Cortisol, Cortisone Levels in Hair May Be Indicators of HIV Disease Progression, Study Finds


New research shows that cortisol and cortisone levels in the hair of people living with HIV were negatively associated with CD4 count, but not with HIV viral load.

Among Chinese patients living with HIV, hair cortisol and cortisone levels were negatively associated with CD4 count, but not with HIV viral load, according to a study published in BMC Infectious Diseases.

Whereas past research has mostly studied the correlation between acute or short-term glucocorticoid exposure and HIV disease progression, this study focused on long-term exposure and how hair glucocorticoid levels were associated with CD4 count and HIV viral load—2 main markers of HIV disease progression.

After exclusions following the collection of hair samples, a total of 1198 Chinese patients living with HIV who had received combination antiretroviral therapy (cART) were included in the study.

The median age was 38 years and most (64.3%) were male. Most participants were of Han ethnicity, married, and employed, and most did not smoke or drink during the study period and washed their hair less than 4 times per week.

Regarding HIV treatment and viral load, 79.7% of participants were receiving first-line cART, 92.8% were reporting optimal cART adherence (≥95%), and only 2.9% had an HIV viral load of at least 200 copies/mL, indicating that the majority of participants had achieved viral suppression.

Participants were excluded if they:

  • had a linguistic, mental, or physical inability to respond to the assessment questions;
  • had opportunistic infections or endocrine diseases, such as Cushing syndrome;
  • were actively taking hormonal medications or had a known history of illegal drug use; or
  • had chemically treated hair or scalp hair in the posterior vertex was less than 1 cm.

Hair samples were collected by cutting strands from the posterior vertex area as close to the scalp as possible, and then wrapping the hair thatch in foil to transport to the researchers.

“Recently, hair cortisone levels have been served as a useful additional biomarker for assessing long-term glucocorticoid exposure,” the study authors explained. “As well known, circulating cortisol levels are dynamically regulated partially through the activity of the 11β hydroxysteroid dehydrogenase (11β-HSD) enzyme, where cortisol is converted to cortisone by the activity of 11β-HSD type 2 enzyme, and cortisone can be regenerated from cortisol by the activity of 11β-HSD type1 enzyme.”

The authors found that hair cortisol was positively correlated with hair cortisone (r = 0.226; P < .001), and CD4 cell count and HIV viral load were positively correlated (r = 0.070; P < .05).

When comparing hair composition with HIV status, CD4 cell count was negatively correlated with hair cortisol (r = –0.129; P < .001) and cortisone (r = –0.148; P < .001).

When stratifying patients into quartiles based on hair glucocorticoid concentration with other characteristics being controlled, the authors found greater odds of decreased CD4 cell count among those with the highest levels of hair cortisol and cortisone.

Specifically, odds for decreased CD4 cell count were 1.41 (95% CI, 0.99-2.00) and 2.15 (95% CI, 1.51-3.05) times greater among patients in the highest quartile for hair cortisol and cortisone levels, respectively, compared with patients in the lowest quartile for each.

However, there were no significant correlations—positive or negative—observed between hair composition and HIV viral load.

According to the authors, a limitation was using cross-sectional data, as these data did not allow for them to evaluate a causal relationship between hair glucocorticoid levels and HIV disease progression. Additionally, using hair specifically and excluding other forms of glucocorticoid measurements; only using data from people in Guangxi, China; and the lack of data on other factors such as physical exercise were also major limitations.

The authors said future research should focus on the longitudinal relationship of glucocorticoid levels in multiple biological samples as an indicator of HIV disease progression.


Zhang Q, Li X, Qiao S, Liu S, Zhou Y, Shen Z. The relationship of hair glucocorticoid levels to immunological and virological outcomes in a large cohort of combination antiretroviral therapy treated people living with HIV. BMC Infect Dis. 2022;22(1):268. doi:10.1186/s12879-022-07257-x

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