HIV-infected psychiatric patients who disclose their HIV status and sexual orientation experience greater increases in CD4 cell counts than those who don't, according to a report in the January
Psychosomatic Medicine.
"It's probably important for physicians to emphasize with patients
that the difference between mind and body is more metaphor than
reality," Dr. Eric D. Strachan from University of Washington School of
Medicine, Seattle, told Reuters Health. "Good mental health and good
physical health are very often the same thing."
Dr. Strachan and associates investigated whether psychiatric
outpatients in a publicly funded HIV/AIDS clinic showed any
relationship between disclosure of sexual orientation and HIV status
and their immune functioning.
The study involved 373 patients. After controlling for "important
biobehavioral covariates," disclosure of sexual orientation and HIV
status was associated with higher CD4 cell counts over time than was
concealment, the researchers found.
For sexual orientation, only those who were "always open" about
their status showed increases in mean CD4 cell counts over time, the
researchers note, whereas for HIV, both "always" and "mostly open"
disclosure were associated with increases.
"Relieving potential psychological distress by disclosing sexual
orientation and HIV status has a positive impact on CD4 cell counts
over time even among outpatients stressed by psychiatric illness and
economic disadvantage," the investigators conclude.
However, "As has been noted in all of the previous research, these
data do not, in and of themselves, allow for causal inference," the
investigators caution. "It would be premature to suggest that
individuals should disclose sexual orientation and HIV status to be
healthier, especially given one study showing concealment can be
protective for gay men who are rejection-sensitive."
Nonetheless, "Let your patients at least talk with you about how
they feel about disclosure and maybe even help them formulate a plan,"
Dr. Strachan said. "We don't know enough to say it will help, but if
you are supporting the patient's existing desire to disclose, I
certainly don't think it could hurt."
Psychosom Med 2007;69:74-80.
