Psychosocial Stress and Aging in HIV

While life expectancy has increased markedly for people living with HIV (PLWH), gains in
expected years of life have come at a cost - earlier onset and greater frequency of
age-associated comorbid conditions, such as osteoporosis, metabolic syndrome, and
cardiovascular disease. Accumulated multi-morbidity is the likely cause of much higher than
age-expected rates of frailty in PLWH. Perceived stress is prevalent in PLWH and, when
present, associated with worse clinical outcomes, including poor engagement in HIV care,
rapid progression to AIDS, and higher AIDS-related mortality. Stress is a well-documented
risk factor for many illnesses that demonstrate early onset in PLWH, and perceived stress has
been hypothesized to be a cause of aging itself. Nonetheless, the role of perceived stress in
early-onset aging and age-related illness in PLWH is essentially unexplored. Investigating
the interrelatedness of aging, perceived stress, and HIV may elucidate mechanism(s) that
underlie a phenotype of premature aging and functional decline in HIV patients with
implications for understanding fundamental mechanisms of stress and aging in HIV uninfected
populations. The proposed randomized controlled study will estimate correlations between
perceived stress and both aging and HIV-specific outcomes and will measure feasibility of a
cell phone-delivered stress reduction intervention. Participants will complete structured
interviews to measure cumulative life stress, perceived stress, intimate partner violence
exposure (as a traumatic stressor), functional status, frailty, and potential covariates
across the age spectrum in PLWH. Stress measures will be correlated with biomarkers known to
be associated with functional decline in aging, HIV-uninfected populations. The findings from
this exploratory R03, led by a New Investigator, will measure feasibility of mobile
technology for stress reduction interventions and estimate correlations between perceived
stress and markers of aging and HIV disease. The results will be used to determine sample
sizes necessary to perform definitive studies to assess the link between perceived stress and
a phenotype of premature aging, as well as interventional studies of stress modification to
mitigate the onset of early multi-morbidity and functional decline. These findings can be
applicable to both HIV-infected and HIV-uninfected populations.

Inclusion Criteria:

- HIV positive serostatus

- Wake Forest ID clinic patient for at least 12 months

- prescribed ART for at least 6 months

- English fluency (cell phone app and some interview tools are only available in
English)

- consistent access to a smartphone

Exclusion Criteria:

- ART-naive

- unable to perform functional measures

- recent (within 30 days) acute illness requiring medical therapy or hospitalization

- immunosuppressive agents (e.g. > 20 mg/d prednisone or equivalent, chemotherapy,
biologic immune-modulating agents) in the last 6 months

- cancer requiring treatment within 3 years (except for non-melanoma skin cancer)

- use of non-steroidal anti-inflammatory drugs more frequently than once per week within
the last 30 days.

Criteria iii-vi are necessary because of their effects on biomarkers of aging