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To the Editor: Dr Glaser and colleagues¹ make several interesting and controversial points in their article on stress and infectious disease.

First, they suggest that a relationship between stress and infectious disease is implied by studies showing that stress causes immunosuppression; however, these studies, and those investigating vaccine responses, focus on a surrogate outcome—"immune response"—rather than infectious disease.

Second, they cite evidence from 2 studies on the relationship between stressors and the incidence of respiratory tract infections. However, in 1 of these studies, this relationship disappeared after adjustment for smoking status. Moreover, evidence is presented relating to the influence of stress on the pathophysiology of human immunodeficiency virus (HIV) infection and the acquired immunodeficiency syndrome. However, the evidence from these studies is again conflicting, and a meta-analysis of studies examining the role of stressors in recurrence of herpes simplex virus and HIV progression has reported little effect of stressors.² Therefore, . . . [Full Text of this Article]

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RELATED ARTICLE

Stress-Induced Immunomodulation: Implications for Infectious Diseases?
Ronald Glaser, Bruce Rabin, Margaret Chesney, Sheldon Cohen, and Benjamin Natelson
JAMA. 1999;281(24):2268-2270.
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