Anabolic steroids help people with HIV put on weight and muscle mass

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 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.” 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.”

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.

Anabolic steroids and immune system

Testosterone plays a vital role in the development of male characteristics and also of the muscles in our body. Anabolic steroids are commonly consumed for these effects as it is believed to enhance the muscle growth. Athletes and other sports persons are commonly noted to abuse anabolic steroids to improve their performance and to add up muscle mass. The anabolic steroids are available as injections, patches, creams and tablets or capsules.Testosterone is commonly referred to as the male sex hormone that is mainly associated with the development of physical and sexual features in men. This is because of the ‘building’ or anabolic effect of this hormone. Anabolic steroids are generally synthetic forms of testosterone and mimic the action of testosterone. Male hormones such as testosterone is associated with muscle building, bone growth and increased production of red blood cells. Anabolic steroids work in a similar fashion to induce muscle growth. However, along with the muscle building effect, other influences on the body in general are also observed. These include changes in the physical appearance, increased oiliness in the skin and other associated effects.

Anabolic steroids were initially developed to treat a condition known as hypothyroidism wherein the production of testosterone hormone in the testes (testicles) is reduced. Further when some animal tests revealed that testosterone could build muscle mass, the abuse of anabolic steroids began. The anabolic steroids are commonly abused by body builders, weight lifters and also by other athletes involved in different kinds of sports. The steroids are commonly sold without prescription at gyms, sports events and even through mail. The anabolic steroids are generally used as oral products while some are used as injections. In both the forms, steroid abusers tend to take 10 to 100 times higher dosages of these steroids than the normally prescribed doses.

The terms "stacking", "cycling" and "pyramiding" are commonly used by the steroid abusers and these terms signify the dosage pattern of consumption of anabolic steroids. Cycling refers to the periodic use of high doses of steroids while stacking refers to mixing two or more type of steroids for a single dose. Pyramiding refers to the consumption pattern of steroids wherein they are taken initially at low doses and gradually increased over a period of few days or weeks. Steroid abusers follow different patterns for different purposes and may mix these patterns of steroid consumption to suit their specific purpose. Anabolic steroid abuse is noted in individuals of different ages. In a survey in the United States it was reported that steroid abuse was highest in the 12th grade among school children wherein almost 3.5% of the 12th graders were abusing anabolic steroids. However, the trend of steroid abuse among school children was on the decline. Among athletes it has been estimated that about one to six percent may be involved in the abuse of anabolic steroids.   

The abuse of anabolic steroids is associated with a wide number of adverse effects on the body and ranges from simple acne to severe life-threatening events. While many of these effects are reversible some of the effects may be permanent. The severity of the adverse effects is based on the dosages of steroids consumed and duration of the steroid abuse. Higher dosages and longer durations are more commonly associated with severe adverse effects. In case of men, anabolic steroid abuse is associated commonly with decreased sperm production, decrease in the size and function of the testicles, occurrence of baldness, increased development of the breast (gynecomastia), and infertility. Women commonly develop male features such as change in voice (becomes deeper), decrease in the body fat and breast size, excessive hair growth on the body, and male pattern baldness (increased hair loss in the scalp region). Many of these changes may become irreversible on prolonged abuse of anabolic steroids. In both men and women the skin changes that can be noted include oily skin and acne. Increased consumption of anabolic steroids in children results in early maturation and stunted growth.

Increased anabolic steroid abuse can often result in liver failure due to formation of tumors or cysts (fluid filled cavities) in the liver. These can often rupture leading to a significant amount of bleeding. Regular use of anabolic steroids tends to suppress the body’s immune system indirectly and thereby increases the risk of certain common conditions such as cold and flu. Athletes and sportsmen/women who use injectable forms of anabolic steroids often tend to reuse the syringes or share them. Also the syringes available with the steroid doses may not be sterile. These factors increase the risk of developing several infections such as AIDS, hepatitis and other similar infections.

What Is AIDS Wasting?

AIDS wasting is the involuntary loss of more than 10% of body weight, plus more than 30 days of either diarrhea, or weakness and fever. Wasting is linked to disease progression and death. Losing just 5% of body weight can have the same negative effects. Although the incidence of wasting syndrome has decreased dramatically since 1996, wasting is still a problem for people with AIDS, even people whose HIV is controlled by medications.

Part of the weight lost during wasting is fat. More important is the loss of muscle mass. This is also called "lean body mass," or "body cell mass." Lean body mass can be measured by bio electrical impedance analysis (BIA) or by a full body x-ray (DEXA) scan. These are simple, painless office procedures.

AIDS wasting and lipoatrophy can both cause some body shape changes. Wasting is the loss of weight and muscle. Lipoatrophy can cause a loss of fat under the skin. Wasting is not the same as fat loss caused by lipodystrophy. However, wasting in women can start with a loss of fat.

Several factors contribute to AIDS wasting:

Low food intake: Low appetite is common with HIV. Also, some AIDS drugs have to be taken with an empty stomach, or with a meal. It can be difficult for some people with AIDS to eat when they're hungry. Drug side effects such as nausea, changes in the sense of taste, or tingling around the mouth also decrease appetite. Opportunistic infections in the mouth or throat can make it painful to eat. Infections in the gut can make people feel full after eating just a little food. Depression can also lower appetite. Finally, lack of money or energy may make it difficult to shop for food or prepare meals.

Poor nutrient absorption: Healthy people absorb nutrients through the small intestine. In people with HIV disease, several infections (including parasites) can interfere with this process. HIV may directly affect the intestinal lining and reduce nutrient absorption. Diarrhea causes loss of calories and nutrients.

Altered metabolism: Food processing and protein building are affected by HIV disease. Even before any symptoms show up, you need more energy. This might be caused by the increased activity of the immune system. People with HIV need more calories just to maintain their body weight.

Hormone levels can affect the metabolism. HIV seems to change some hormone levels including testosterone and thyroid. Also, cytokines play a role in wasting. Cytokines are proteins that produce inflammation to help the body fight infections. People with HIV have very high levels of cytokines. This makes the body produce more fats and sugars, but less protein.

Unfortunately, these factors can work together to create a "downward spiral." For example, infections may increase the body's energy requirements. At the same time, they can interfere with nutrient absorption and cause fatigue. This can reduce appetite and make people less able to shop for or cook their meals. They eat less, which accelerates the process.

HIV drug therapy

There's little doubting the tremendous impact HIV drug therapy has had on the lives, and futures, of HIV-positive people. Rates of opportunistic infections are still low in the United States and it's abundantly clear that people are living longer with HIV infection—thanks to the availability and widespread use of these treatments.

Unfortunately, the life-extending benefits of HIV drug treatment have opened up a new set of problems for many HIV-positive people. Thousands of HIV-positive people in the U.S. are also infected—or at risk of being infected—with one of several hepatitis viruses. Some of the hepatitis viruses can cause chronic infection, meaning that they remain active for many years and can lead to serious liver damage over time. And because many HIV-positive people are now at a much lower risk of dying from an AIDS-related opportunistic infections, they must now face the challenge of having to manage these other viral diseases that pose a threat to their health and lives.

Viral hepatitis, which can cause long-term liver problems, liver failure and liver cancer, is considered to be a leading cause of death among HIV-positive people. In turn, numerous HIV-positive people must fight two infections at once. AIDSmeds.com has prepared some lessons to help its readers better understand three hepatitis viruses that are a potential threat to their health: hepatitis A virus (HAV), hepatitis B virus (HBV) and hepatitis C virus (HCV).

Hepatitis A is caused by the hepatitis A virus (HAV). HAV is spread from one person to another when the feces (shit) of someone with the virus gets into another person's mouth. There are a number of ways that this can happen:

    Eating food – particularly food that is raw or not thoroughly cooked (shellfish, for example) – that has been handled or prepared by someone who has hepatitis A.
    Drinking water or ice that is contaminated with feces.
    Engaging in oral-anal sex ("rimming") with someone who has hepatitis A.
    Rarely, HAV can also be spread through blood-to-blood exposure (sharing intravenous drug injection equipment, for example).

Hepatitis A is an acute form of hepatitis, meaning that it does not cause long-term (chronic) infection. If you have had hepatitis A once, you cannot be infected with the virus again. However, you can still be infected with other hepatitis viruses (hepatitis B virus and hepatitis C virus, for example).

People with HIV are not at greater risk of becoming infected with HAV than anyone else. However, some studies suggest that people with HIV are more likely to experience prolonged symptoms of hepatitis A, meaning that it might take longer for someone who is HIV-positive to recover fully from hepatitis A.

Another important issue to consider is that many people with HIV are taking anti-HIV medications that can be toxic to the liver. Some of these medications can make symptoms of hepatitis A worse. In turn, it might be necessary to stop all anti-HIV medications until the hepatitis A has run its course or until liver enzyme levels have returned to normal. If you are HIV-positive, are taking anti-HIV medications, and develop hepatitis A, do not stop your anti-HIV medications without first discussing it with your doctor.