Hair Measurements of Cortisol, DHEA, and DHEA to Cortisol Ratio as Biomarkers of Chronic Stress among People Living with HIV in China: Known-Group Validation

PLOS ONE, Dec 2019

Background Existing literature suggests that endocrine measures, including the steroid hormones of cortisol and Dehydroepiandrosterone (DHEA), as well as the DHEA to cortisol ratio in the human hair can be used as promising biomarkers of chronic stress among humans. However, data are limited regarding the validity of these measures as biomarkers of chronic stress among people living with HIV (PLWH), whose endocrine system or hypothalamic pituitary adrenal (HPA) axis may be affected by HIV infection and/or antiretroviral therapy (ART) medications. Method Using hair sample data and self-reported survey from 60 PLWH in China, we examined the validity of three endocrine measures among Chinese PLWH using a known-groups validation strategy. High-stress group (n = 30) and low-stress group (n = 30) of PLWH were recruited through individual assessment interviews by a local licensed psychologist. The endocrine measures in hair were extracted and assessed by LC-APCI-MS/MS method. Both bivariate and multivariate analyses were conducted to examine the associations between the endocrine measures and the stress level, and to investigate if the associations differ by ART status. Results The levels of endocrine measures among Chinese PLWH were consistent with existing studies among PLWH. Generally, this pilot study confirmed the association between endocrine measures and chronic stress. The high stress group showed higher level hair cortisol and lower DHEA to cortisol ratio. The higher stress group also reported higher scores of stressful life events, perceived stress, anxiety and depression. Hair cortisol level was positively related to anxiety; DHEA was negatively associated with stressful life events; and the DHEA to cortisol ratio was positively related to stressful life events and perceived stress. ART did not affect the associations between the endocrine measures and stress level. Conclusions Our findings suggest that hair cortisol and DHEA to cortisol ratio can be used as promising biomarkers of chronic stress among PLWH. Clarifying the role of steroid hormones in the psychoimmunology of PLWH may yield important implications for clinical practice and psychological intervention.

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Hair Measurements of Cortisol, DHEA, and DHEA to Cortisol Ratio as Biomarkers of Chronic Stress among People Living with HIV in China: Known-Group Validation

January Hair Measurements of Cortisol, DHEA, and DHEA to Cortisol Ratio as Biomarkers of Chronic Stress among People Living with HIV in China: Known-Group Validation Shan Qiao 0 1 Xiaoming Li 0 1 Samuele Zilioli 1 Zheng Chen 1 Huihua Deng 1 Juxian Pan 1 Weigui Guo 1 0 Department of Health Promotion Education and Behavior, School of Public Health, University of South Carolina, Columbia, South Carolina, United States of America, 2 Department of Psychology, Wayne State University , Detroit, Michigan , United States of America, 3 Research Center for Learning Science, Southeast University , Nanjing , China , 4 Beihai Center of Disease Control and Prevention , Beihai, Guangxi , China 1 Editor: Urs M. Nater, University of Marburg , GERMANY - Data Availability Statement: All relevant data are within the paper and its Supporting Information files. Funding: The study was funded by NIH grant #R01HD070698. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing Interests: The authors have declared that no competing interests exist. Background Existing literature suggests that endocrine measures, including the steroid hormones of cortisol and Dehydroepiandrosterone (DHEA), as well as the DHEA to cortisol ratio in the human hair can be used as promising biomarkers of chronic stress among humans. However, data are limited regarding the validity of these measures as biomarkers of chronic stress among people living with HIV (PLWH), whose endocrine system or hypothalamic pituitary adrenal (HPA) axis may be affected by HIV infection and/or antiretroviral therapy (ART) medications. Method Results Using hair sample data and self-reported survey from 60 PLWH in China, we examined the validity of three endocrine measures among Chinese PLWH using a known-groups validation strategy. High-stress group (n = 30) and low-stress group (n = 30) of PLWH were recruited through individual assessment interviews by a local licensed psychologist. The endocrine measures in hair were extracted and assessed by LC-APCI-MS/MS method. Both bivariate and multivariate analyses were conducted to examine the associations between the endocrine measures and the stress level, and to investigate if the associations differ by ART status. The levels of endocrine measures among Chinese PLWH were consistent with existing studies among PLWH. Generally, this pilot study confirmed the association between endocrine measures and chronic stress. The high stress group showed higher level hair cortisol and lower DHEA to cortisol ratio. The higher stress group also reported higher scores of stressful life events, perceived stress, anxiety and depression. Hair cortisol level was positively related to anxiety; DHEA was negatively associated with stressful life events; and the DHEA to cortisol ratio was positively related to stressful life events and perceived stress. ART did not affect the associations between the endocrine measures and stress level. Conclusions Our findings suggest that hair cortisol and DHEA to cortisol ratio can be used as promising biomarkers of chronic stress among PLWH. Clarifying the role of steroid hormones in the psychoimmunology of PLWH may yield important implications for clinical practice and psychological intervention. Introduction HIV (Human Immunodeficiency Virus), the virus that causes AIDS (Acquired Immunodeficiency Syndrome), has become one of the most serious health and developmental challenges for humans since it was reported in 1981 [ 1 ]. Worldwide there were 35 million people living with HIV (PLWH) and 1.5 million deaths were attributed to the condition in 2013 [ 2 ]. In addition to physical health complications, people affected by HIV are often stigmatized and face recurrent discrimination across a variety of social realms, including work and health care settings [ 3 ]. This combination of chronic psychological and physical stressors can have daunting consequences for individual psychological wellbeing, which in turn can further exacerbate physical symptoms [ 4 ]. The risk of having mental health problems is higher in PLWH than general population. Globally, an estimated 350 million people of all ages suffer depression by 2015, accounting for 5% of the total population in the world [ 5 ]. One recent literature review suggested that the mean prevalence of depression and anxiety among HIV patients was 33.6% and 28.38% respectively, with a higher prevalence in low and middle income counties (41.36% and 33.92%, respectively)[ 6 ]. Psychological problems may have adverse effects upon medication adherence and other HIV-related outcomes [ 7 ]. Within this context, it becomes a priority to develop interventions aimed at helping PLWH mitigate stress. However, a fundamental requirement for developing effective interventions is to identify reliable indicators that provide a comprehensive psychobiological profile of an individual's (...truncated)


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Shan Qiao, Xiaoming Li, Samuele Zilioli, Zheng Chen, Huihua Deng, Juxian Pan, Weigui Guo. Hair Measurements of Cortisol, DHEA, and DHEA to Cortisol Ratio as Biomarkers of Chronic Stress among People Living with HIV in China: Known-Group Validation, PLOS ONE, 2017, Volume 12, Issue 1, DOI: 10.1371/journal.pone.0169827