Sex Differences in Cognitive Response to a Hydrocortisone Challenge in HIV

描述（由申请人提供）：尽管有有效的艾滋病毒治疗方法，但认知缺陷仍然存在。新的数据表明，与男性相比，延迟性记忆障碍是艾滋病毒阳性女性认知障碍的一个核心特征。此外，压力与艾滋病毒血清状态相互作用，特别是对文字记忆产生负面影响。本申请旨在研究与压力相关的糖皮质激素（GC）增加作为HIV+女性言语记忆缺陷的潜在贡献者。GC在压力源后释放，是非HIV感染者中压力和记忆功能障碍之间关系的关键媒介。相关证据表明，健康女性比健康男性更容易受到GC的认知影响。在这里，我们建议将这项研究扩展到艾滋病毒，并专门研究GC反应对认知功能的因果作用。具体来说，我们建议在82名HIV阳性成人（41名男性，41名女性）中进行一项双盲、安慰剂对照、交叉研究，调查氢化可的松对HIV患者认知功能影响的性别差异。这种设计的一个创新特征是基于最近的证据，即GC对认知的影响取决于与应激激素暴露有关的认知评估的时间。因此，我们建议检查GC如何在急性（干预后30分钟）和延迟（干预后240分钟）后影响认知功能。我们假设，急性和延迟损害的程度对文字记忆将更大的艾滋病毒阳性女性相比，艾滋病毒阳性男性。据我们所知，这将是第一个阐明GC对HIV认知影响的药理学挑战研究。这样的演示将提供关键的洞察力压力相关的增加GC作为一种机制的基础上明显更大的赤字在艾滋病毒+女性的口头记忆相比，男性。确定这种机制是设计旨在降低压力和GC的临床试验的关键第一步，以改善认知功能，特别是在HIV+女性中。

DESCRIPTION (provided by applicant): Cognitive deficits persist despite the availability of effective therapies for HIV. New data indicates that, in contrast to men, delayed memory impairments are a central feature of cognitive impairment in HIV+ women. Furthermore, stress interacts with HIV serostatus to negatively impact verbal memory in particular. This application proposes to investigate stress-associated increases in glucocorticoids (GCs) as a potential contributor to verbal memory deficits in HIV+ women. GCs are released after a stressor and are the key mediator of the relationship between stress and memory dysfunction in non-HIV-infected individuals. Correlational evidence suggests that healthy women are more vulnerable to the cognitive effects of GCs than healthy men. Here we propose to extend this research to HIV and specifically examine the causal role of GCs response on cognitive function. Specifically, we propose to investigate sex differences in the impact of hydrocortisone on cognitive function in HIV in a double-blind, placebo-controlled, cross-over study in 82 HIV+ adults (41 men, 41 women). An innovative feature of this design builds on recent evidence that the effects of GCs on cognition depends on the timing of the cognitive assessment in relation to stress hormone exposure. Therefore, we propose to examine how GCs impact cognitive function both acutely (30 minutes post- intervention) and after a delay (240 minutes post-intervention). We hypothesize that the magnitude of acute and delayed impairments on verbal memory will be greater in HIV+ women compared to HIV+ men. To the best of our knowledge, this will be the first pharmacologic challenge study to elucidate the cognitive effects of GCs in HIV. Such a demonstration will provide critical insights into stress-related increases in GCs as a mechanism underlying the apparent greater deficit in verbal memory in HIV+ women compared to men. Identifying this mechanism is a critical first step in the design of clinical trials aimed at lowerng stress and GCs in order to improve cognitive function, particularly in HIV+ women.