Friday, April 3, 2015

How to Stop Weight Loss While HIV Positive people

HIV-positive people often experience rapid weight loss, commonly referred to as wasting. Wasting happens to people both on and off HIV medications. People experiencing wasting can lose 5 to 10 percent or more of their total body weight in just six months. Not all of the weight lost is body fat. In fact, large portions of lost mass can come from tissue and muscle. Keep in mind that each person's body responds differently to HIV and some will still experience weight loss despite their best efforts to prevent it. Human immunodeficiency virus (HIV) causes acquired immunodeficiency syndrome (AIDS) by destroying CD4+ "helper T cells". In healthy individuals, helper T cells organize immune responses that protect the body from infection. When HIV invades the human system, it binds to co-receptors (typically CXCR4 or CCR5) on the surfaces of CD4+ cells and macrophages and introduces viral genetic material into these cells.

Once HIV has gained entry into the host cell, viral RNA is reverse transcribed into viral DNA and combines with the DNA of the host cell—so as the infected cell replicates, so, too, does the virus. Reverse transcription from viral RNA to viral DNA is a target for some antiviral drugs. As CD4+ cell levels become depleted with advancing HIV infection, viral replication within macrophages, dendritic cells and other cell types sustains viral load. HIV can be categorized based on its interaction with surface co-receptors during attachment and entry into host cells. Three primary entry methods comprise a large percentage of HIV cases – R5, which utilizes the receptor CCR5 to gain entry, X4, which uses the CXCR4 co-receptor, and X4R5, which uses both.

Given the dependency upon these cell-surface co-receptors for entry, some strains of HIV are unable to infect individuals who harbor mutations in the gene encoding the co-receptor. These people are resistant to the subtype(s) of HIV that would normally utilize a wild-type receptor to gain entry into host cells.

Make sure you're eating, at minimum, enough calories to maintain your weight. Also take into account additional calories you burn through exercise. Talk to your doctor about appetite-enhancing drugs that can counter the appetite-suppressing effects of many HIV medications. Try multiple small meals and snacks throughout the day if you have trouble finishing the regular three meals. Work with your doctor to find the right HIV medication regimen. Opt for one that controls your disease progression with the fewest side effects. HIV medications, and HIV itself, can cause diarrhea, vomiting, mouth sores and side effects that limit your ability to eat foods or absorb nutrients. Sometimes tweaking medications or adding new ones to your treatment plan can help with side effects.

Weight lift or do strength-training exercises at least two to three times per week. These activities will help build up muscle tissue and prevent muscle loss associated with wasting. Work each major muscle group, including your arms, legs, back, chest, shoulders and abdominal muscles. Never work the same muscle group two days in a row to help prevent muscle injury. Even lifting very small weights at home can help. Talk to a counselor or therapist about your feelings associated with your illness. HIV patients often experience depression, which can contribute to a loss of appetite or disinterest in taking good care of yourself. Work with your therapist to develop a treatment plan that may include medications, coping strategies, group therapy and support groups.
Consider prescription treatments that build up muscle strength and tissue. Ideal medications will also prevent muscle and tissue loss, according to the Tufts University School of Medicine. Treatments include steroids, testosterone injections and human growth hormone. Talk to your doctor to see if one or more of these treatments has benefits that outweigh their risks.

AIDS wasting, which leads to significant weight loss in people with HIV, causes severe loss of weight and muscle and can lead to muscle weakness, organ failure and shortened lifespan. Researchers have long sought to reverse this common, destructive effect of HIV with mixed success. The wasting stems from loss of the body’s ability to grow muscle and from low levels of testosterone. Anabolic steroids are synthetic substances similar to the male sex hormone testosterone that promote growth of skeletal muscle and the development of male sexual characteristics.

Although most recently in the news for their misuse by professional athletes, anabolic steroids have legitimate medical application for men with low testosterone and people with certain types of anemia. Two anabolic steroids available in the United States, Nandrolone Decanoate and Oxandrolone, have been used to help increase weight and muscle mass in small studies of people with wasting.  Conversely, anabolic steroid use has been associated with increased rates of HIV in those who share needles or use non sterile needles when they inject steroids.

In the review studies, anabolic steroids were administered to patients either orally or by injection. The main side effects were mild and included abnormal liver function tests; acne; mild increase in body hair; breast tenderness; increased libido, aggressiveness and irritability; and mood swings — all common side effect of anabolic steroid use. “The risks and side effects of taking anabolic steroids long-term are certainly of concern,” Johns said. “We were unable to assess these risks in our review due to the short duration of treatment in the studies.”

Wayne Dodge, the HIV/AIDS program director at the Group Health Cooperative in Seattle, suggests that clinicians should obtain blood testosterone levels, “if an HIV-infected individual has had significant weight loss, significant fatigue or muscle wasting, and particularly if associated with a significant decrease in libido and erections. If testosterone is in the low or low-normal range then a trial of steroids could be tried. The individual and the clinician should decide what result would constitute a successful trial: weight gain of 15 pounds, a 30 percent improvement in sense of well-being or a successful erection once a week.”

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