Effect of Human Growth Hormone on Exercise Capacity in Patients With HIV

Over 700 patients with HIV-associated wasting while receiving HAART were randomly assigned to double-unsighted treatment for 12 weeks with recombinant human growth hormone (rhGH) daily or on alternate days, or to placebo. Maximum exercise intensity increased by a median of 2.35 kJ in the alternate-days group and 2.60 kJ in the daily group but decreased by 0.25 kJ in the placebo group. The median difference between the daily and placebo groups was 2.85 kJ (P < .0001). These improvements suggest that rhGH treatment may enable patients with wasting to perform activities of daily living that would be exhausting without rhGH treatment.

Wasting, characterized by loss of body weight and lean tissue, including skeletal muscle, was a common display of HIV infection before the introduction of HAART. Studies in the 1980s showed that wasting was an independent danger element for mortality in patients with AIDS and that there was a manage relationship between the degree of wasting and the danger of death. Despite the success of HAART in improving survival of patients with HIV infection in the developed earth, weight loss remains an independent predictor of mortality in the HAART interval.

Therefore, HIV-related wasting represents an significant clinical difficulty in the management of HIV infection. A low functional capacity, characterized by low maximal aerobic capacity compared with that of duration-matched healthy persons, is an significant manifestation of HIV infection. This may be attributable to the adverse effects on muscular function from mitochondrial damage that is caused by nucleotide reverse transcription inhibitor (NRTI) antiretroviral medication use, as well as to the loss of muscle tissue, which constitutes part of the wasting syndrome.

Treatment options for patients with HIV-related wasting include nutritional advice and exercise; testosterone replacement treatment is also indicated in men with gonadal dysfunction. In adding, the use of recombinant human growth hormone (rhGH) has attracted increasing attention as a potential treatment, after initial reports that this agent promotes nitrogen retention and protein synthesis in patients with HIV infection.

In an original randomized placebo-controlled trial conducted before the introduction of HAART, treatment with rhGH, 6 mg daily (DD) for 12 weeks, in patients with HIV-related wasting produced signifi -cant improvements compared with placebo in corpse weight, lean cadaver mass (LBM), and practise capacity on a treadmill. Subsequently, a great double-blind placebo-controlled study was designed to investigate the effects of rhGH remedy on exercise capacity, cadaver weight, and body composition in HIV-infected patients with wasting who were receiving HAART. The prime efficacy end point of the study was change in greatest train intensity from baseline to 12 weeks. The initial results of the study have been reported elsewhere. Here we present-day a more detailed examination of the exercise content data from this study and consider the implications of the patient's ability to effect daily tasks without excessive fatigue.

Anabolic Steroids Help People with HIV Gain Weight

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. The review covered 13 studies of adults age 24 to 42 with HIV, 294 of whom received anabolic steroids for at least six weeks and 238 of whom received placebo. The average weight increase 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.”
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 nonsterile 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 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.” The reviews authors conclude that further studies are needed to determine if increase in weight leads to improved physical functioning and quality of life, and ultimately increased survival, as well as the potential for serious side effects, especially with prolonged use.

The effects of anabolic steroids on people with immune hormone deficiency

Anabolic steroids are synthetically produced variants of the naturally occurring male sex hormone testosterone. "Anabolic" refers to muscle-structure, and "androgenic" refers to increased man sex characteristics. "Steroids" refers to the class of drugs. These drugs can be legally prescribed to treat conditions resulting from steroid hormone deficiency, such as delayed puberty, as well as diseases that effect in loss of lean muscle mass, such as cancer and AIDS.

Some people, both athletes and non-athletes, abuse anabolic steroids in an attempt to enhance performance and improve physical appearance. Anabolic steroids are taken orally or injected, typically in cycles rather than continuously. "Cycling" refers to a pattern of use in which steroids are taken for periods of weeks or months, after which use is stopped for a interval of period and then restarted. In addition, users often combine several different types of steroids in an attempt to maximize their effectiveness, a practice referred to as "stacking."

The immediate effects of anabolic steroids in the brain are mediated by their binding to androgen (male sex hormone) and estrogen (female sex hormone) receptors on the surface of a cell. This anabolic steroids receptor complex can then shuttle into the cell nucleus to influence patterns of gene expression. Because of this, the acute effects of anabolic steroids in the brain are substantially different from those of other drugs of abuse. The most significant difference is that anabolic steroids are not euphorigenic, meaning they do not trigger rapid increases in the neurotransmitter dopamine, which is responsible for the "great" that often drives substance abuse behaviors. However, long-term use of anabolic steroids can eventually have an impact on some of the same brain pathways and chemicals such as dopamine, serotonin, and opioid systems that are affected by other drugs of abuse. Considering the combined result of their complex direct and indirect actions, it is not surprising that anabolic steroids can affect mood and behavior in significant ways.
Preclinical, clinical, and anecdotal reports suggest that steroids may contribute to psychiatric dysfunction. Research shows that abuse of anabolic steroids may lead to aggression and other adverse effects. For example, although many users report feeling right about themselves while on anabolic steroids, extreme mood swings can also occur, including manic-like symptoms that could lead to violence. Researchers have also observed that users may suffer from paranoid jealousy, extreme irritability, delusions, and impaired judgment stemming from feelings of invincibility.

Animal studies have shown that anabolic steroids are reinforcing that is, animals will self-administer anabolic steroids when given the opportunity, just as they do with other addictive drugs. This property is more hard to demonstrate in humans, but the potential for anabolic steroids abusers to become addicted is consistent with their continued abuse despite physical problems and negative effects on social relations. Also, steroid abusers typically spend large amounts of time and money obtaining the medication: this is another indication of addiction. Individuals who abuse steroids can experience withdrawal symptoms when they stop taking anabolic steroids these include mood swings, fatigue, restlessness, loss of appetite, insomnia, reduced sex drive, and steroid cravings, all of which may contribute to continued abuse. One of the most dangerous withdrawal symptoms is depression when persistent, it can sometimes lead to suicide attempts.

Research also indicates that some users might turn to other drugs to alleviate some of the negative effects of anabolic steroids. For example, a study of 227 men admitted in 1999 to a private treatment center for dependence on heroin or other opioids found that 9.3 percent had abused anabolic steroids before trying any other illicit drug. Of these, 86 percent first used opioid to counteract insomnia and irritability resulting from the steroids. There has been very little research on treatment for anabolic steroids abuse. Current knowledge derives largely from the experiences of a little number of physicians who have worked with patients undergoing steroid withdrawal. They have learned that, in general, supportive therapy combined with training about possible withdrawal symptoms is sufficient in some cases. Sometimes, medications can be used to restore the balance of the hormonal system after its disruption by steroid abuse. If symptoms are severe or prolonged, symptomatic medications or hospitalization may be needed.

Injections of anabolic steroids carry the risk for infection with AIDS or hepatitis

Anabolic steroids are drugs thatare forms of the hormone testosterone. They are known for their effects on muscle. However, they also have effects like growth of facial hair, deepening of the voice, and changes in behavior.
Anabolic steroids are occasionally prescribed to help AIDS patients gain weight and to treat some types of severe anemia. These drugs are also used illegally by some athletes to improve performance, and by others to get a more muscular appearance. Anabolic steroids have dangerous physical and psychological side effects. These may be more dangerous in young adults because they can stop growth, and in females they can cause permanent changes in the voice and genitals.
After stopping these drugs, people can experience severe depression and moodiness. Injections of anabolic steroids carry the risk for infection with AIDS or hepatitis if needles are shared. Anabolic steroids obtained without a prescription are unreliable and may contain additional substances and may not even contain the steroids.
Anabolic steroid use causes decreased levels of HDL or “good” cholesterol, increased levels of LDL or “bad” cholesterol, and serious liver toxicity within 12 weeks, according to a study that measured the effects of anabolic steroids on men with HIV wasting ailment.

The researchers found that as expected, anabolic steroids lead to gains in both lean corpse mass and fat in men with HIV wasting.

“This is all right information for people with devastating wasting illnesses, who suffer from the effects of loss of muscle mass and whose most immediate danger is that they will die of their disease,” observes Grunfeld. “But for people who aren’t this sick and who take anabolic steroids, there may be serious problems if these complications occur.” Grunfeld, who is also a professor of medicine at the University of California, San Francisco, observes that “the biggest use of these steroids today is among body builders and athletes, who take these drugs to build muscle, but who could wind up with significantly damaged hearts and livers.”

The randomized, double-blind trial among 262 HIV-positive men was the largest study of its type on men with HIV-associated weight loss, according to the study authors. For the first 12 weeks of the trial, the men were randomly assigned to receive everyday doses of either 20, 40, or 80 milligrams of the anabolic steroid oxandrolone or a placebo. They were allowed to receive open-label oxandrolone for the second 12-week interval.

Grunfeld says the adverse effects of the steroids were clear-cut within the first 12 weeks. “HDL plummets. LDL goes up. This predisposes people to an increased risk of heart assail. Furthermore, we found grade III and grade IV liver toxicity in some men, which means a very significant risk of serious liver harm.” The men’s testosterone levels were also depressed. These effects were not seen in men taking placebo, according to Grunfeld.

The researchers observed that in men with the most wasting, the 20 milligram dose was more effectual than higher doses in promoting heaviness gain. Subjects who weighed more and were healthier - and were therefore more like athletes who use the drugs, observes Grunfeld - required higher doses to gain heaviness. This is significant, he says, because it demonstrates in healthy people, “you need a higher dose to get a benefit - and the higher the dose, the more the toxicity.” Based on observed changes in HDL and LDL, Grunfeld estimates that heart attack risk would be increased 58 percent among men attractive 20 milligrams of oxandrolone per day, two-fold with a 40 milligram daily dose, and three-fold with 80 milligrams. “Add smoking or hypertension, and the risk becomes really serious,” he says.

The ability to promote gains in both muscle and fat makes these drugs unique among the medications used for HIV wasting disease, notes Grunfeld. He says that among patients with serious wasting illnesses, the benefits of immediate heaviness gain could still potentially outweigh the risks of longer-term heart and liver damage. For these patients, he says, it is significant to have a store of fat as well as muscle mass, because “opportunistic infections burn up muscle if there’s no fat there. The more fat you have, the less muscle you burn.” Nonetheless, he notes, “We would still terminate the medication among anyone who has grade III or grade IV liver toxicity.” Grunfeld, who has no further plans to study steroids, says he would like to see the current study validated in two future studies by other investigators. The first would look exclusively at the 20 milligram dose in patients with important wasting, because “it may travail and have less toxicity.” The second would investigate whether the same toxic effects occur in healthy individuals who take anabolic steroids.