Risk of invasive pneumococcal disease remains high for people living with HIV

The risk of cancer is increased twofold for people with HIV compared to individuals in the general population, Danish investigators report in the online edition of AIDS. But the increased risk was almost entirely due to higher incidence of smoking-related cancers and also malignancies caused by viral infections. The risk of other cancers did not differ between the people with HIV and people who did not have HIV.

“In the present study we found that the increased risk of non-AIDS cancer was largely confined to cancers associated with smoking and viral infections,” write the authors. “The risk of cancers that are not considered strongly related to smoking or viral infections did not differ between the HIV-infected and the background population, and the impact of immune deficiency was limited.”

Non-AIDS-related cancers are an increasingly important cause of serious illness and death among people with HIV. The exact causes are uncertain. However, possible explanations include high rates of smoking, a high burden of viral co-infections such as hepatitis C virus (HCV) and human papillomavirus and immune suppression caused by HIV.

Investigators from Denmark wanted to establish the proportions of cancers in people living with HIV attributable to smoking, viral infections, and HIV-related immune suppression.

They therefore compared the incidence of cancer between people with HIV and matched controls in the general population. Results were stratified according to smoking status and immune deficiency. Cancers were categorised as smoking-related, virus-related or 'other'.

The HIV-positive population consisted of 3503 individuals who received care between 1995 and 2011. Their average CD4 count at baseline was 450 cells/mm3. At the time of inclusion in the study, 77% were taking HIV therapy and, for 92% of follow-up time, the people with HIV were taking antiretroviral therapy.

The control population consisted of 12,979 individuals. There were 157 cancer diagnoses among the people living with HIV compared to 255 diagnoses among the controls. The overall incidence of cancer was twice as high in people with HIV compared to the controls (IRR = 2.0; 95% CI, 1.6-2.5).

The incidence of cancers related to viral infections was almost twelvefold higher in the HIV-positive population than in the HIV-negative controls (IRR = 11.5; 95% CI, 6.5-20.5). Incidence of smoking-related cancers was almost threefold higher among people with HIV (IRR = 2.8; 95% CI, 1.6-4.9). The risk of other cancers did not differ between the people living with HIV and the HIV-negative controls.

Incidence of smoking-related cancers associated with current smoking was significantly higher among the people living with HIV (IRR = 21.35; 95% CI, 2.88-158.5) than the controls (IRR = 4.12; 95% CI, 1.74-9.78). For the people with HIV, a lowest-ever (nadir) CD4 count below 200 cells/mm3 was associated with a more than threefold increase in the risk of lung cancer (IRR = 3.54; 95% CI, 1.00-12.59). No patients with a nadir CD4 count above 200 cells/mm3 developed a smoking-related cancer.

Smoking-related and virus-associated malignancies accounted for 23% and 43% of cancers diagnosed in the HIV-positive population. Virological cancers were rare in the controls. The fractions of all cancers in the HIV-positive population attributable to smoking and viral infections were 27% and 49%, respectively.

For cancer types considered associated with smoking, the proportion attributed to smoking was 91%. The proportion of virus-related cancers attributed to having HIV was also 91%.

For cancers not strongly related to smoking or viral infections, the proportion attributable to being HIV positive and immune deficiency were 0%.

Deca Durabolin highly effective drug

Deca Durabolin has an active life of 14-16 days and is detectable over a period of 16-18 months. Belonging to the category of anabolic-androgenic steroids and classified as a 2.16 anabolic steroid, Deca is a highly effective drug that is available in different forms such as creams, pills, capsules and gels. Medically, the drug is advised to stimulate immune system enhancements and offer dramatic relief to HIV/AIDS patients and even treat specific blood disorders as part of the adjuvant therapy. This steroid is used by sportsmen to benefit from the improved recuperation time between workouts, protein synthesis, and nitrogen retention. Nandrolone is the base hormone, but it is better known under the trade name Deca Durabolin, which contains Nandrolone Decanoate. This popular preparation takes the Nandrolone hormone and adds a Decanoate ester chain. This ester chain is attached during the manufacturing process and it serves dual purposes. The main purpose is to make the hormone oil soluble, so it can be put in an amp or multi-dose vial. The second purpose of this ester chain is to slow-release the steroid by keeping deca from interacting with androgen receptors until the ester chain is cleaved off by enzymes in your body. Since Nandrolone Necanoate cannot attach to an androgen receptor until enzymes in your body have cleaved off the Decanoate ester, it causes the steroid to slow-release into your system over many days. For medical use, the ester’s main function is to allow the hormone to be injected only once every 3 weeks. However, bodybuilders may inject Deca Durabolin weekly or as often as every three days.

Moreover, this steroid is admired as its use even for long anabolic steroid cycles does not result in side effects like oily skin, male pattern baldness, and prostate complications. If that was not all, Deca use is considered of great use to mask minor joint pain and old nagging injuries besides reducing the inflammation of soft tissues and promoting masculine (secondary sexual) characteristics, including growth of the vocal cords, testicles, and body hair. This steroid is commonly used in doses of 300-800 mg per week by men and 50-100 mg per week by women or in doses of 600 mg per week for 12-16 weeks by men for bulking cycles and 400 mg per week for 12-16 weeks by men in cutting cycles.

A popular Deca Durabolin cycle is all about using Dianabol-30 mg every day for week 1-3 and then 40 mg every day for week 4-6 and complementing it with Sustanon 250 mg every week for week 1-12, Clomid 50 mg every week for week 10-12, and Deca Durabolin-200 mg for the first week and then 300 mg per week for 2nd and 3rd weeks, and 400 mg every week for 4th and 5th weeks, and 300 mg every week for the sixth week. Overdosing or use of low grade or abuse of Deca Durabolin can lead to side effects such as may even cause heart attack, edema, prostate enlargement, menstrual problems, liver toxicity, liver damage, and gynecomastia (female-like breasts). It may even cause elevated blood pressure, shrinking of the testicles, bone age advancement, bad effect on cholesterol levels, increased aggression, oily skin, acne, clitoral hypertrophy, infertility, and sexual dysfunction.

Side Effects:   
Side effects with Deca are much less than other steroids such as straight testosterones.  In fact, people choose Deca for this reason.  It’s not toxic to the liver and not particularly toxic to other organs of the body, and it’s highly effective.  That makes for a potent muscle-building brew; one you can really sink your teeth into without the threat of a lot of consequence.  It’s not, however, totally without them. Knowing how vain most bodybuilders truly are, most are thrilled that Deca doesn’t have acne as a side-effect.  In rare cases, there will be slight breakout, but not among the majority.  Now, that’s when you take 400mg/week.  But like anything worth doing, Deca is worth overdoing.  Right in the neighborhood of 600-1000mg/week is what I’m talking about.  This is where side effects begin to emerge and where you need to be aware of what they are.  Attitude can get hostile, sex drive can be out of control, sperm production can be non-existent (with prolonged use) and headaches can prevail. Also, the more you take, the more water you’ll have just beneath the skin to smooth out your appearance.  It really depends upon how vain you are. 

Pain in people with HIV

Pain is experienced through a complex set of interactions between parts of the body where pain is located,  the central nervous system in the spine; and the brain. These interactions occur via signals that travel back and forth between these parts of the body to make a person aware of pain, its location and its intensity.

Types and levels of pain vary by individual and the respective stage of HIV infection.  Almost all people in very advanced stages of infection experience pain.

 The various types of pain include:
- Neuropathic pain: Pain that attacks the nervous system is very common, and felt by around 30 percent of people with AIDS. It particularly affects the feet, hands and face, and has a tingling, burning or numbing effect.
- Headaches: These vary in intensity and can result from a wide range of factors including muscle tension, stress, sinusitis, migraine, and infection of the nervous system.
- Gastrointestinal pain: This affects all areas of the digestive system including the throat, stomach and intestines. Mouth ulcers and cold sores also affect the lips which can make eating difficult.
- Chest pain: This can be caused by opportunistic infections such as tuberculosis and bacterial pneumonia.

Aside from creating discomfort and distress, pain can also be a major hindrance to living a productive, fulfilled life. People with HIV who experience pain may not be able to earn a living, care for their families, or take part in social activities to the extent they would were they not in pain. Friends and family too may have to divert time from other activities to care for their loved-one in pain. Pain and its effect on life can also lead to emotional problems such as depression and anxiety.

Pain relief should be seen as a vital component of HIV treatment itself. If painful side effects of antiretroviral drugs can be averted through effective pain control, people will be more inclined to adhere to their treatment, and will be able to stop the replication of HIV far more effectively. Additionally, a USA-based study found that people living with HIV who experienced pain were 50 percent less likely to attend their medical appointments. Assessment of pain should be carried out before and during the treatment of pain in order to effectively control the pain and amend the treatment, if necessary. The various assessments include physical checks that may identify a particular symptom as the cause of the pain; having the patient describe how and when pain is at its worst or best; and examining the patient’s medical and psychosocial history and background, including a history of substance use and abuse, that may influence subsequent treatment.

No one besides the individual can more accurately say how much pain someone is in and therefore the patient should be at the center of pain assessment:

When being assessed, patients can be asked to describe their pain intensity on a variety of scales including a 0-10 range with “0” being “No pain” and “10” being “Worst possible pain”; a descriptive scale with, for example, the patient describing their pain as “moderate” or “severe”; or simply on a line, with pain increasing further along the scale. Children or speakers of other languages may convey their pain by selecting from a series of illustrations depicting different levels of happiness or sadness.

The Brief Pain Inventory is widely used to assess pain. It asks patients not only to explain the location and intensity of pain, but also to describe how it interferes in seven areas of life including work, walking, mood and relations with others.