Low-Dose Hydrocortisone May Boost Attention and Learning in Women With HIV, Clinical Trial Finds - Video

Could a low dose of a hormone-like medicine help reverse cognitive problems linked to chronic stress in women living with HIV?

A randomized clinical trial published in JAMA Network Open found that a single 10 mg oral dose of hydrocortisone improved attention and verbal learning within hours in women with suppressed HIV. Four weeks of daily treatment was also linked to improved delayed memory recall, although the between-group difference was not statistically significant.

Researchers from Johns Hopkins University studied 81 women with HIV, averaging 55 years of age. Participants reported stress, mood or anxiety disorders and measurable cognitive impairment.

The trial had two phases. First, participants received oral low-dose hydrocortisone or placebo in a crossover design, with testing at 30 minutes and four hours. Attention improved at both time points, while verbal learning showed a significant improvement at four hours. Cortisol levels peaked 75 minutes after dosing.

In the second phase, participants took hydrocortisone or placebo daily for four weeks. Delayed recall improved significantly among women receiving hydrocortisone, but the improvement was not significantly greater than that seen with placebo. Researchers also found no biomarker that explained the cognitive changes.

The study targeted the hypothalamic-pituitary-adrenal (HPA) axis, the body’s stress-response system. Hydrocortisone is chemically identical to cortisol, a hormone involved in attention, learning.

Treatment was safe and well tolerated, with no serious adverse events or meaningful metabolic, liver or HIV-related changes.

However, the findings do not establish hydrocortisone as a treatment for cognitive impairment. The researchers say it should not replace established approaches such as cognitive behavioural therapy, exercise, sleep interventions and stress reduction.

Further research is needed to determine whether HPA-axis modulation can become part of multimodal strategies for cognitive health in women with HIV.

REFERENCE: Rubin LH, Xu Y, Wu S, et al. Low-Dose Hydrocortisone and Cognition in Women With HIV: A Randomized Clinical Trial. JAMA Netw Open. 2026;9(8):e2629185. doi:10.1001/jamanetworkopen.2026.29185