Abrams DI, Shade SB, Couey P, McCune J, Lo J, Bacchetti P, Chang B, Epling L, Liegler T, Grant RM.

Dehydroepiandrosterone (DHEA) and HIV: a randomized placebo-controlled study.

Community Consortium, Positive Health Program, University of California, San Francisco, 3180 18th St, Ste 201, San Francisco, CA 94110. dabrams@php.ucsf.edu

PURPOSE: The study was designed in response to preliminary data suggesting that DHEA inhibits the expression of HIV in latently infected cells and might thus be a potential adjunct to currently available antiretroviral therapy. The primary objective was to determine DHEA's impact on latent HIV infection; additionally, we examined its effect on persistent viral replication, host immunity and non-immune aspects of host restoration.

METHODS: Forty HIV-infected subjects with suppressed viremia on a stable antiretroviral regimen were randomized in double-blind fashion to receive either DHEA or placebo for 12 weeks, followed by open-label DHEA for an additional 12 weeks. Intensive virologic monitoring included plasma viral load (lower limits of detection 50 copies/mL and 2.5 copies/mL) and quantitative cultures of replication competent virus reservoirs in blood cells. A full battery of immunologic measurements was performed. Hormonal measurements, body weight and body composition were obtained. Quality of life was assessed with a variety of instruments.

RESULTS: DHEA was bioavailable as ascertained by increased levels of DHEA, DHEA(S) and androstenedione in recipients' plasma compared to the control group. HIV plasma viral load did not decrease and may, in fact, have increased in the DHEA arm, and there was no apparent immunologic effect compared to placebo recipients. There appeared to be no benefit with regard to lean muscle mass or bone density in the DHEA treated group. DHEA treatment had a positive impact on mood and quality of life.

CONCLUSIONS: DHEA supplementation in fully suppressed HIV patients was associated with an improvement in quality of life but appeared to have no beneficial antiviral, immunomodulatory, hormonal or body composition effects, suggesting that it not be routinely used as an adjunctive therapy in this population.

 

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