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Selected Presentations from CROI 2018
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

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