Wednesday, October 29, 2014

Anabolic steroids and retrospective studies of HIV

Anabolic steroids are orally-ingested, synthetic (man-made) drugs that act like testosterone. They cause growth and development of male sexual organs, secondary sex characteristics, and increases in muscle size and strength. They are used for treating delayed puberty in boys, anemia, low muscle mass due to AIDs or HIV, breast cancer, and for replacing testosterone in men with low testosterone levels. Anabolic steroids often are abused by athletes for increasing muscle mass and performance. Non-athletes and non-competitive body builders also abuse anabolic steroids for cosmetic reasons. Anabolic steroids have many side effects because testosterone, which they mimic, has many effects in the body. The long list if side effects from anabolic steroids include shrinking of testicles, breast enlargement (gynecomastia), low sperm count, increased hair growth, deeper voice and reduced breast size in women, high blood pressure, heart attack, stroke, high cholesterol, rage, violence and aggression. Liver disease and liver cancer also can occur.

Anabolic steroids increase blood levels and effects of cyclosporine by decreasing the breakdown of Cyclosporine. They also reduce the breakdown of Warfarin (Coumadin), increasing blood levels of Warfarin and the risk of bleeding from warfarin.
High-dose steroid therapy has been proven effective in AIDS-related Pneumocystis pneumonia (PCP) but not in non-AIDS-related cases. We evaluated the effects on survival of steroids in HIV-negative patients with PCP. Retrospective study patients admitted to the ICU with hypoxemic PCP.
HDS were associated with increased mortality in HIV-negative patients with PCP via a mechanism independent from an increased risk of infection. Pneumocystis jiroveci pneumonia (PCP) is a major cause of acute respiratory failure in immunocompromised patients. Malignant disease, steroid treatment, and transplantation of solid organs or bone marrow are the leading causes of T-cell suppression, which is associated with a high risk of opportunistic infections, including PCP. The number of patients with T-cell suppression has risen in recent years, resulting in an increased incidence of PCP. In recent studies, more than 8% of patients with hematological malignancies admitted to the ICU for acute respiratory failure had PCP. Mortality rates of up to 30% have been reported in cancer patients with PCP.

Studies done in the 1990s showed that adjunctive treatment with high-dose steroids (HDS) was associated with a dramatic decrease in mortality during PCP episodes in HIV-positive patients. Corresponding proof of efficacy is not available for HIV-negative patients with PCP, and findings from the three available studies, all retrospective, are conflicting. In a 1998 study in 30 patients, the 16 patients given adjunctive HDS had no difference in mortality but spent less time on mechanical ventilation compared to the 14 patients managed without steroids. The second study, reported in 1999, compared 15 patients with HDS and 8 without HDS and found no significant differences in mortality or ICU stay length. The most recent study was published in 2011 and found no significant difference in mortality between the 59 patients given HDS and the 29 other patients. More over two retrospective studies from our group could not conclude of outcome improvement with adjunctive steroid in that setting. The small sample sizes may have jeopardized the ability of these studies to detect significant differences between patients given HDS and other patients.

The pathophysiology of PCP may differ between patients with and without HIV infection. Studies have shown that HIV-negative patients with PCP were older and had a larger number of co-morbidities, longer symptom duration at diagnosis and higher neutrophil counts in bronchoalveolar lavage fluid, compared to HIV-positive patients. Conceivably, these differences between the two populations might affect the ability of steroid therapy to provide therapeutic benefits.

Here, our objective was to determine whether HDS produced therapeutic benefits in HIV-negative patients with severe PCP requiring admission to the intensive care unit (ICU). To increase the sample size for our investigation, we included patients from four different sources, namely, three previously published studies and a teaching-hospital ICU database. We analyzed data from three retrospective studies of HIV-negative patients with Pneumocystis jiroveci pneumonia. The first study included HIV-negative patients admitted to two ICUs between 1988 and 1996 for PCP and compared patients who did (n=23) and did not (n=8) receive HDS in addition to standard treatment. The second study described HIV-negative patients with PCP managed in the ICU between 1989 and 1990 and looked for predictors of mortality, 33 of the 39 patients received HDS. Finally, the third study compared 56 cancer patients with PCP to 56 cancer patients with bacterial pneumonia admitted to the ICU between 2001 and 2006 of the patients with PCP, 21 received HDS. Only patients from theses studies who were admitted in ICU were included in the present study. In addition to the data from these three studies, we included data from patients admitted for PCP to the ICU of the Saint Louis Teaching Hospital, Paris, France, between 2006 and 2011. The IRB from Clermont Ferrand approved data collection for the addition of patients from St Louis hospital in this non international study. Medical chart were reviewed by the investigators (VL or AD) for all included patients . For all four sources of patients, inclusion criteria were age over 18 years, ICU admission, and PCP. Only definite case of PCP were considered (positive IF for pneumocystis or MGG coloration in BAL). Exclusion criteria were patients with HIV infection and patients who were not admitted to the ICU. Moreover, colonized patients defined with positive P. jiroveci PCR only, without any pulmonary symptom or treatment of P. jiroveci were not included.

Tuesday, October 21, 2014

Symptoms of HIV

People with HIV can live long and healthy lives with access to treatment. Since HIV was first reported substantial progress in the research and development of antiretroviral drugs has been made. There are now more than 20 approved antiretroviral drugs. Despite this, people with HIV face many barriers to accessing affordable, effective HIV treatment.

Taking HIV treatment requires effort and commitment as drugs must be taken at exact times each day. Some people may experience serious side-effects or may not respond to certain drugs. Treatment, care and support can help people to adhere to treatment and address any problems they may have with their treatment regimen.
This is the main type of treatment for HIV or AIDS. It is not a cure, but it can stop people from becoming ill for many years. The treatment consists of drugs that have to be taken every day for the rest of a person’s life.

The aim of antiretroviral treatment is to keep the amount of HIV in the body at a low level. This stops any weakening of the immune system and allows it to recover from any damage that HIV might have caused already.

The drugs are often referred to as: antiretrovirals, ARVs, anti-HIV or anti-AIDS drugs. Taking two or more antiretroviral drugs at a time is called combination therapy. Taking a combination of three or more anti-HIV drugs is sometimes referred to as Highly Active Antiretroviral Therapy (HAART).

If only one drug was taken, HIV would quickly become resistant to it and the drug would stop working. Taking two or more antivirals at the same time vastly reduces the rate at which resistance would develop, making treatment more effective in the long term. Our starting, monitoring and switching HIV treatment page has more about drug resistance.

Most people who are infected with HIV experience a short, flu-like illness that occurs two to six weeks after infection. After this, HIV often causes no symptoms for several years. The flu-like illness that often occurs a few weeks after HIV infection is also known as seroconversion illness. It's estimated that up to 80% of people who are infected with HIV experience this illness.

The most common symptoms are:
    fever (raised temperature)
    sore throat
    body rash

Other symptoms can include:
    tiredness
    joint pain
    muscle pain
    swollen glands (nodes)

The symptoms, which can last up to four weeks, are a sign that your immune system is putting up a fight against the virus. These symptoms can all be caused by conditions other than HIV, and do not mean you have the virus. However, if you have several of these symptoms, and you think you have been at risk of HIV infection, you should get an HIV test. After the initial symptoms disappear, HIV will often not cause any further symptoms for many years. During this time, known as asymptomatic HIV infection, the virus continues to spread and damage your immune system. This process can take about 10 years, during which you will feel and appear well.

It is important to remember that not everyone with HIV experiences early symptoms, so you should still take an HIV test if you have put yourself as risk, even if you experience no symptoms.

Late-stage HIV infection:
If left untreated, HIV will weaken your ability to fight infection so much that you become vulnerable to serious illnesses. This stage of infection is known as AIDS, although doctors now prefer to use the term late-stage HIV infection. Typically, a person with late-stage HIV infection has:

    persistent tiredness
    night sweats
    weight loss
    persistent diarrhoea
    blurred vision
    white spots on the tongue or mouth
    dry cough
    shortness of breath
    fever of above 37C (100F) that lasts a number of weeks
    swollen glands that last for more than three months

At this stage, you are at increased risk of life-threatening illnesses such as tuberculosis, pneumonia and some cancers. Many of these, though serious, can be treated and your health is likely to improve if you start HIV treatment.

Wednesday, October 15, 2014

Testosterone and exercise help weight gain in HIV wasting

Testosterone is the androgen secreted in the male testis and in the female ovaries. It is very important hormone for the proper growth of the human body. In men, testosterone plays a very important role in development of the secondary sexual characters. The sexuality of the men is dependent considerably on the testosterone levels in his body. The men with the less level of testosterone are often found to be weak and usually fail to perform well during the sex, whereas men with high level of testosterone are always healthy and found to excellent during the sexual encounter. It is the testosterone that helps to build the sexual stamina and guides the erection mechanism. But, due to low levels of testosterone many of the men are failing to perform well during the sex.

The main reason for the reduction in the testosterone level is aging. Also few other factors like stress, tensions, injuries to testis, inadequate sleep, and too much exercising decrease the testosterone levels in the body. There are various medications available to increase the levels of testosterone, but please don’t take them as they may affect your health adversely or if at all you want to take them consult the doctor. But, guys you can increase the levels of testosterone even without taking any of these medicines. So, go through the list of the food items mentioned below and have them regularly to increase the testosterone levels:

Eggs: Daily intake of egg is found to be very good source to increase the testosterone levels. Even it has been proved through the research that egg are very good source of proteins that promote the production of the testosterone. Eggs along with the proteins also contain the Vitamin A that stimulates the production of the testosterone. If you are having very low testosterone content then you should certainly start eating egg daily and you would be able to see the difference in few months.

Meat: Non-vegetarian food items are found to be very rich in the testosterone content. You can certainly boost the testosterone levels in the body by including meat in your daily diet. Meat includes the high amount of proteins that in accordance with the minerals like zinc that promotes the production of the testosterone. White meat chicken is one of the healthiest lean meats available that is best to increase the testosterone levels. But, please make a note that keep the meat intake in control otherwise it may also increase the fats and carbohydrates in the body and make you prone to many other hazardous diseases.

Vegetables: The intake of vegetables regularly will never make you prone to the low testosterone levels. Spinach is specifically very good to boost the testosterone levels in the body. The most important benefit of vegetable intake is that it doesn’t promote any hazardous effect to your health like the non-vegetarian food items. Tomatoes also are found to prop up the testosterone levels as they are rich in Vitamin A. Vegetables intake increase the testosterone levels in the body very fast, and you can see the effects in short span of time in comparison to other food items.

Fruits: One of the best methods to increase the production of the testosterone in the body is to eat the fruits regularly. Fruits are the rich source of the vitamins and minerals that prop up the testosterone production in the body. Fruits also are found to decrease the influence of the factors that affects the testosterone production adversely. Fruit intake reduces the production of the dihydrotestosterone that is found to reduce the testosterone levels in the body. The best fruit to induce testosterone levels is Apple, which if you eat regularly for about 2 months will surely increase the testosterone levels in your body. The other fruits are Pineapple, Orange, and Mango that also increases the testosterone level in body.

Milk and Milk Products: Drinking milk daily can help you to improve the testosterone levels in the body. Milk is considered as the whole food so its intake can boost the production of testosterone. Milk contains adequate amount of minerals, vitamins, and proteins that maintains the level of the testosterone in the body and doesn’t allow it to drop below the normal level. Milk products are also rich in nutrients. So, if you having the low level of testosterone, you need to include the milk and milk products in your daily diet routine.

Further evidence that anabolic steroids or resistance exercise (weight training) can help replace lean muscle tissue lost in HIV wasting appears in a study published in this week's edition of the Journal of the American Medical Association. However, using anabolic steroids with an exercise programme did not result in any greater benefit than using one element on its own.

61 HIV-positive men whose body weight had declined by more than 5% in the previous 6 months, and who had low serum testosterone levels (< 12.1 nmol/L (349 ng/dL) were randomly assigned to receive either 100mg Testosterone Enanthate weekly as an intramuscular injection or a placebo injection. They were also randomly assigned to a programme of resistance exercise or to maintain their normal activity levels.

Daily food intake was standardized for all four groups at 1.5g of protein per kg of body weight and 40kcal per kg of body weight, a diet very high in protein and carbohydrates. The authors cannot explain why the testosterone and exercise group failed to perform better than the exercise alone or testosterone alone group, despite the expected additive effect of combining the two interventions.

After 16 weeks, muscle strength had improved by 20-30% in all groups apart from the placebo group, and this improvement was statistically significant.