title: 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.
abstract: 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.
  
  
  METHODS
  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.
authors.affiliation: Department of Health Promotion Education and Behavior, School of Public Health, University of South Carolina, Columbia, South Carolina, United States of America.
authors.forename: Shan
authors.initials: S
authors.lastname: Qiao
authors.affiliation: Department of Health Promotion Education and Behavior, School of Public Health, University of South Carolina, Columbia, South Carolina, United States of America.
authors.forename: Xiaoming
authors.initials: X
authors.lastname: Li
authors.affiliation: Department of Psychology, Wayne State University, Detroit, Michigan, United States of America.
authors.forename: Samuele
authors.initials: S
authors.lastname: Zilioli
authors.affiliation: Research Center for Learning Science, Southeast University, Nanjing, China.
authors.forename: Zheng
authors.initials: Z
authors.lastname: Chen
authors.affiliation: Research Center for Learning Science, Southeast University, Nanjing, China.
authors.forename: Huihua
authors.initials: H
authors.lastname: Deng
authors.affiliation: Beihai Center of Disease Control and Prevention, Beihai, Guangxi, China.
authors.forename: Juxian
authors.initials: J
authors.lastname: Pan
authors.affiliation: Beihai Center of Disease Control and Prevention, Beihai, Guangxi, China.
authors.forename: Weigui
authors.initials: W
authors.lastname: Guo
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000378:metabolism*; D002681:China / Q000453:epidemiology; D002908:Chronic Disease; D003687:Dehydroepiandrosterone / Q000378:metabolism*; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology / Q000523:psychology; D015497:HIV-1; D006197:Hair / Q000737:chemistry*; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D008297:Male; D013315:Stress, Psychological / Q000175:diagnosis* / Q000209:etiology / Q000378:metabolism; D053719:Tandem Mass Spectrometry
chemical_list: D015415:Biomarkers; D003687:Dehydroepiandrosterone; D006854:Hydrocortisone