the possible impact of forgiveness on patients' emotional well-being, the care of their own health and the health of others, engagement in treatment and adherence to medical regimens.

"It is hypothesized that being able to "forgive and forget," to let go of angry thoughts and feelings, may promote the body's natural ability to return hyper-aroused physiological systems back to more normal levels of homeostasis," Dr. Temoshok explains. "This state of homeostatis is critical in maintaining an even keel, slowing the progression of AIDS and in maintaining a higher quality of life."

As part of a 60- to 90-minute structured interview, patients will compare themselves to three identified coping styles. Do they handle stress proactively, do they feel hopeless and/or that they've given up, or perhaps they've masked a state of depression with a seemingly positive veneer -- the "Type C" coping style first described and researched in the 1980s by Dr. Temoshok in studies of cancer progression. This type of evaluation, Dr. Temoshok says, is less threatening to patients than answering personal questions on a questionnaire and will help researchers understand their coping patterns and proclivities.

Biological markers in the patients' blood work may provide the first indications of proof that there is indeed a direct correlation between mental and physical health, but the study's real focus will be on the more difficult to measure coping and homeostatic mechanisms believed to be so interconnected with the progression of disease and functioning of the immune system.

"Emotional coping and adaptation appear consistently in the literature as key among non-medical factors predictive of health outcomes," says Dr. Temoshok. "We must evaluate the contribution that factors such as forgiveness may have on health -- both across the board and for those already afflicted with serious and chronic life-threatening conditions."

---University of Maryland

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