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  Conference on Retroviruses
and Opportunistic Infections (CROI)
Boston, Massachusetts
March 4-7, 2018
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Low-Dose Hydrocortisone Improves Learning and Memory in Women With HIV
  25th Conference on Retroviruses and Opportunistic Infections (CROI), March 4-7, 2018, Boston
Mark Mascolini
WEBCAST: http://www.croiwebcasts.org/console/player/37191?mediaType=slideVideo&&crd_fl=1&ssmsrq=1522781539799&ctms=5000&csmsrq=707
A single 10-mg oral dose of hydrocortisone improved learning and memory for up to 4 hours in a randomized placebo-controlled crossover trial of US women with HIV infection [1]. The antiinflammatory had measurable cognitive impacts both 30 minutes and 4 hours after dosing.
Hydrocortisone is an oral or topical corticosteroid often used to treat inflammation-related conditions [2]. Researchers at Johns Hopkins University and collaborators at other centers noted that hydrocortisone has improved cognition in people with posttraumatic stress disorder and in men with HIV [3]. Notably, glucocorticoids impair learning and memory in healthy people. The Hopkins team conducted this trial to extend hydrocortisone research to women with HIV.
The study involved a community sample of 36 women with HIV. Age averaged 36.6 years, and 39% of participants had less than a high school education. Thirty-four women (94%) were black and 20 (56%) unemployed. The double-blind, placebo-controlled trial randomized women to take a single 10-mg oral dose of hydrocortisone or placebo and then to take the opposite pill later. Researchers measured salivary cortisol and cytokines throughout these sessions, and women took standard tests of learning/memory, executive function, working memory, attention/concentration, and visuospatial abilities 30 minutes and 4 hours after dosing.
Low-dose hydrocortisone significantly increased salivary cortisol compared with placebo. Levels peaked about 150 minutes after dosing then returned to baseline concentrations after 4 hours. Three learning/memory measures improved with hydrocortisone versus placebo through 30 minutes (delay recall, total learning, delay clustering), and those improvements reached statistical significantly at 4 hours. Working memory, executive function, and visuospatial abilities improved with hydrocortisone versus placebo through 30 minutes but not at 4 hours.
Drops in markers of inflammation through 30 minutes and 4 hours suggested that low-dose hydrocortisone may enhance cognitive function by reducing inflammation.
The researchers suggested that "enduring benefits" of low-dose hydrocortisone from 30 minutes to 4 hours suggest this approach has "potential clinical utility" in improving learning/memory in women with HIV. In the study of men with HIV [3], improvements occurred 30 minutes after dosing but did not persist for 4 hours. The investigators have begun larger, longer studies to explore possible sex-specific effects of low-dose hydrocortisone on cognitive function.
1. Rubin LH, Phan L, Keating SM, Maki PM. Low dose hydrocortisone enhances cognitive functioning in HIV-infected women. 25th Conference on Retroviruses and Opportunistic Infections (CROI). March 4-7, 2018. Boston. Abstract 420.
2. Mayo Clinic. Hydrocortisone (oral route). https://www.mayoclinic.org/drugs-supplements/hydrocortisone-oral-route/description/drg-20075259
3. Rubin LH, Phan KL, Keating SM, Weber KM, Maki PM. Brief report: Low-dose hydrocortisone has acute enhancing effects on verbal learning in HIV-infected men. J Acquir Immune Defic Syndr. 2017;75:e65-e70. https://www.ncbi.nlm.nih.gov/pubmed/28141781


Hydrocortisone https://en.wikipedia.org/wiki/Hydrocortisone
It is used as an immunosuppressive drug, given by injection in the treatment of severe allergic reactions such as anaphylaxis and angioedema, in place of prednisolone in patients needing steroid treatment but unable to take oral medication, and perioperatively in patients on long-term steroid treatment to prevent Addisonian crisis. It may also be injected into inflamed joints resulting from diseases such as gout.


SUD=substance use disorder; †Childhood Trauma Questionnaire & percentages reported indicate moderate-to-severe abuse/neglect