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.

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.

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.

Drug for reduction of abdominal fat in HIV patients may also reduce fatty liver disease

The only drug to receive FDA approval for reduction of the abdominal fat deposits that develop in some patients receiving antiviral therapy for HIV infection may also reduce the incidence of fatty liver disease in such patients. The International AIDS Conference - Massachusetts General Hospital (MGH) investigators report that daily injections of Tesamorelin significantly reduced fat in the liver without affecting glucose metabolism.

"Tesamorelin's ability to reduce liver fat in conjunction with the reduction of abdominal fat may be clinically important for patients with HIV infection who have fatty liver disease along with increased abdominal fat," says Steven Grinspoon of the MGH Neuroendocrine Unit and Program in Nutrition Metabolism, the study's senior author. "While some patients with nonalcoholic fatty liver disease have a benign course, others may develop a more serious condition involving liver inflammation, cellular damage and fibrosis, which can progress to cirrhosis and end-stage liver disease or to liver cancer."

Between 30 and 40 percent of HIV-infected patients develop nonalcoholic fatty liver disease (NAFLD), often but not always in conjunction with lipodystrophy, the abnormal abdominal fat accumulation that develops in 20 to 30 percent of patients receiving antiretroviral drugs. Tesamorelin stimulates the body's release of growth hormone, which is reduced in HIV lipodystrophy and several studies by Grinspoon's team and others led to the 2010 approval of the drug to treat the lipodystrophy.

In designing the current study, the MGH team originally planned to further investigate tesamorelin's effects on abdominal fat with a secondary focus on fat in the liver and muscle, and on markers of inflammation and cardiovascular risk. But since several studies suggested a significant incidence of NAFLD in HIV-infected patients, the study's goals were broadened to focus on Tesamorelin's ability to reduce fatty deposits in the liver as well as abdominal fat in general. The study enrolled 48 adult patients who were receiving antiretroviral treatment for HIV and had developed excessive abdominal fat deposits. Participants were first randomized to receive daily injections of either Tesamorelin or a placebo. In addition, since growth hormone treatment can lead to increased blood sugar levels and reduced insulin sensitivity, half of those in each group also had a procedure that analyzes insulin secretion and resistance at the study's outset and at assessment sessions conducted at three months and at the end of the six-month study. The assessments also included comprehensive measures of factors related to HIV infection, lipid and glucose metabolism, along with analysis of abdominal fat by CT scan and of liver fat by MR spectroscopy.

At the end of the study period, participants receiving Tesamorelin had a significant, modestly sized decrease in liver fat along with the expected reduction in overall abdominal fat. Those receiving placebo treatment had increases in both measures. Although Tesamorelin treatment did appear to have reduced insulin sensitivity and raised blood sugar levels at the three-month assessment, by six months both measures had returned to levels observed at the study's outset, implying that the drug's impact on glucose metabolism was only temporary.

"Tesamorelin's neutral long-term effects on insulin sensitivity and glucose are important, since HIV patients with abdominal fat accumulation may have underlying insulin resistance, so it's important to know that won't be worsened by this treatment," says Grinspoon, a professor of Medicine at Harvard Medical School. "Since we know that liver fat is associated with inflammation in the liver, reducing it may result in less inflammation. Indeed levels of AST, a marker of liver inflammation, were reduced in response to tesamorelin in our study.

One of Favorites Anabolic Steroids and immune system

Primobolan is generally advised in case of men suffering from the deficiency of a hormone known as androgen in men. In some rare instances this drug has also been advised to treat a condition known as aplastic anaemia which is mainly characterised by the deficiency of blood cells. In some other instances it has been advised to counter the abnormal weight loss associated with certain disorders or following major trauma. It is illegal to obtain and use Primobolan without being prescribed by the doctor.
Primobolan has been advised for women suffering with breast cancer in some instances as it has been believed to aid in the reduction of the tumor size. The anabolic steroids such as Primobolan reduce the excretion of nitrogen from the tissue. This retention of nitrogen within the muscle tissues aids in the building of muscle mass to a certain extent. The muscle building effect may be present to a certain extent while no clear evidence about enhancement in athletic performance has been observed with the use of Primobolan.

Primobolan supposedly burns fat thereby reducing its amount in the body. This effect of Primobolan has increased its popularity among athletes who look at building a lean mass with less fat in their body. Further it has been stated that Primobolan prevents wasting of muscles and reverses the effects of anaemia. Anabolic steroids may enhance the formation of blood cells in some instances. In case of individuals suffering from chronic immune disorders such as AIDS, Primobolan has been advised as immune booster drug.

Being described as Arnold Schwarzenegger’s favorite steroid, Primobolan is widely abused in sports and bodybuilding. It is considered that it Primobolan builds strength with adding bulk to the muscles. Primobolan is generally more favoured by athletes as it helps them to maintain a lean body mass while improving the ability of the muscles to contract. Also it has been proposed that it is not associated with the common side-effects of other steroids such as acne, water retention, infertility and others. In case of body builders, it is used during the bulking or cutting cycles.

Chronic abuse of Primobolan is associated with a number of adverse effects. Providing a constant supply of synthetic steroids to the body can have a multitude of side-effects on the normal functioning of various organs in the body. The body regularly requires steroids at a controlled level and is generally produced within our body. Loading up the body with steroids though may provide benefit to a certain extent, the harmful effects always have an upper hand. Some of the major effects have been discussed below.
Effect on heart

Prolonged use of Primobolan has been associated with a wide number of effects both directly and indirectly on the heart. An increase in the blood pressure is commonly noted. Other effects such as abnormal changes in the cells and tissues of the heart and premature onset of heart related disorders are also noted in chronic abusers of anabolic steroids. Occurrence of stroke has been reported in anabolic steroid abusers. Other neurological symptoms such as mania, hallucinations, mood swings and depression have also been associated with the abuse of Primobolan.

Ingestion of high doses of Primobolan within short interval periods can result in vomiting and gastric irritation. Primobolan can alter the normal functioning of the liver resulting in the elevation of certain enzyme levels that can often be harmful. At times, it results in the increased incidence of jaundice in chronic abusers. Excessive use of anabolic steroids such as Primobolan can result in a condition called peliosis hepatitis. This abnormal condition of the liver is generally characterized by the formation of cysts (fluid filled cavities) in the liver. These cysts affect the liver function and at times result in liver failure which may lead to life threatening situations. The incidence of liver tumors is also noted to be increased in individuals who abuse Primobolan. Increased occurrence of cancer of the prostate gland has been noticed in anabolic steroid abusers. Prolonged use of Primobolan is associated with increased proliferation of the cells and tissues of the prostate gland, a condition commonly referred to as prostate hypertrophy.

HIV-1 and immune system

Of the two major types of HIV, only one, HIV-1, typically causes AIDS in infected people who don't receive treatment. A study published by Cell Press November 21st in the journal Immunity reveals how HIV-1 escapes detection by essentially becoming invisible to a patient's immune system, whereas HIV-2 triggers protective immune responses in patients. This understanding of how HIV-1's "invisibility cloak" works could lead to the development of effective vaccines against HIV-1.

"Our study shows for the first time exactly how immune cells sense the virus and how the virus uses one of its proteins to tune its stealthiness and infectivity," says senior study author Nicolas Manel of the Institut Curie. "We also show how to modify the virus so that it is properly recognized and leads to a beneficial immune response."

Individuals who are infected with both HIV-1 and HIV-2 do better than those infected with HIV-1 alone, suggesting that the immune response against HIV-2 protects against the effects of HIV-1 infection. While searching for an explanation in previous studies, Manel and his collaborators found that HIV-2, but not HIV-1, naturally infects and activates dendritic cells, which play a major role in triggering protective immune responses. But until now, it was not known how HIV is detected in dendritic cells.

In the new study, Manel and his team focused on the capsid—the protein shell of a virus that encloses its genetic material. By mutating HIV-1 and HIV-2 capsids, they discovered that these viral proteins control the ability of dendritic cells to sense the viruses and activate immune responses.

The researchers found that the HIV-1 capsid allows the virus to escape detection by dendritic cells under normal conditions. But when they mutated the HIV-1 and HIV-2 capsids, the dendritic cells produced immune responses without getting infected by the viruses. These cells relied on a protein called cyclic GMP-AMP synthase (cGAS) to sense the viral DNA in the cytosol before the foreign DNA became integrated into the host genome.

These findings open new avenues for the development of effective treatments against HIV-1. "By modifying the capsid of a virus, we could engineer a virus that is both better recognized by the immune system and that has also lost its ability to infect cells," Manel says. "Beyond capsid-mutated viruses, our results suggest that activating the cGAS pathway in dendritic cells could induce immunity against HIV-1.

Anabolic steroids for the treatment of weight loss in HIV-infected people

Individuals with HIV infection often lose weight during the course of their disease. Furthermore, low serum concentrations of testosterone are common in individuals with HIV infection, particularly those with weight loss. Treatment of weight loss with anabolic steroids in HIV-infected individuals may be beneficial. Randomized controlled trials that compared the use of an anabolic steroid to placebo to treat weight loss in adults with HIV were included. Randomized controlled trials that compared the use of anabolic steroids to placebo for the treatment of weight loss in adults with HIV were selected. Change from baseline in lean body mass or in body weight was reported as on outcome measure.

Two reviewers independently assessed the trials for quality of randomization, blinding, withdrawals and adequacy of allocation concealment. For continuous data, weighted mean differences (WMD) were calculated. For dichotomous outcomes, risk differences, were calculated. Because of uncertainty as to whether consistent true effects exist in such different populations and treatments, the authors decided a priori to use random effects models for all outcomes.

Thirteen trials met the inclusion criteria. Two hundred ninety-four individuals randomized to anabolic steroid therapy and 238 individuals randomized to placebo were included in the analysis of efficacy for change from baseline in lean body mass. Three hundred forty-three individuals randomized to anabolic steroid and 286 randomized to placebo were included in the analysis of efficacy for change from baseline in body weight. The mean methodological quality of the included studies was 4.1, of a maximum 5 points. Although significant heterogeneity was present for both outcomes, the average change in lean body mass was 1.3 kg (95% CI: 0.6, 2.0), while the average change in total body weight was 1.1 kg (95% CI: 0.3, 2.0). A total of eight deaths occurred during the treatment period; four in the anabolic steroid treatment groups and four in the placebo-treatment groups (risk difference 0.00, 95% CI -0.03, 0.03). The risk difference for withdrawals or discontinuations of study medication due to adverse events was 0.00 (95% CI: -0.02, 0.03).

Although the results of the trials were heterogeneous, on average, the administration of anabolic steroids appeared to result in a small increase in both lean body mass and body weight as compared with placebo. While these results suggest that anabolic steroids may be useful in the treatment of weight loss in HIV infected individuals, due to limitations, treatment recommendations cannot be made. Further information is required regarding the long-term benefit and adverse effects of anabolic steroid use, the specific populations for which anabolic steroid therapy may be most beneficial and the optimal regime. In addition, the correlation of improvement in lean body mass with more clinically relevant endpoints, such as physical functioning and survival, needs to be determined. Testosterone has been demonstrated to increase muscle mass and lean body mass in testosterone-deficient but otherwise healthy men.
Individuals with HIV infection often lose weight and have low blood levels of testosterone; thus, the use of anabolic steroids in the treatment of weight loss in individuals with HIV infection may be beneficial.

The purpose of this review was to evaluate anabolic steroids as a means of treatment of weight loss in individuals with HIV infection.
However, the results were not consistent among individual trials and the average increase was small and may not be clinically relevant.
Furthermore, the results need to be interpreted with caution as this meta-analysis was limited due to small sample sizes, short duration of treatment and of follow-up; and heterogeneity of the study populations, the anabolic interventions, and concomitant therapies.
Furthermore, low serum concentrations of testosterone are common in individuals with HIV infection, particularly those with weight loss. Our objectives were to assess the efficacy and safety of anabolic steroids for the treatment of weight loss in adults with HIV infection. Androgen deficiency is a common endocrine abnormality among men and women with human immunodeficiency virus (HIV) infection. Low testosterone concentrations are associated with lower CD4 cell count, advanced stage of illness, medication use, and weight loss. Signs and symptoms may be nonspecific. The most useful laboratory indicator is the serum bio available (free) testosterone concentration. A number of different testosterone preparations for treatment of androgen deficiency in HIV-infected men now exist. Administration of testosterone significantly increases weight and lean body mass, energy, quality of life, and depression scores in HIV-infected men with low testosterone levels. Newer trans dermal and gel preparations provide more-consistent steady-state dosing but are not as well tested, and sufficient testosterone concentrations may not be achieved with their use. Androgen deficiency is also common among HIV-infected women. Preliminary studies suggest that use of physiological testosterone administration, to achieve testosterone levels within the normal range, is of benefit in HIV-infected women, but further studies are necessary to define the therapeutic role of androgen therapy in this population.