Hair cortisol and chronic stress exposure in chronic Hepatitis B patients

Author(s): Hie-Won Hann, Jerrold Meyer, Grace Park, Peter D Block, Hee-Soon Juon

Background: The purpose of this study is to address the prolonged exposure to stress associated with chronic HBV infection. We, therefore, explored the measure of stress cortisol hormone (CORT) in the hair as a biomarker of chronic stress in CHB patients. Materials and Methods: Eligible CHB patients identified from an existing patient cohort were enrolled in this prospective study. Data collection was done using medical chart reviews, face-to-face interview in Korean or English, and hair and blood samples. Results: We collected hair samples of 50 CHB patients (age 34-74 years) with the duration of CHB diagnosis (1-51 years, 23.8 ± 10). About three-fourths were male. More than 40% had family history of HBV infection. Hair samples weighing 19.6-29.9 mg were processed and analyzed for cortisol. Mean cortisol levels were 16.42 pg/ mg (27.59 SD) ranging from 2.7 to 168.1 pg/mg. About 16% (n=8) had below normal hair cortisol level (<5.9 pg/mg). Two patients had high above normal hair cortisol levels (112.2 and 168.1 pg/mg). The rate of distress measured by Distress Thermometer (DT) (defined by the DT cutoff >=4) was 48%. Distress was positively correlated with hair cortisol level (r=.395, p<.05) among those with below-normal hair cortisol levels. Conclusion: The mean of hair CORT in our CHB patients (16.4, 95% CI: 8.5-24.4) was lower than other studies of adults, suggesting long-term suppression of hair cortisol production in the course of CHB and antiviral therapy. This study indicates a possible hypothesis that the cortisol levels of CHB patients might have been suppressed and their HPA-axis down-regulated after having been stressed for years related to the disease. This study suggests a need for further research to determine the longitudinal effects of chronic stress on hair cortisol levels and liver disease progression in CHB patients.