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][4].

Taking corticosteroids at the same time as conventional treatments for moderate to severe Pneumocystis pneumonia (PCP) can improve the response to treatment^[5]. Dexamethasone can also improve survival rates in HIV-positive patients with tuberculous meningitis^[6].

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 the symptoms of Cushing’s syndrome due to raised corticosteroid levels^[7][8]. 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.