Glucocorticoids in Hair May Be a Marker for HIV Disease Progression

Close up of human hair
Close up of human hair
Researchers assessed the relationship between long-term exposure to glucocorticoids and HIV disease progression.

Increased concentrations of glucocorticoid in hair may be a marker for decreased CD4 cell counts among patients with HIV infection, according to results of a study published in BMC Infectious Diseases.

Researchers in China enrolled patients with HIV infection (N=1191) between 2017 and 2018 to evaluate the relationship between glucocorticoid concentrations in hair and indicators for HIV disease progression, including CD4 cell count and HIV viral load. For this study, hair samples from the scalp were evaluated by liquid chromatography-tandem mass spectrometry and related with CD4 count and viral load.

Among patients included in the study, the median age ranged between 31 and 40 years in 493 (41.4%), and the overall median BMI was 21.3 (range, 13.1-31.6) kg/m2. In addition, 65.1% were of Han ethnicity, 56.6% were married, 60.2% had completed 9 years of education or fewer, 60.3% earned less than 3000 Yuan (~$460) monthly, and 79.7% were on first-line combination antiretroviral therapy (cART). Of the patients on cART, 92.8% reported optimal adherence.

Among the included patients, the median hair cortisol concentration was 28.17 (range, 0.20-3587.90) pg/mg and median hair cortisone was 27.45 (range, 0.20-1893.17) pg/mg.

For HIV status, 55.0% of patients had decreased CD4 counts (<500 cells/mm3), and the overall median CD4 count was 470 (range, 8-1685) cells/mm3. Of note, most patients (97.1%) were virogically suppressed (HIV viral load, <200 copies/mL).

A comparison between hair composition and HIV status found that CD4 cell count was negatively correlated with hair cortisol (r, -0.129; P <.001) and cortisone (r, -0.148; P <.001). However, hair cortisol and cortisone were positively correlated (r, 0.226; P <.001), as were CD4 cell count and HIV viral load (r, 0.070; P <.05). No significant correlations were observed between hair composition and HIV viral load.

Further analysis was conducted that stratified patients into quartiles on the basis of hair cortisone and cortisol concentration and controlled for sociodemographic, lifestyle, and HIV-related characteristics. Results showed that the 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 fourth quartile vs those in the first quartile, respectively.

This study was limited by its cross-sectional design, as the researchers were unable to evaluate the causal relationship between hair glucocorticoid composition and CD4 cell count.

According to the researchers, “future work will focus on the longitudinal relationship of cortisol and cortisone… in various biological samples [that] indicate… 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