"In summary, patients who reported high levels of stress had significantly higher levels of peripheral proinflammatory cytokines, especially IL-6. The levels in our patients who reported stress averaged more than 6 times the standard cut off of 2.5 pg/mL, which has been determined to be predictive of physical decline.12 TNF-α levels were also significantly higher in patients with stress. Despite the limited sample size in this pilot study, the findings suggest that psychological stress could be a cofactor in the comorbidity of HIV-infected patients. This hypothesis requires further investigation."