Dehydroepiandrosterone (DHEA) Effects on HIV Replication and Host Immunity: A Randomized Placebo-Controlled Study
ABSTRACT Prior studies have indicated that dehydroepiandrosterone (DHEA) may have immunomodulatory properties as well as positive effects on mood, quality of life, and body composition. Preliminary data suggest that DHEA inhibits expression of human immunodeficiency virus 1 (HIV) in latently infected cells; thus, it might be a potential adjunct to currently available antiretroviral therapy. The objective was to determine DHEA's impact on latent HIV infection, persistent viral replication, immunity, and nonimmune aspects of health restoration. A randomized, double-blind, placebo-controlled 24-week outpatient intervention included 40 subjects with suppressed HIV viremia on a stable antiretroviral regimen. Participants were randomized with equal probability 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 assays (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. Measurements of hormones, body weight, and body composition were obtained. Quality of life was assessed using validated questionnaires. DHEA was bioavailable as ascertained by increased levels of DHEA, DHEA(S), and androstenedione in recipients' plasma compared to the control group. The titers of infectious HIV culturable from blood trended upward in the DHEA arm although there was no significant change in plasma HIV RNA level. No significant immune effects were observed with DHEA. There appeared to be no benefit with regard to lean muscle mass or bone density in the DHEA recipients. DHEA treatment had a positive impact on overall quality of life. 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.
- SourceAvailable from: Jean-Pierre Savineau
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- "DHEA has been tested as a therapy in diverse diseases, including depression, cognitive function, osteoporosis, adrenal insufficiency, infection with HIV or lupus erythematosus (Rabkin et al., 2006; Abrams et al., 2007). The optimal dose of DHEA in these studies appeared to be between 25 and 200 mg/day (similar to our study, 0.3 and 3 mg kg "
ABSTRACT: This review describes the cellular and molecular mechanism heterogeneity of dehydroepiandrosterone (DHEA) and its putative therapeutic role in vascular remodeling diseases such as pulmonary artery hypertension (PAH). PAH is characterized by enhanced pulmonary artery smooth muscle cell (PASMC) proliferation, constriction and resistance to apoptosis, all of which contribute to increase the pulmonary artery wall thickness, resistance and therefore pressure. The etiology of PAH remains elusive. Nonetheless, the implications of endothelial dysfunction (decreased nitric oxide generation and increased endothelin production etc), PASMC K(+) channel/mitochondrial axis disruption (voltage-gated K(+) channel (Kv1.5) downregulation and mitochondrial membrane potential hyperpolarization) and the activation of survival pathways such as PI3K/Akt are now accepted. Therefore, a drug able to target all of these abnormalities would be of a great therapeutic interest for the treatment of PAH. We and others have demonstrated that DHEA, a clinically available drug with a low adverse effect profile, is able to achieve these effects. In several animal models of vascular remodeling diseases such as PAH, DHEA has been demonstrated to be a good anti-proliferative and pro-apoptotic drug, decreasing vascular remodeling, and a potent vasodilator. A better understanding of the DHEA mechanisms of action may allow the development of new and better therapies to treat vascular remodeling diseases such as pulmonary hypertension.Pharmacology [?] Therapeutics 03/2010; 126(2):186-99. DOI:10.1016/j.pharmthera.2010.02.003 · 7.75 Impact Factor