The course of human immunodeficiency virus (HIV) disease varies widely. Some patients deteriorate rapidly while others live for years, even after an illness that defines the acquired immunodeficiency syndrome (AIDS). The reasons for these different rates of decline are not known, but psychosocial variables have been put on the list of possible host factors.1 The notion has been that one's adaptive coping or fighting spirit might somehow delay or even prevent HIV's inexorable attack—and conversely, that distress and despair might measurably accelerate progression of the disease.
See also pp 2563 and 2568.
Such a notion is based on more than the understandable hope that one's mind can prevail over an illness with no known medical cure. Accumulating evidence supports the belief held since Hippocrates that vigor, resilience, and perceived support are associated with more favorable medical outcomes.2 Furthermore, stress and depression have been shown to affect the immune