DHEA Clinical Experience: Interview with Jon Kaiser, M.D.

Jon Kaiser, M.D., has been treating HIV in San Francisco since 1987. He has been known for combining complementary and mainstream treatment approaches, and is the author of IMMUNE POWER: A COMPREHENSIVE TREATMENT PROGRAM FOR HIV (1993, St. Martin's Press). In 1995 he joined the Conant Medical Group in San Francisco.

Dr. Kaiser has been using DHEA in HIV treatment since late 1994, and now has about 200 HIV patients using it.

ATN: Who seems to benefit most from DHEA?

Dr. Kaiser: There are two groups. Some patients are asymptomatic, but blood tests show a lower than optimal level of DHEA. Others with low blood levels have symptoms which optimal levels of DHEA can treat: fatigue, depression, weight loss, and chronically not feeling well. DHEA seems to protect the body against effects of stress.

DHEA declines as AIDS patients get sicker. I believe that everyone with HIV should have a test for DHEA level.

ATN: What are optimal levels of DHEA?

Dr. Kaiser: The standard test gives a range of 180 to 1200 (nanograms/dl) as "normal" -- this just means the range which is prevalent in the population, not the best value. I try to maintain a range of 300-600 for men, and 200-500 for women, which is typical for a young adult.

There is also a test for DHEA sulfate (DHEA-S). The blood levels for DHEA-S are much higher than those for DHEA, but the units of the test are different, so the numbers come back about the same. The lab I use, Immunodiagnostic Laboratories Inc., in San Leandro, has developed an in-house test for DHEA-S which costs about $100, compared to about $200 for the standard test for DHEA.

ATN: How accurate are these tests?

Dr. Kaiser: I have sent identical blood samples for each test, and the results come back fairly close. The tests do seem to be consistent.

What doses do you recommend?

Dr. Kaiser: If the goal is to maintain a level of 300-600, and patients come in between 100 and 300, I recommend 200 mg once per day, in the morning with food. This gets about 90 percent of the patients into the optimal range.

If they come in with under 100 -- and quite a few patients with HIV do -- I recommend 200 mg twice a day.

After at least four weeks, it's good to get a second blood test, so that the dose can be adjusted if necessary.

ATN: What side effects have you seen?

Dr. Kaiser: There are almost never reports of side effects with DHEA. Occasionally a patient will have an unpleasant or uncomfortable reaction to it -- maybe one person in 100.

ATN: What is the cost, say of the lower dose, 200 mg once per day?

Dr. Kaiser: Through the pharmacy I suggest, it comes to about $1.50 per day.

DHEA is not a standard drug at this time. Few pharmacies carry it; you have to get it through a compounding pharmacy. I use Medical Center Pharmacy, in Virginia (800/723-7455); they seem to have good quality assurance, as we consistently see blood levels rise. They require a doctor's prescription. DHEA is also available from some of the buyers' clubs.

ATN: Do you see rises in CD4 counts?

Dr. Kaiser: I do not usually see short-term effects on viral load or CD4 counts.

In order to get definitive results about DHEA, I would propose a large simple trial, with some patients randomly assigned to optimize their DHEA level as I described, and others not put on DHEA. Do a two or three year study on symptoms, incidence of infections, and mortality. These differences will probably only show up in a long-term study. You might get a faster result by using quality of life measures.

But DHEA is inexpensive and largely unpatentable. So it is an uphill battle to get any clinical trials done. [No trials are listed by the AIDS Clinical Trials Information Service, 800/TRIALS-A, at this time.]

ATN: When people do seem to benefit, how long does it takes for them to notice feeling better?

Dr. Kaiser: About two to four weeks. That's how long it take for them to obtain a steady-state level of the hormone. If there is just a small change, say from 200 to 300, they may not notice any difference; it may take a larger change, such as 200 to 500 to feel the difference.

ATN: What experience do you have in treating women?

Dr. Kaiser: I have put a number of women on DHEA. You aim for a lower optimum range, and are a bit gentler with the dosage. I have not had any women have androgenic (masculinizing) side effects; most are doing quite well with the treatment. The optimal range for women is 200-500.

ATN: How does DHEA fit into overall HIV treatment?

Dr. Kaiser: My philosophy of HIV treatment includes normalizing almost any hormone that falls below normal or to low normal levels -- whether it is testosterone, or estrogen, or DHEA. I think that optimizing those levels to what a normal, healthy young adult had, makes patients the strongest and healthiest.

I have also treated HIV-negative men in their 50s or 60s for other conditions; some of them have very low DHEA levels, and we use DHEA as part of an overall treatment program.

ATN: If DHEA becomes classified as a Schedule III controlled substance, could you still prescribe it?

Dr. Kaiser: Hopefully I could continue to use it as I do today.