Most of the studies that measured DHEA levels in HIV positive subjects were done before the availability of highly active antiretoviral therapy (HAART). So researchers in New York conducted a study to find out about the changes in DHEA and testosterone levels in HIV positive people, some of whom were using HAART. The researchers found that as CD4+ counts fell and viral load rose, DHEA levels were also likely to be reduced. Moreover, PHAs on HAART tended to have increased levels of DHEA compared to their levels before they used HAART.
Researchers enrolled 169 HIV positive males whose profile at the start of the study was as follows:
Subjects were regularly monitored over the course of one year.
In people, DHEA is produced in the form of either DHEA or DHEA-sulfate (DHEA-S). Technicians usually measure DHEA-S because it is produced in larger quantities than DHEA and is easier to detect. As well, DHEA and DHEA-S can be converted into each other and are considered to be the same.
Testosterone can be found in the blood, either attached to proteins or unattached. The unattached form is called "free" testosterone and is the form with hormonal activity. Once testosterone is bound by proteins, it is difficult for the body to gain access to this hormone. As a result, it is the free testosterone that has body-building and other effects generally attributed to testosterone.
The researchers found that the following proportion of subjects had the indicated levels of the following hormones:
The general trend detected was that as CD4+ cell counts fell and viral load rose, DHEA levels decreased significantly.
Over the course of the 12-month study, the following events occurred:
Those subjects who developed AIDS or died were likely to have the following lab measurements one year before these events:
At the start of the study, only eight subjects were taking combination therapy that included a PI. Over the course of the study, this figure increased to 32 subjects. That this study was conducted around the time that PIs began to be released explains these numbers.
DHEA levels increased significantly among men who started PI therapy than in men who were not taking PIs. Levels of free testosterone did not change significantly in men who were or were not using PIs. In this study, neither DHEA nor testosterone levels were linked to the presence of fatigue or depression.
The results from this study confirm those from at least two other studies in which researchers found that DHEA levels fell with increasing immune deficiency. An interesting finding is that potent anti-HIV therapy appears to restore DHEA levels in some subjects. The results from this study may not apply to other groups such as injection-drug users and women with HIV infection, both of whom were not studied.
REFERENCES:
1. Ferrando FJ, Rabkin JG and Poretsky L. Dehydroepiandrosterone sulfate (DHEAS) and testosterone relation to illness stage and progression over one year. Journal of Acquired Immune Deficiency Syndromes 1999;22:146-154.
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