Corticosteroids

Corticosteroids are a group of approved immunosuppressive and anti-inflammatory drugs. They can be administered in either oral or intravenous forms, or are inhaled as a treatment for asthma.

The most commonly used corticosteroids include prednisolone, hydrocortisone (Efcortesol / Hydrocortone / Solu-Cortef), dexamethasone (Decadron) and fluticasone propionate (Flixotide).

The immunosuppression caused by corticosteroids can lead to a higher rate of infections such as oral thrush and herpes simplex while they are being taken. However, they suppress flare-ups that can occur due to restoration of the immune system after a patient starts taking antiretroviral therapy.

Corticosteroids might benefit people with early HIV infection, by reducing the over-activation of the immune system that is responsible for the destruction of CD4 T-cells.1 Prednisolone can also increase CD4 cell counts and reduce the risk of developing AIDS for over two years, in patients with established infection.2 Giving prednisolone to antiretroviral-naive patients or to patients during a structured treatment interruption can also reverse or slow the decline in CD4 cell count, prolonging the time a patient can remain off therapy.3

Taking corticosteroids at the same time as conventional treatments for moderate to severe Pneumocystis pneumonia (PCP) can improve the response to treatment.4 Dexamethasone can also improve survival rates in HIV-positive patients with tuberculous meningitis.5

Side-effects of corticosteroids include stomach pain, bloating, muscle pain, menstrual irregularities, hair growth, weight gain and increased appetite.

Combining corticosteroids, particularly fluticasone or prednisolone, with ritonavir (Norvir) can cause bone damage and symptoms of Cushing’s syndrome due to raised corticosteroid levels.6 7 Symptoms include weight gain, weakening of the skin, sweating, facial hair growth and psychological disturbances. Dexamethasone can also reduce the levels of most protease inhibitors, as it is an inducer of the CYP3A4 enzyme.

References

  1. Lu W et al. Glucocorticoids rescue CD4+ T lymphocytes from activation-induced apoptosis triggered by HIV-1: implications for pathogenesis and therapy. AIDS 9: 35-42, 1995
  2. Andrieu JM et al. Long-term clinical, immunological and virologic impact of glucocorticoids on the chronic phase of HIV infection. BMC Med 2: 17, 2004
  3. Ulmer A et al. Low-dose prednisolone reduces CD4+ T cell loss in therapy-naive HIV-patients without antiretroviral therapy. Eur J Med Res 10: 105-109, 2005
  4. Briel M et al. Adjunctive corticosteroids for Pneumocystis jiroveci pneumonia in patients with HIV-infection. Cochrane Database Syst Rev 3: CD006150, 2006
  5. Thwaites GE et al. Dexamethasone for the treatment of tuberculous meningitis in adolescents and adults. N Engl J Med 351: 1741-1751, 2004
  6. Samaras K et al. Iatrogenic Cushing’s syndrome with osteoporosis and secondary adrenal failure in human immunodeficiency virus-infected patients receiving inhaled corticosteroids and ritonavir-boosted protease inhibitors: six cases. J Clin Endocrinol 90: 4394-4398, 2005
  7. Penzak SR et al. Prednisolone pharmacokinetics in the presence and absence of ritonavir after oral predisone administration to healthy volunteers. J Acquir Immune Defic Syndr 40: 573-580, 2005

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Community Consensus Statement on Access to HIV Treatment and its Use for Prevention

Together, we can make it happen

We can end HIV soon if people have equal access to HIV drugs as treatment and as PrEP, and have free choice over whether to take them.

Launched today, the Community Consensus Statement is a basic set of principles aimed at making sure that happens.

The Community Consensus Statement is a joint initiative of AVAC, EATG, MSMGF, GNP+, HIV i-Base, the International HIV/AIDS Alliance, ITPC and NAM/aidsmap
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This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.

NAM’s information is intended to support, rather than replace, consultation with a healthcare professional. Talk to your doctor or another member of your healthcare team for advice tailored to your situation.