Psychoneuroendocrine and cellular immune pathways are
cross-regulatory mind-body metabolic processes, and have
direct effects on immune surveillance of HIV and the onset and
progression of AIDS [16,17]. These inter-relationships permeate
to the cross-regulation of bone metabolism and cellular immunity
(i.e., osteoimmunology, osteo-psychoneuro-immunology) [18].
To be clear, the role of psychoneuroimmunology in IRIS is putative
and hypothetical at this stage, but the supporting lines of
evidence are compelling. The very fact that about one third of the
ARV-treated patients develop IRS is suggestive of certain shared
features of immune deregulation among a fairly large cohort of
HIV/AIDS patients. The observation that one among the primary
features of IRIS is aggressive RAS is indicative that the perception
of psycho-emotional stress may play an important role in the
IRIS process because the causative factor of stress and anxiety
in the onset of RAS and other oral lesions is well documented
[19]. Indeed, stress and anxiety have seriously harmful outcomes
to the oral cavity, including potentially severe damage to the
temporomandibular joint, which can be even more significant in
HIV/AIDS patients [18,20].