Wednesday, August 27, 2014

Effects of nutrition on HIV Disease progression

The links between HIV and nutritional status run both ways. It has long been known that weight loss strongly predicts illness or death among people with HIV. More recently it has been found that this applies even to people taking antiretroviral treatment. Losing as little as 3-5% of body weight significantly increases the risk of death, losing more than 10% is associated with a four- to six-fold greater risk. A Zambian study involving nearly 30,000 patients has shown that failure to gain weight six months after the start of antiretroviral treatment increases the chance of death ten fold when compared with those who gain over 10 kilograms.

Various micro nutrients have been linked to changes in the rate at which HIV infection progresses to AIDS. Low levels of vitamin A, vitamin B12, vitamin E and selenium seem to accelerate progression. The effects of other micro nutrients, however, are more controversial. One such example is zinc. Although zinc is essential for a healthy immune system, it has been shown to play a role in HIV’s replication cycle. 12 On the other hand, some scientists claim zinc delays HIV disease progression.
There is strong evidence that malnourished people are less likely to benefit from antiretroviral treatment. One study in Malawi found that patients with mild malnutrition (a low body weight for their height) were twice as likely to die in the first three months of treatment. For those with severe malnutrition the risk was six times greater than for those of healthy body weight. Researchers in Singapore have reported similar findings. A study in Zambia showed death rates in the first three months of starting antiretroviral treatment were highest (95%) among the most severely malnourished. This is not just an issue for developing countries for example a study of people receiving antiretroviral treatment in Sydney, Australia found that one in three did not have access to nutritious food, and one in five said they regularly went hungry.

Without food or the right nutrition, taking antiretroviral drugs can be so painful that people simply don’t. In a choice between taking pills with no immediate or obvious effect, and eating food to survive, food will almost certainly take priority every time. A health worker in Zimbabwe, where malnutrition is widespread, explained that taking antiretroviral drugs on an empty stomach is like digesting razor blades. The result is that many simply do not take them. In resource-poor countries, treatment in children is made more difficult because many children with HIV are severely malnourished. Very little is known about how best to treat such children and in particular whether it is best to start antiretroviral treatment before or after nutritional rehabilitation. The World Health Organisation recommends treating the malnutrition first, but stresses that “further research on these matters is urgently needed.”

The ways in which the body digests, absorbs and makes use of drugs are very similar to the ways in which it treats food, providing many opportunities for food-drug interactions. As explained later in this article, a number of foods and supplements are known to alter the effects of antiretroviral drugs. It is also possible that some micro nutrient deficiencies may make the drugs less effective, or may worsen side effects.
The chance of someone transmitting HIV is linked to the amount of virus in their bodily fluids, which is known as the viral load. In theory, micro nutrient deficiencies may increase viral load by enabling HIV to replicate faster, or by weakening the immune system. Similarly, someone whose immune system has been weakened by micro nutrient deficiencies may be more likely to acquire HIV. Research in this area has, however, been largely inconclusive. The strongest evidence links low levels of retinol (the animal form of vitamin A) in women’s blood with increased rates of mother-to-child transmission.

Poor nutrition may also affect the spread of HIV in a very different way: by altering sexual behavior. One study of two thousand people in Botswana and Swaziland found that women lacking enough food to eat were less likely to use condoms and more likely to engage in risky activities, such as exchanging sex for money or resources.

Dietary advice should be tailored to individual circumstances. However, in general the recommendations for people living with asymptomatic HIV infection are much the same as for everyone else, meaning a healthy, balanced diet. Only three differences are worth noting:

- Because people with untreated HIV tend to burn more energy, the total number of calories should be around 10% higher than the usual guideline amounts, and up to 30% higher during recovery from illness. The balance of fat, protein and carbohydrates should remain the same.
- Many experts recommend a daily multivitamin (usually without iron, except in menstruating women or people with iron deficiency).
- The World Health Organisation recommends vitamin A supplements every 4-6 months for young children living with HIV in resource-poor settings.

HIV positive people suffering loss of appetite may need to make an extra effort to ensure they are eating enough. Helpful suggestions include eating several small meals per day, taking exercise to stimulate appetite, possibly mashing or liquidizing food to ease swallowing, and seeking advice from a health provider or dietician.

If other approaches have failed to reverse wasting then doctors may recommend a liquid food supplement, an appetite stimulant, or resistance exercise to build muscle. Other possibilities include steroids and hormone treatments, though these can be expensive and have serious side effects.

Wednesday, August 20, 2014

Growth hormone reduces liver fat in HIV-infected patients

In a preliminary study, HIV-infected patients with excess abdominal fat who received the growth hormone-releasing hormone analog Tesamorelin for 6 months experienced modest reductions in liver fat a theme issue on HIV/AIDS. Patients infected with HIV demonstrate a high prevalence of nonalcoholic fatty liver disease, estimated at 30 percent to 40 percent. The issue is being released early to coincide with the International AIDS Conference.

In human immunodeficiency virus (HIV) infection, abdominal fat accumulation is associated with ectopic (out of place) fat accumulation in the liver. Nonalcoholic fatty liver disease (NAFLD) may progress to end-stage liver disease and liver cancer. To date, there are no approved pharmacological strategies to reduce liver fat. Takara L. Stanley of Massachusetts General Hospital and Harvard Medical School, Boston, and colleagues randomly assigned 50 antiviral-treated HIV-infected men and women with abdominal fat accumulation to receive Tesamorelin (n=28), or placebo (n=22), subcutaneously daily for 6 months.

The researchers found a modest but statistically significant decrease in liver fat with Tesamorelin. Hepatic lipid to water percentage (a measure of liver fat), decreased in the Tesamorelin group (median, -2.0 percent) compared with placebo (median, 0.9 percent). In addition, there was a significant reduction in abdominal fat: the average change was -9.9 percent with Tesamorelin vs 6.6 percent with placebo.

"The decrease in liver fat in this study suggests that strategies to reduce visceral adiposity merit further investigation in HIV-infected patients with NAFLD, a condition for which there are no approved treatments. Importantly, NAFLD is associated with visceral adiposity and other metabolic abnormalities in HIV," the authors write. AIDS is the sixth leading cause of death among people aged 25 - 44 in the United States. This is an improvement since it was the number one killer in 1995. At the end of 2010, an estimated 91,500 people in the UK were living with HIV. Of these, around 1 in 4 (22,000 in total) did not know they were infected.

The World Health Organization (WHO) estimates that around 34 million people in the world are living with HIV. The virus is particularly widespread in sub-Saharan African countries, such as South Africa, Zimbabwe and Mozambique.
AIDS is caused by HIV infection. The virus attacks the immune system leaving the individual susceptible to life-threatening infections and cancers. Common bacteria, yeast, parasites, and viruses that usually do not cause serious disease in people with healthy immune systems can turn deadly for AIDS patients. HIV is found in all the body fluids including saliva, nervous system tissue and spinal fluid, blood, semen, pre-seminal fluid, which is the liquid that comes out before ejaculation, vaginal secretions, tears and breast milk. Only blood, semen, and breast milk have been shown to transmit infection to others. The virus is transmitted by sexual contact including unprotected oral, vaginal, and anal sex and via transfusion of contaminated blood that contains HIV.

Another mode of transmission is sharing needles or injections with HIV infected individuals. A pregnant woman can transmit the virus to her unborn baby through their shared blood circulation, or a nursing mother can transmit it to her baby in her breast milk. HIV infection does not spread by casual contact, mosquitoes, touching or hugging.
Those at highest risk include injection drug users who share needles, babies born to mothers with HIV (especially if the mother had not received anti- HIV therapy during pregnancy), those engaging in unprotected vaginal or anal sex with HIV positive individuals, and those who received blood transfusions or clotting products between 1977 and 1985 (before screening for HIV became standard practice).

HIV infection may cause no symptoms for a decade or longer. At this stage carriers may transmit the infection to others unknowingly. If the infection is not detected and treated, the immune system gradually weakens and AIDS develops. Acute HIV infection takes a few weeks to months to become a non-symptomatic HIV infection. Then it becomes early symptomatic HIV infection and later it progresses to AIDS.

Wednesday, August 13, 2014

Deca Durabolin used effectively to treat muscle wasting associated with HIV

Deca Durabolin is the brand name for an injectable steroid originally produced by Organon in 1962. It contains the active hormone Nandrolone with the Decanoate ester. The Nandrolone hormone is highly anabolic and produces very few side effects when used in reasonable doses, the Decanoate ester is a fatty acid which slows its release into the body over several weeks.

Nandrolone is technically a derivative of testosterone but it is created by removing the carbon atom at the 19th position of the steran nucleus, which creates a completely different family of steroids (the 19nor-testosterone family). It is one of the most versatile steroids on the market today, and can be used successfully in both bulking and cutting cycles, while in the clinical setting it has been used effectively to treat muscle wasting associated with HIV and AIDS. Deca Durabolin doesn’t produce many estrogenic side effects due to its low rate of aromatization (metabolic conversion to estrogen via the aromatase enzyme). Its ability to improve collagen synthesis and bone mineral content  is highly prized by bodybuilders and athletes who may have nagging injuries or joint pains.

But it’s not just Deca’s healing attributes which have made it such a popular steroid; bodybuilders and athletes have found Deca Durabolin to be one of the best all-around steroids for gaining lean mass and we see this played out in various clinical studies also. Muscle gained with this product is very solid with minimal bloat, as long as dosages are kept reasonable.

Because Deca Durabolin is so popular, that it’s important to note that it is considered a very long acting steroid, but the research is very inconsistent regarding just how long lasting it is. In healthy, normal, men one study found an average half-life of 8 days (but the range was from 5 to 17 days) at a dose of 50 mg, while another study found an average half-life of 5.9 days at a dose of 200 mg, another found an average of 7.7 days at a dose of 100 mg, and a final study  looked at showed an average of 7.1, 11.7, and 11.8 days depending heavily on the dose being either 50 mg, 100mg, or 150 mg, respectively.

In a practical sense, people will still shoot Deca once a week, but I thought it was important to show that typical half-life charts don’t factor in every single dose or dose response.

And, to further complicate things, the milligram per milliliter concentration and location of injection site heavily determines the actual blood plasma concentration achieved by a single shot of Nandrolone Decanoate: gluteal shots of Nandrolone Decanoate give you higher blood plasma levels of the parent hormone, and more highly concentrated preperations (mg/ml) also give you a higher overall blood level – and will probably provide better results, all things being equal.

Practical Use: Deca-Durabolin is easily the most versatile anabolic steroid on the market today (testosterone just misses that mark by virtue of the fact that women need to avoid it). It can be used in cutting cycles as well as bulking cycles, depending on the other compounds (and diet) one chooses.

Deca Duaraoblin Side Effects: Deca is one of the most mild steroids on the market in terms of side effects. Men who are very prone to hair loss will sometimes experience this with Deca-Durabolin, and gynecomastia is possible with higher doses. The most common side effect experienced with Deca-Durabolin is sexual dysfunction, although most users simply stack it with testosterone and avoid this entirely.

Used By: Because it’s so versatile, Deca-Durabolin is used by athletes, bodybuilders, and powerlifters alike. Women have found it to be mild enough to use at low doses, and many champion physiques of both genders have been built with its use. The only people who would be well advised to avoid Deca are drug tested athletes, as Nandrolone metabolites are detectable in urine for up to 18 months after the last injection.

Deca Durabolin Dosage: For men, an average dose of Deca-Durabolin is in the range of 200-600 milligrams. In women, 50 milligrams is a much more reasonable dose, although I have seen women go up to 100 milligrams without experiencing intolerable side effects.

Deca Duraboline Cycle: Deca-Durabolin works well with virtually every steroid. A good cutting cycle could include Deca, Winstrol, and testosterone – while a good bulking cycle could include Deca, Testosterone, and Anadrol.