People with HIV who are treated with anabolic steroids

People with HIV who are treated with anabolic steroids to prevent AIDS wasting may realize modest gains in weight and muscle mass, a new review shows. 13 studies of adults period 24 to 42 with HIV, 294 of whom received anabolic steroids for at least 6 weeks and 238 of whom received placebo. The average weight grow in those taking anabolic steroids was nearly three pounds.

“The magnitude of weight gain observed may be considered clinically relevant,” said lead author Karen Johns, a medical assessment officer from the agency Health Canada. “One hopes there would be greater weight gain with the long-term use of anabolic steroids; however, this has not been proven to date in clinical trials.”
In the most recent issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and property of existing medical trials on a topic.

AIDS wasting, which leads to important 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 extensive sought to reverse this common, destructive result of HIV with mixed success. The wasting stems from loss of the body’s ability to increase muscle and from low levels of testosterone. Anabolic steroids are synthetic substances similar to the male gender 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 little studies of people with wasting. Conversely, anabolic steroids use has been associated with increased rates of HIV in those who share needles or use nonsterile needles when they inject steroids. 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 important weight loss, important fatigue or muscle wasting, and particularly if associated with a significant decrease in libido and erections. If testosterone is in the low or low-standard range then a trial of steroids could be tried. The individual and the clinician should decide what result would constitute a lucky trial: weight gain of 15 pounds, a 30 percent improvement in sense of well-being or a successful erection once a week.”

Use of Testosterone and Anabolic Steroids in Patients Who Have HIV

Decreases in energy, sense of well-being, libido, muscle strength and muscle mass occur often in patients who have persistent diseases, such as HIV infection. When these symptoms were first recognized in HIV-positive patients, they were thought to be manifestations of HIV infection but may possibly be associated with hypothyroidism. Most HIV-infected patients who have hypogonadism have secondary or central hypogonadism, not prime testicular failure. In HIV-infected hypogonadal men, administration of testosterone appears to increase overweight-free mass, muscle mass, and quality of living (increased libido, erectile role, and sense of well-being). Similarly, anabolic steroid hormones appear to increase lean body weight and decrease fat content. Although androgens have been used for the treatment of HIV-related wasting and for hypogonadism, many questions remain unanswered, including those regarding the large-term effects, if any, of suppression of luteinizing hormone and follicle-stimulating hormone, as well as the long-term possibilities of malignancy of the prostate and of hepatocellular cancer. Appropriate doses of the various preparations of testosterone and anabolic steroids have not been determined. For several years, androgens particularly testosterone have been used for the treatment of HIV-related wasting. Despite a substantial cadaver of literature on the topic, there remain a big number of unanswered questions. Perhaps the best place to begin a review of the role of androgens in counteracting wasting is to recall the standard physiology of testosterone.

The testes have 2 principal functions - spermatogenesis and the secretion of testosterone. Spermatogenesis is a function of the Sertoli cells and is stimulated by follicle-stimulating hormone (FSH), which is secreted by the pituitary gland. Negative feedback on the pituitary gland to command the release of FSH is provided by the hormone inhibin, which is thought to be secreted by either the Sertoli cells or the cells of the spermatogenic tubules.
The compound of testosterone begins with the mobilization of cholesterol by the steroid acute regulator protein. The dominant steps implicated in synthesizing testosterone from cholesterol are the development of pregnenolone, 17- -hydroxypregnenolone, dehydroepiandrosterone (DHEA), androstenedione, and testosterone. A less dominant pathway involves the formation of progesterone from pregnenolone, followed by 17-hydroxyprogesterone, androstenedione, and testosterone.

Regardless of the pathway, the rate-limiting step in the synthesis of testosterone is the primary formation of pregnenolone from cholesterol. This movement is catalyzed by the enzyme P-450scc (cholesterol side-chain cleavage enzyme) and is inducible by luteinizing hormone (LH) secreted by the pituitary gland. Once released from the testes, testosterone may be converted to dihydrotestosterone (DHT) in various target cells by the enzyme 5 -reductase. Testosterone may also be converted to estradiol by the enzyme P-450arom (aromatase). Testosterone regulates the secreting of LH through a negative feedback structure. Under normal circumstances, the pituitary gland is very sensitive to the feedback provided by testosterone. In patients who have low blood levels of testosterone, blood levels of LH are increased. Testosterone also acts on the hypothalamic-pituitary axis to suppress the stimulating action of gonadotropin-releasing hormone on the pituitary release of LH.

AIDS Wasting

AIDS wasting syndrome is a condition associated with advanced HIV disease. It involves overall weight loss, but more importantly, the loss of lean cadaver mass, or muscle, which sometimes may be replaced by fat. Weight loss results from a number of factors, alone or in combination, including lack of appetite, nausea, diarrhea, oral problems that build eating difficult, and problems related to intestinal absorption and use of nutrients. The condition was much more prevalent in the developed planet before combination antiviral remedy became available.

A correct diagnosis and the proper intervention for each individual are as important in treating AIDS wasting as they are for any other medical difficulty. Early intervention is often most successful, and a variety of effective and relatively inexpensive tools (such as nutritional supplements, appetite stimulants, and exercise) can be used. HGH is not a universal treatment for treating AIDS wasting. While it can have a dramatically beneficial effect in some individuals (presumably those with a deficiency of natural HGH), the majority may see no good.

The current hGH regimen for AIDS wasting consists of a daily injection administered at bedtime to mimic the natural cycle of growth hormone release into the bloodstream. The dose is 4-6 mg, based upon body weight. HGH alone is likely to effect in weight gain that is primarily fat, while adding a regimen of resistance exercise, such as weight training, can help construct lean cadaver mass. The average cost of HGH remedy for AIDS wasting is approximately $250 per day.

Risks and Side Effects:
Because hGH is a protein that would be destroyed in the stomach and intestines by digestive enzymes, it cannot be taken as a pill and must be injected subcutaneously (under the skin). HGH should not be taken by people with acute critical illness due to complications of open heart or abdominal surgery, multiple accidental trauma, or acute respiratory failure. HGH may stimulate the growth of active tumors and should not be used by people who have cancers that are not under control. HGH also may affect blood triglyceride levels and may increase the risk of developing diabetes in those who are already at risk, particularly people who are obese. Individuals taking insulin may need to have their doses adjusted. In spite of Dr. Kotler's findings, there may be increased cardiovascular risk with long-term HGH use, perhaps related to insulin resistance. Studies of growth hormone have not been conducted in pregnant women.

Up to 50% of all people experience mild to moderate musculature discomfort when starting hGH, and about 25% experience some fluid retention and swelling of the hands and feet. While both generally decrease as the body becomes accustomed to the drug, a significant number of people must stop taking HGH due to these side effects. Some people develop carpal tunnel syndrome (CTS, a condition characterized by numbness, pain, or tingling in the wrists or hands) while taking HGH, CTS typically resolves when the drug is discontinued. Other possible side effects include nausea, diarrhea, flu-like symptoms, and chest pain; only rarely are these severe enough to require discontinuation of treatment.

HIV-patients gain weight and muscle mass with steroids

People who are suffering from the dreaded HIV-virus and making use of anabolic steroids to prevent AIDS wasting tend to gain modest gains in terms of muscle mass and weight, according to a new review. Anabolic steroids are synthetic substances like to the masculine sex hormone testosterone that promote growth of skeletal muscle and the development of man sex characteristics. Although most recently in the news for their misuse by professional athletes, anabolic steroids have valid 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 nonsterile needles when they inject steroids.

We were unable to assess these risks in our review due to the small duration of treatment in the studies. It is worth nothing that AIDS wasting results in considerable loss of cadaver weight in HIV-patients apart from muscle loss. It stems from human body’s inability to promote muscle growth and testosterone levels, which can be effectively handled with anabolic steroids.

AIDS wasting syndrome (cachexia) is a condition associated with advanced HIV disease. It involves overall weight loss, but more importantly, the loss of lean body mass, or muscle, which sometimes may be replaced by fat. Weight loss results from a number of factors, alone or in combination, including lack of appetite, nausea, diarrhea, oral problems that build eating hard, and problems related to intestinal absorption and use of nutrients. The condition was much more prevalent in the developed world before alliance antiretroviral remedy became available.

A correct diagnosis and the proper intervention for each individual are as important in treating AIDS wasting as they are for any other medical problem. Early intervention is often most successful, and a variety of effective and relatively inexpensive tools (such as nutritional supplements, appetite stimulants, and exercise) can be used. HGH is not a universal remedy for treating AIDS wasting. While it can have a dramatically beneficial effect in some individuals (presumably those with a deficiency of natural hGH), the majority may see no benefit. The current hGH regimen for AIDS wasting consists of a daily injection administered at bedtime to mimic the normal cycle of growth hormone release into the bloodstream. The portion is 4-6 mg, based upon body weight. HGH alone is likely to result in weight gain that is primarily overweight, while adding a regimen of resistance exercise, such as weight training, can help build lean cadaver mass.

The human papillomavirus and HIV positive women

HIV positive women respond well to a vaccine against the human papillomavirus (HPV), even when their immune structure is struggling, according to newly published results of an international clinical trial. The study's findings counter doubts about whether the vaccine would be helpful, said the Brown University medical professor who led the study. Instead, the data support the World Health Organization's recommendation to vaccinate women with HIV.

HPV causes cervical and other cancers. The commonly used HPV vaccine Gardasil had not been tested in seriously immune-suppressed women with HIV, said Dr. Erna Milunka Kojic, associate professor of medicine at the Warren Alpert Medical School of Brown University and The Miriam Medical centre. Despite the WHO advice, she said, skeptics have wondered whether the vaccine would be safe and helpful for women with weakened immune systems who were already likely to have been exposed to HPV through sex. Vaccines are often less effective in HIV-positive people.

To address that debate, Kojic's study, dubbed "AIDS Clinical Trials Group Protocol 5240," measured the safety and immune system response of the vaccine in HIV-positive women aged 13 to 45 with a wide range of immune statuses. In the vast majority of the 315 volunteers who were vaccinated at sites in the United States, Brazil, and South Africa, the vaccine built up antibodies against HPV and posed no unusual safety issues during the 28 weeks they were each involved.

"The vaccine works for HIV-infected women in terms of developing antibodies," Kojic said. Co-author Dr. Susan Cu-Uvin, professor of public condition and of obstetrics and gynecology at Brown, said women with HIV are especially susceptible to cervical cancer from HPV because their weakened immune systems are less able to clear the virus. That makes vaccinating HIV-positive women especially important, so long as it's safe and they respond. This is a very safe vaccine. It doesn't have any systemic side effects among these women who are already taking medicine for other conditions. To investigate that response in the context of HIV, the study grouped women by their CD4 cell count, a measure of immune system health. Group A had CD4 counts above 350, group B rested between 200 and 350. Group C was composed of women with counts below 200, the defining level of AIDS for which response to an HPV vaccine had not yet been studied.

Steroid Can Restore Body Tissue in HIV-Positive People

Of the 3 orally dynamic anabolic steroids, Oxandrolone has been studied in HIV-infected patients more extensively than has oxymetholone. Stanozolol is used for the treatment of hereditary angioedema and has not been used for its anabolic effect in this patient populace to any great extent.

One of the earlier studies of Oxandrolone in HIV-infected patients was begun before the introduction of the PIs. Sixty-three HIV-infected men with a deprivation of corpse weight greater than 10% were randomized to receive placebo, oxandrolone, 5 mg/d or Oxandrolone, 15 mg/d. The patients who received 15 mg/d of oxandrolone gained weight throughout the 16-week interval, whereas those who received 5 mg/d of oxandrolone maintained their weight. In contrast, the patients who received placebo continued to lose weight.

In a follow-up study, which has not yet been published, patients were randomized to placebo or to 1 of 3 dosages of Oxandrolone 20 mg/d, 40 mg/d, or 80 mg/d. The patients in the group who received 40 mg/d had the most statistically significant weight gain. However, both the patients in this assembly and those who received 80 mg/d showed important increases in serum levels of liver transaminases.

A study published in 1999 sought to terminate whether a regimen of supraphysiologic doses of androgen (testosterone) plus an anabolic steroid (oxandrolone) would better the LBM and strength gains achieved with advancing resistance exercise in HIV-infected men who had practised weight loss. A second objective of the study was to determine whether antiretroviral remedy with a PI prevented lean corpse anabolism.

All subjects in the study participated in supervised progressive resistance exercise for 8 weeks. At the same period, they received testosterone, 100 mg/wk, by intramuscular injection. Twenty-four eugonadal men were then randomized to either placebo or oxandrolone, 20 mg/d. Twenty-two patients completed the read. The results indicated that compared with patients who received placebo, those who received oxandrolone experienced improved nitrogen weigh (P = .05); increased LBM (P = .005) and increased muscle strength, as judged by either maximum weight lifted (P = .02 to .05) or dynamometry (P = .01 to .05). The results were like regardless of whether the patients were taking a PI. However, compared with placebo, oxandrolone was associated with a statistically significant decrease in blood levels of high-den-sity lipoprotein (HDL) cholesterol (P < .001).

Because all patients in the study participated in progressive opposition training and received testosterone, only an additive effect of Oxandrolone versus placebo was being decided. Therefore, the study appears to be valid even though the number of patients enrolled was little. On the other hand, had the design of the study called for dividing the patients into multiple groups, so that not all patients received testosterone or participated in progressive resistance exercise, the number of patients required to reach statistical significance would have been much higher on the organization of 350.

The conclusions that can be drawn from the study are that Oxandrolone 20 mg/d, added to a program consisting of both progressive resistance exercise and physiologic doses of testosterone improved the anabolic and functional responses in patients who showed HIV-related weight loss.

Only 1 study of oxymetholone in HIV-infected patients has been reported. This study was a nonblinded pilot trial that was completed in Germany and reported in 1996. Patients were randomly assigned to receive either Oxymetholone (14 patients) or Oxymetholone plus ketotifen (16 patients). Ketotifen is an H1-receptor antagonist that has been shown to block tumor necrosis factor A. The patients receiving the medications under study were compared with 30 matched control patients who met the same inclusion criteria, such as advanced HIV infection and chronic cachexia.

At entry into the study, all patients had experienced significant weight loss (greater than 12 kg [26.4 lb]). The average weight get by the patients who received Oxymetholone was 8.2 kg (18 lb), a 14.5% grow over weight at entry (P < .001). The average weight gain by the patients who received association therapy was 6.1 kg (13.4 lb), a 10.9% increase over weight at entry (P < .005). The untreated control patients lost an average of 1.8 kg (4 lb). Both groups of treated patients showed improvement in the ability to perform activities of daily living and in several quality-of-life variables. Although this study was not a double-blind clinical trial, the investigators believed that the results suggested the need for a randomized, double-blind, placebo-controlled, multicenter trial.

Risk of AIDS among athletes who use anabolic steroids

Sometimes, athletes who use anabolic steroids may share the needles, syringes or other equipment they use to introduce these drugs. By sharing needles, syringes or other equipage, a individual becomes a great danger for HIV transmission. HIV is the virus that causes AIDS.

If a person shares needles, syringes and other equipment to inject steroids into the vein (IV), in the muscles or under the skin, small amounts of blood from the individual infected with HIV may be injected into the bloodstream of the next person to use the equipment. HIV attacks the body's defense system, making the body less able to fight off infections and cancers. There's no vaccine or cure for HIV or AIDS. People who may have been exposed to HIV should be tested. If they find out they have the virus, they can start treatment early. You can't tell just be looking at someone if he or she has HIV. And, since someone can be infected with HIV for many years without having any symptoms, some people may not know they have HIV. Anyone who has ever shared a needle to shoot any drugs even once could become infected with HIV and should be tested.

The importance of exercise has become a mantra for many people, those trying to stay healthy and those with a chronic sickness - HIV included. But when you have HIV, exercise becomes an significant part of disease management. Regular exercise can help you cope with many of the common side effects caused by the ailment and the drugs you must take, says Nelson Vergel, founder of the Cadaver Positive Wellness Clinic in Houston. Exercise not only increases lean muscle mass and heart and lung function, but it also helps you "improve your self-image and mental outlook," says Vergel, co-author of Built to Survive, which examines the importance of diet and exercise in people who are HIV-certain.

Ergogenic aids are substances that some athletes use to better strength and stamina. Anabolic steroids are one class of ergogenic aid that many adults and even adolescents often employ in their efforts to improve their athletic performance and advent. According to the American College of Sports Medicine, individuals who are experienced in weight lifting and employ the use of anabolic steroids will experience increases in strength and muscle significantly beyond those from training alone. It is this need to win and get a competitive edge that drives athletes to seek a variety of ergogenic aids.

Effects of anabolic steroids:
Anabolic steroids, favourite among athletes and corpse-builders, increase muscle mass. A variety of types are combined in a procedure called "stacking," which athletes use to gain the best attributes from each particular medication. "Blood doping" increases red blood cell content, which improves muscular stamina. Red blood cells transport oxygen to the working muscles. Obtaining a higher percentage of transport vehicles allows the muscles to work harder and for a longer duration without weariness. Some pharmacological drugs such as beta blockers can be used to reduce anxiety and tremors. This is useful for individuals competing in sports that require smooth, focused movements, such as archery or shooting.