Splitting Hairs for HIV

Over the past 40 years, HIV has shifted from a terminal diagnosis to a chronic disease whose patients can, with the help of treatment, live a long life. But HIV progression can vary widely between people, resulting in the need for adequate biomarkers to predict progression and guide targeted interventions. High glucocorticoid levels have previously been implicated, but research into the association between cortisol and HIV progression has been inconsistent, with serum, saliva, and urine only providing short-term snapshots of cortisol levels. Could hair offer a better estimate of the relationship between long-term glucocorticoid exposure and HIV progression?

Liquid samples provide insights into cortisol levels over a few minutes to two hours – but hair samples can reflect exposure over weeks or months. Recently, researchers investigated the relationship between hair glucocorticoid levels and two indicators of HIV progression – CD4 count and viral load – in people with HIV treated with antiretroviral therapy (1). The results? Although hair glucocorticoid levels were negatively associated with CD4 count, surprisingly, an even stronger association emerged between hair cortisone levels and CD4 count. This relationship did not extend to viral load in people with HIV.

Though CD4 cell count is a known marker of HIV progression, longitudinal research is needed to determine hair glucocorticoid levels’ predictive capacity for HIV progression, taking into account external factors such as lifestyle and medications that could influence cortisol levels, CD4 count, and viral load.