Anabolic steroid and HIV therapy

Sometimes, athletes who use anabolic steroids may share the needles, syringes or other equipment they use to inject these drugs. By sharing needles, syringes or other equipment, a person becomes a high risk 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 person 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.

These have shown some benefit in a variety of human disorders, including HIV-related muscle wasting and other catabolic conditions such as chronic obstructive pulmonary disease, severe burn injuries, and alcoholic hepatitis. Because of their diverse biological actions, anabolic steroids have been used to treat a variety of other conditions, including bone marrow failure syndromes, constitutional growth retardation in children, and hereditary angioedema.

Anabolic steroid side effect, safety, risks and danger:
Anabolic steroid therapy is associated with various side effects that are generally dose related, therefore, illicit use of mega doses for the purpose of bodybuilding and enhancement of athletic performance can lead to serious and irreversible organ damage. The most common side effects of anabolic steroids are some degree of masculinization in women and children, behavioral changes (eg, aggression), liver damage, and alteration of blood lipid levels and coagulation factors. Anabolic steroids could also raise levels of homo cysteine. Bodybuilders who used the muscle-building anabolic steroids have increased levels of homo cysteine, an amino acid tied to increased mortality, heart disease risk and blood vessel damage.

HIV (human immunodeficiency virus) is the virus that causes AIDS (acquired immune deficiency syndrome). The HIV retrovirus may be passed from one person to another when infected blood, semen, vaginal secretions or other bodily fluids come in contact with an uninfected person's broken skin or mucous membranes. People with HIV have what is called HIV infection and are fit and well. Some of these people will develop AIDS as a result of their HIV infection. Growth hormone is a popular bodybuilding and performance enhancing aid, and the use of recombinant human growth hormone (rHGH, or simply GH) to treat various conditions in HIV infection has been debated with excitement for years. Indeed it is licensed for the treatment of wasting syndrome in advanced stages of AIDS. GH is also a commonly used bodybuilding and performance enhancing drug, which can be purchased on the black market; used to help both muscle anabolism / strength and reduction in body fat levels. Both of these applications have possible significance in the treatment of HIV.

Other than in the treatment of wasting disease, results from the studies using rHGH to treat body changes associated with HIV and/or drugs used to treat HIV have been very favourable. One which has been studied extensively is the use of rHGH in reducing HIV-associated adipose redistribution syndrome (HARS). However, the positive effects of HGH treatment in HIV may be more direct. Several studies have proposed that rHGH may bolster the immune system in ways that might improve clinical outcomes in HIV. HIV-associated adipose redistribution syndrome (HARS)
HARS is a type of lipodystrophy (abnormal distribution of body fat), where there is accumulation of excess truncal fat and visceral adipose tissue, as opposed to regular gynoid (glutes and hips) or android (abdomen) deposition. This is observed in HIV infected people, moreso as virus load increases. Although not a debilitating condition in itself (indeed extra body fat can prolong life if followed by wasting), HARS is unpleasant for the individual, giving reduced confidence in body image; another negative aspect of the disease.

rHGH therapy has been shown to significantly reduce HARS, leading to an improved body image, and significant improvement in psychological well-being. Numerous studies have demonstrated the benefits of this, leading to rHGH being licesenced for the treatment of HARS in some countries. It should also be noted that improvement in psychological well-being could also contribute to a positive clinical outcome, in that it reduces the effects of wasting.

Immune system:
Of most interest in HIV therapy are the possible benefits of rHGH use on the immune system, since HIV's primary adverse effect is reduction in the immune system. It has been clearly demonstrated that rHGH does benefit the immune system, but the method by which it helps is still under debate. One theory is that rHGH may stimulate renewal of the thymus gland, an important organ in the immune system. This may, in turn, lead to improved immune health in people with HIV. Studies are now examining whether or not renewing thymus tissue leads to better health and longer survival.

The thymus is necessary for developing new T-lymphocytes, which are key immune cells in the defense against disease, and numbers of which steadily reduce in HIV as infection progresses. In particular the thymus gland is involved in the development of CD4+ and CD8+ cells, and it is the CD4+ level which is a very critical marker in HIV outcome. Without some thymus activity, immune reconstitution that produces a wide range of functional CD4+ cells is not believed to be possible. Thus, the state of the thymus in HIV disease and how therapies affect it are of great interest to those researching ways to restore the immune system.

Napolitano et al (2002) researched rHGH and its impact on the thymus in HIV. Doses ranged from 1.5 (4.5IU) to 3.0mg (9IU) per day for 6–12 months in healthy HIV volunteers. After six months, marked increases in thymus mass were noted, beyond what has been seen using anti-HIV therapy alone. This increase was sustained during the course of rHGH therapy and correlated with a higher CD4+ count, suggesting that the thymus is functioning properly and helping make new T-cells, further suggesting a stronger immune system. When rHGH was stopped, there was a loss of thymus mass; however, CD4+ cell count increases seen over the course of therapy were sustained despite this loss of mass.

Napolitano later (2003) did a twenty-person study using 3mg (9IU) rHGH a day injected under the skin (subcutaneous injection). This was followed by 1.5mg (4.5IU) rHGH a day for another six months, for a total of one year of daily therapy. Of the 20 volunteers (all of whom stayed on anti-HIV therapy during the study), ten took one year of rHGH according to the schedule described above while the other ten were merely observed. After one year, the group on rHGH stopped therapy and were observed for a second year, while the group who hadn't taken rHGH therapy then started one year of it. The size of the thymus increased in those on rHGH during the first year, but not among the second group. Those on rHGH had a significant increase in thymus mass while those only on anti-HIV therapy actually had a slight decrease. Interestingly the most pronounced increase in both naïve and total CD4+ cell counts were seen among those on rHGH with a rise in the hormone IGF-1 (insulin-like growth factor-1) which is also associated with immune function. In subjects with pronounced increase in IGF-1 levels due to rHGH use, naïve cells increased by 95% and CD4+ increased by 25%.

The two main goals of HIV treatment

The only way to diagnose HIV is to take a test which looks for signs of the virus in the blood. Presence of the virus in the blood is termed as HIV positive (HIV+). If no signs of the virus are found in the blood, the result is considered negative. It is diagnosed on the basis of positive results from two different HIV tests.

The plasma HIV RNA test (a viral load test) is recommended when recent infection is suspected. The test detects the virus in the blood within 9 days of infection; before the body develops detectable antibodies to it.

Antibody tests: The antibody tests check for HIV antibodies that the body produces in response to the infection. In most people, antibodies to the virus are not detectable during a window period of 3 to 12 weeks after infection. Hence, a HIV antibody test is not useful during this period. Retesting should be done after three months to confirm the test results. Some of the antibody tests are as follows:

    Rapid HIV antibody test, the most common HIV test, is done using blood, urine or saliva and can produce results within an hour.
    Enzyme-linked immunosorbent assay is an antibody test that is usually the first one used to detect HIV infection. If the result is positive, the test is usually repeated to confirm the diagnosis.
    Western blot test is one of the oldest but most accurate confirmatory antibody tests. It is done to confirm the results of two positive ELISA tests

Polymerase chain reaction (PCR, a viral load test) test finds either the RNA or the DNA of the HIV in white blood cells even if other tests are negative for the virus. The PCR test is very useful to find a very recent infection, screen blood for HIV before donation and in babies born to mothers infected with the virus. Protein p24, the antigen on HIV that produces an antibody response in the body is produced in excess early in the infection. Antigen p24 tests detect these proteins in the blood. This test is usually not used for general HIV diagnostic purposes. HIV-infected people may not have any symptoms of disease for eight to ten years or longer (asymptomatic period). Their CD4 (T-cell) count should be watched closely during this time. If they have a CD4 count below 200 and if AIDS-related conditions appear, then they are considered to have AIDS.

The two main goals of HIV treatment are:

    to prevent the virus from damaging the immune system
    to halt or delay the progress of the infection

Antiretroviral (ARV) drugs are used for treating and preventing HIV infection. They stop or interfere with the reproduction of the virus in the body. HIV therapy includes combinations of drugs. Antiretroviral therapy (ART) consisting of combination of three or more antiretroviral drugs to suppress the virus. ART does not cure HIV infection. It controls replication of the virus thereby strengthening an individual’s immune system to fight off infections. These drugs must be taken at the right time every day. Incorrect or inconsistent therapy can mutate the virus causing resistance to treatment. In such cases, other medication options must be used. The amount of the virus in the blood (viral load) is measured to monitor the efficacy of the treatment. The goal of treatment is to get an undetectable viral load in lab tests.

There is no cure for HIV. But the progression of the virus in the body can be reduced to a near halt with continued adherence to appropriate antiretroviral therapy. If the infection has progressed to AIDS, treatment may also include drugs to fight and prevent the opportunistic infections.

People with HIV need counseling and psychosocial support in addition to antiretroviral treatment. A high quality of life needs to be maintained with basic hygiene, adequate nutrition and safe water. Testosterone levels decline naturally as a man gets older. Symptoms of low testosterone may appear earlier in some men. This is called hypogonadism and the symptoms include:

    Low libido or sex drive
    Erectile dysfunction or impotence
    Fatigue and lethargy
    Muscle weakness
    Shaving less often, loss of body hair
    Breast growth
    Reduced testicle size
    Skin changes on the skin, smooth, fine wrinkles

Living with HIV – diagnosis, treatment and prevention

The plasma HIV RNA test (a viral load test) is recommended when recent infection is suspected. The test detects the virus in the blood within 9 days of infection; before the body develops detectable antibodies to it. The only way to diagnose HIV is to take a test which looks for signs of the virus in the blood. Presence of the virus in the blood is termed as HIV positive (HIV+). If no signs of the virus are found in the blood, the result is considered negative. It is diagnosed on the basis of positive results from two different HIV tests.

Antibody tests: The antibody tests check for HIV antibodies that the body produces in response to the infection. In most people, antibodies to the virus are not detectable during a window period of 3 to 12 weeks after infection. Hence, a HIV antibody test is not useful during this period. Retesting should be done after three months to confirm the test results. Some of the antibody tests are as follows:

    Rapid HIV antibody test, the most common HIV test, is done using blood, urine or saliva and can produce results within an hour.
    Enzyme-linked immunosorbent assay (ELISA) is an antibody test that is usually the first one used to detect HIV infection. If the result is positive, the test is usually repeated to confirm the diagnosis.
    Western blot test is one of the oldest but most accurate confirmatory antibody tests. It is done to confirm the results of two positive ELISA tests

Polymerase chain reaction (PCR, a viral load test) test finds either the RNA or the DNA of the HIV in white blood cells even if other tests are negative for the virus. The PCR test is very useful to find a very recent infection, screen blood for HIV before donation and in babies born to mothers infected with the virus.

Protein p24, the antigen on HIV that produces an antibody response in the body is produced in excess early in the infection. Antigen p24 tests detect these proteins in the blood. This test is usually not used for general HIV diagnostic purposes.

HIV-infected people may not have any symptoms of disease for eight to ten years or longer (asymptomatic period). Their CD4 (T-cell) count should be watched closely during this time. If they have a CD4 count below 200 and/or if AIDS-related conditions appear, then they are considered to have AIDS.

The two main goals of HIV treatment are:

  -  to prevent the virus from damaging the immune system
  -  to halt or delay the progress of the infection

Antiretroviral (ARV) drugs are used for treating and preventing HIV infection. They stop or interfere with the reproduction of the virus in the body.

HIV therapy includes combinations of drugs. Antiretroviral therapy (ART) consisting of combination of three or more antiretroviral drugs to suppress the virus. ART does not cure HIV infection. It controls replication of the virus thereby strengthening an individual’s immune system to fight off infections. These drugs must be taken at the right time every day. Incorrect or inconsistent therapy can mutate the virus causing resistance to treatment. In such cases, other medication options must be used. The amount of the virus in the blood (viral load) is measured to monitor the efficacy of the treatment. The goal of treatment is to get an undetectable viral load in lab tests.

There is no cure for HIV. But the progression of the virus in the body can be reduced to a near halt with continued adherence to appropriate antiretroviral therapy. If the infection has progressed to AIDS, treatment may also include drugs to fight and prevent the opportunistic infections. People with HIV need counselling and psychosocial support in addition to antiretroviral treatment. A high quality of life needs to be maintained with basic hygiene, adequate nutrition and safe water.

Can treatment prevent HIV from advancing to AIDS? Treatment with anti-HIV medications prevents the virus from multiplying and destroying the immune system, thus helping the body fight off infections and cancers and preventing HIV from advancing to AIDS.

The most popular drugs and human immunodeficiency virus

HIV (human immunodeficiency virus) is a virus that attacks the immune system, making it hard for the body to fight off infection and some diseases. Without treatment, HIV eventually causes AIDS (acquired immunodeficiency syndrome).

Initial HIV symptoms are similar to those of the flu and include fatigue, fever, weight loss, and swollen lymph nodes in the neck, armpits, or groin. Although there currently is no cure for HIV infection, a combination of medicines called highly active antiretroviral therapy, or HAART, helps keeps the immune system healthy for most people. Treatment can also prevent or delay the development of AIDS.

The most popular drugs (excluding alcohol and tobacco) were nitrites (poppers), used by 27% of study participants, and cannabis, cocaine and erectile dysfunction drugs (Viagra¸ Cialis), which were each used by about 20%. Ketamine and MDMA (ecstasy) were used by about 12% of participants, GHB or GBL by 9% and methamphetamine and mephedrone by 7%. All other individual drugs including various opiates, psychedelics, crack and anabolic steroids were used by less than 4% of study participants. Three per cent of the sample reported injecting drug use (68 people) of whom four reported sharing injecting equipment with persons of unknown serostatus.

The pattern for which drugs were most used stayed the same as the number of different drugs increased; in men who had used just one drug in the last three months, poppers were the most popular, closely followed by cannabis; in men who had used three, these two drugs plus cocaine and erectile dysfunction drugs predominated, and in men who had used more than five drugs there was more or less equal use of these drugs plus ketamine, GHB, MDMA and, to a slightly lesser extent, methamphetamine.

Any drug use was especially strongly associated with younger age, smoking, having disclosed they had HIV to partners, and being non-adherent to antiretroviral therapy (ART). Men who reported drug use were also somewhat more likely to have sex with other HIV-positive rather than HIV-negative partners or partners whose HIV status was unknown.

Men who reported using four or more drugs were more likely than other men who used drugs or men who did not use drugs to either not be on ART or to have a viral load over 50 copies/ml, and also to be young and to have a higher proportion of partners who also had HIV.

Compared with men over 60, men under 40 were 70% more likely to use any drug, 50% more likely to have disclosed to partners that they had HIV, 40% more likely to smoke and 30% more likely to be non-adherent to ART.


There was also a strong and consistent correlation between the numbers of different drugs used in the last three months and the various sexual behaviour indicators: the more different drugs people used, the more sex, condom-less sex, risky sex, STIs, group sex and partners they had. For instance, whereas 10% of men who had any drug use had higher-risk condom-less sex, 16% of the men who had used five or more different drugs in the last three months had done so (39 individuals), and whereas 15% of men who had any drug use had been diagnosed with an STI in the last three months, 24% of men who had used five or more drugs had had an STI. This correlation was particularly strong for group sex and number of partners.

In general, men who used drugs were about 40 to 70% more likely to have high-risk sex than men who did not use drugs, while users of ‘club drugs’ like GHB and mephedrone, erectile dysfunction drugs, nitrites (poppers) and cocaine were 90% more likely to have higher-risk sex.

Antiretroviral treatment prevents AIDS

Antiretroviral treatment (ART) manages an HIV infection by hampering the ability of the virus to attack the immune system's T-helper cells. ART kills HIV, reducing the risk of opportunistic infections and preventing the number of T-helper cells (CD4 count) dropping, in turn preventing AIDS.

In 2013, the World Health Organisation (WHO) released new recommended guidelines on antiretroviral treatment. They recommend that people start taking ART earlier than before, when their CD4 count is 500 cells/mm3, previously it was 350 cells/mm3. This is due to the wealth of benefits that are seen if people start treatment earlier, including greater success at delaying or eliminating the onset of AIDS.

Significant health gains have been noticed where treatment access has improved, especially among populations with high HIV prevalence. For example, in KwaZulu Natal province in South Africa, life expectancy has risen by 11 years since HIV treatment was scaled up in 2003. An HIV infection will cause a person's health to be compromised if they do not take antiretroviral treatment (ART). Eventually, someone living with HIV who is not taking ART will experience serious health issues and opportunistic infections, leading to AIDS.

People who are taking ART, but who do not adhere to it correctly may find that HIV becomes resistant to their treatment, allowing HIV to reproduce and multiply in their body again. This increases the risk of progressing to AIDS, and is evidence of the cause and effect relationship between HIV and AIDS.

For example, only a quarter of people living with HIV in sub-Saharan Africa have achieved viral suppression (where the level of HIV in their body has become undetectable) because of shortfalls in treatment provision or not adhering to their drugs. In 2012, 1.2 million of the 1.6 million AIDS-related deaths that year were in sub-Saharan Africa.
Even a partially effective HIV vaccine could save millions of lives. Experts have calculated that a vaccine that is 50 percent effective, given to just 30 percent of the population could reduce the number of HIV infections in the developing world by more than half over 15 years. An HIV vaccine that was more than 50 percent effective could cut the infection rate by more than 80 percent.

An HIV vaccine would have a number of key advantages over today’s HIV prevention options. In particular, the protection offered by a vaccine during sex would not depend on the consent of both partners (unlike condom use), and would not require behaviour change (unlike abstinence). An HIV vaccine would also be invaluable for couples wishing to conceive a child while minimising the risk of HIV transmission.

Children could be given an HIV vaccine before ever being exposed to HIV, and ideally this would protect them from all routes of HIV transmission. Vaccinating large numbers of people would probably require relatively little equipment and expertise, and would be much simpler and cheaper than providing antiretroviral treatment for those already infected. An HIV vaccine could be effective in either of two ways. A “preventive” vaccine would stop HIV infection occurring altogether, whereas a “therapeutic” vaccine would not stop infection, but would prevent or delay illness in people who do become infected, and might also reduce the risk of them transmitting the virus to other people. Although a preventive vaccine would be ideal, a therapeutic vaccine would also be highly beneficial.

The basic idea behind all HIV vaccines is to encourage the human immune system to fight HIV. The immune system works using a combination of cells and chemicals called antibodies. Early vaccine research focused on teaching the immune system to produce antibodies that would block HIV entering human cells. However, products designed to work this way failed in clinical trials because the antibodies worked only against lab-cultured HIV, not against the wild strains of the virus. Research has found a very small number of HIV-infected people produce 'broadly neutralising antibodies' to HIV. These antibodies, which neutralise a high percentage of the different types of HIV, are now the basis for new research into vaccine development.

Other research has focused on encouraging the immune system to produce cells to fight HIV. Nevertheless, many scientists believe such “cell-mediated” approaches will not be very effective on their own, even as therapeutic vaccines. It seems likely that a really effective vaccine will have to take a two-pronged approach involving both cells and antibodies.

Antibody Building and HIV Infection

Scientists at the National Institutes of Health have identified long-sought and elusive broadly neutralizing antibodies to HIV in a pair of papers. These proteins produced by the immune system are crucial for creating a preventive vaccine, and could also have therapeutic uses developed in the coming years or decades.

Variations in individuals' immune systems can dramatically affect responses to infection—HIV is no exception. The result generally can be shown as a bell curve, with a group of people whose disease progresses rapidly, a broad middle segment who progress typically, and a small group of "elite controllers" whose immune systems are quite effective at containing HIV viral replication.

The quest to figure out why has focused primarily on the adaptive immune system, because CD4+ and CD8+ T cells have a clearly demonstrated capacity to kill cells infected with HIV. But that response only arises some days, weeks and even months after a person has been exposed to HIV and the virus has integrated itself into cellular DNA, establishing lifelong infection. The adaptive immune response can only contain an established infection, it cannot prevent that infection from occurring at its onset.

B cells are the first line of defense against infection. They attack at the initial exposure to a pathogen, and can prevent the establishment of infection—and HIV is no exception. But there are a number of reasons why it has proved difficult to identify their contribution to neutralizing the deadly virus.

HIV transmission is not very efficient. Exposed persons may avoid infection for a variety of mechanical (barrier) and biological reasons, such as the virus's failure to penetrate to the surface of mucosal tissue or dendritic cell difficulties in latching onto the virus to carry it to a lymph node. So it is challenging to conclusively identify the contribution of a specific immune response that can prevent an initial infection.

Over the years, it has become clear that there are factors other than CD4+ and CD8+ T cells that help to control the virus in at least a portion of those infected with HIV.

Researchers have identified several antibodies that can neutralize the virus. Most of them bind weakly to small, often deep, pockets on the virus. In most instances, once infection becomes established rapidly mutating HIV evolves resistance to those narrowly focused antibodies, often by adding glycans or sugars to its outer envelope, which shields or blocks antibody access to the binding site.

What is needed is an antibody that binds strongly to a surface site on the virus, and which cannot be easily blocked. It is also important that the binding site is greatly conserved across the many strains of HIV.

Researchers at NIH Vaccine Research Center (VRC) decided to look at neutralizing antibodies in the blood of persons who are able to better control HIV infection. Elite controllers were not part of the mix because they seem to control HIV through their adaptive immunological system T cell mechanisms.

Using sophisticated reverse-engineering techniques, the researchers identified three proteins that are broadly neutralizing, which they labeled VRC01, VRC02 and VRC03. They also isolated the B cells that produced them.

The first two antibodies have very similar chemical structures and bind to HIV's gp120 trimer spike on its surface. The virus uses the trimer to link up with a CD4 receptor, which is the first of many steps taken to enter and infect a host cell. The antibody and gp120 spike bind in a way that is, in part, similar to the way that the spike and CD4 receptor bind.

As a result, VRC01 and VRC02 binding is particularly long and strong compared with the bonds formed by other antibodies. Further, the binding site on the gp120 spike is well exposed and not likely to become blocked by the addition of sugars to the viral envelope.

The two antibodies neutralized 91 percent of the 190 different HIV isolates that the team tested. Those isolates represent all of the various clades or strains of HIV present worldwide, says John Mascola, one of the VRC research team leaders. Also, the antibodies were able to neutralize all of the limited number of HIV variants that are transmitted sexually—a key point, because 80 percent of all new infections result from sexual activity.

VRC01 and VRC02 occur naturally and are produced by what are called RSC3 memory-specific B cells, an extremely rare component of the immune system. Using flow cytometry, the NIH team could isolate only 29 of those cells from among the 25 million cells that they screened. Furthermore, the proteins produced by those B cells often are immature and it appears that the proteins must undergo a series of combinations before they become functional VRC01 or VRC02.

X-ray crystallography allowed the researchers "to identify the [antibody's] binding site down to the atomic level structure…. It is a particularly invariant part of the CD4 binding site, which is exposed," Mascola says. He calls that knowledge "a blueprint from which to design new vaccines. It allows us to try to design a protein that mimics and presents that specific site to the immune system" to stimulate B cells "to crank out the antibody."

Mascola acknowledges the complex nature of the VRC01 and VRC02 antibodies and their low naturally occurring numbers may prove to be an obstacle to developing a vaccine. It is too early to understand all of the issues surrounding the stimulation of antibody production and the concentration necessary to afford protection from infection.

The VRC research team has designed vaccine antigens that already are in preclinical study in small animals. If those prove successful, the work may advance into a monkey model, although it is not completely clear how monkeys can control the simian version of HIV and not progress to advanced disease. The identification of VRC01 and VRC02 may also help to advance a better understanding of the disease in monkeys.

Mascola says these discoveries also may lead to development of a "therapeutic vaccine" or immune-based therapy that helps train the immune system of an HIV-infected person to better control the virus without the use of drugs.

It may be possible to mass-produce these antibodies for passive administration as an adjunct or substitute for current small molecule drugs used to treat HIV. And if production costs can be reduced sufficiently there may be a role for them in topical microbicides as a preventative for HIV exposure.

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.

Protein also helps prevent muscle wasting in HIV patients

Human immunodeficiency virus, or HIV, is a retrovirus that causes acquired immunodeficiency syndrome, also known as AIDS. Patients with HIV are more susceptible to frequent infections because the virus destroys the body's immune system. Patients with HIV must be mindful about what they ingest as contaminated foods can cause serious illnesses. Proper nutrition in HIV patients is important to maintain general health.

Patients with HIV are advised to eat low bacteria foods to prevent transmission of serious infections, according to University of California. Patients should avoid raw foods such as raw eggs, raw meat or raw seafood such as sushi, oysters and shellfish. Raw fruits and vegetables should be washed thoroughly. A separate cutting board should be used for cutting raw meat to avoid transmission of microorganisms to other foods.

Proteins and Carbohydrates:

Patients with HIV should be on a high-protein and high carbohydrate diet. Protein build muscles and maintain a strong immune system. Protein also helps prevent muscle wasting in HIV patients. Carbohydrate-rich foods provide energy needed to fight HIV infection. Increased intake of carbohydrates also helps prevent the breakdown of proteins in the body to produce energy. Examples of high-protein and high-calorie foods suitable for HIV patients include include protein drinks, milk shakes, powdered milk, shredded milk, yogurt, meat, fish and milk. Patients with HIV are advised to drink 8 to 10 cups of filtered water everyday. Extra water helps reduce the side effects of medications and flush out extra medications and toxins from the body, according to the University of California. Water also helps prevent dehydration and constipation. Patients with nausea and vomiting should avoid drinking water with meals. HIV patients should avoid caffeinated beverages such as coffee, tea, cocoa and chocolate milk because they contain caffeine which can worsen dehydration.

HIV patients with decreased appetite should try to eat six to eight small meals rather than three large meals. Patients experiencing painful mouth sores that prevent food intake can benefit from high-protein drinks. Patients with mouth sores should avoid citrus fruits and spicy foods. A BRAT diet can also be useful for HIV patients experiencing diarrhea. BRAT diet foods are bananas, rice, apples and tea. HIV patients with diarrhea should avoid fried foods, high-fat foods and high-fiber foods. Consult the doctor about taking a multivitamin everyday to supplement nutrients as HIV causes reduced absorption of nutrients.

Possible ways of transmission HIV in sport

Athletes are at risk of blood borne infections through bleeding injuries or injection of drugs with contaminated syringes. Prevention should focus on reducing non-sport associated risky behavior, as well as dealing appropriately with bleeding injuries. The risk of transmission of hepatitis B virus is particularly high in athletes in contact and collision sports, those who live in or travel to endemic regions, injecting drug abusers, and those who practice first aid when there is no healthcare practitioner available. It is recommended that such athletes and also adolescent athletes, should be vaccinated against the virus as a routine. Blood borne infections such as hepatitis B virus (HBV), hepatitis C virus (HCV), and HIV are all major health problems. According to the World Health Organization (WHO), there are 34–46 million people with HIV world wide, about 5million of them newly infected. Approximately 3 million people died of AIDS in 2003. Who also reported that “Hepatitis B is one of the major diseases of mankind and is a serious global public health problem”. There are more than 350 million people who have chronic, lifelong, infections of HBV world wide. These carriers are at high risk of serious diseases such as liver cirrhosis and primary liver cancer which kill more than one million of them a year. The American Medical Society for Sports Medicine and the American Orthopaedic Society for Sports Medicine have suggested that these infections are increasing among athletes, and they create important and complex problems for sports medicine practitioners. News of infected athletes with HIV, especially well known athletes, causes concern among other athletes.

HIV is transmitted through sexual contact, parenteral exposure to blood and blood components, contamination of open wounds or mucous membranes by infected blood, and perinatal from an infected mother to fetus or infant. Hepatitis B and C are spread through the same routes as HIV. There is a theoretical risk of blood borne infections being transmitted during sporting activities, from bleeding wounds or exudate skin injury of an infected athlete to the injured skin or mucous membrane of other athletes. It is generally reported that this risk is extremely low.

This risk may be higher in contact and collision sports, especially wrestling, boxing and tae know do, because of the higher risk of bleeding injuries and prolonged close body contact. Athletes taking part in these sports should be aware of these small theoretical risks. Players of basketball, field hockey, ice hockey, judo, soccer, and team handball are at a moderate risk, and those who participate in sports that require little physical contact such as baseball, gymnastics and tennis are at the lowest risk.

According to researchers in the Center for Disease Control and Prevention (USA), the risk of transmission of HIV during sports, except boxing, is small—less than one potential transmission in one million games. This risk is calculated by other researchers to be one transmission in 43 (range 1–85) million games, based on the following factors: (a) the estimated prevalence of HIV among athletes the risk of per cutaneous HIV transmission in health care, the risk of a bleeding injury in American football. However, this calculated risk may still be an overestimate because it has been back calculated from the risk through needle stick injuries, and this is probably much greater than the risk resulting from skin injury in sports.

There are no confirmed reports of HIV transmission during sport. Torre et al reported one case of seroconversion of HIV as a result of a bleeding injury during a football match in Italy. However, it was later suggested that this report was not sufficiently well documented to confirm that the transmission occurred during sports activity. Transmission in a non-sports setting for this man, who worked in a drug dependency rehabilitation center, could not be ruled out.

Transmission of HIV during bloody street fights has been reported in the literature. Generally, street fist fights can be considered similar to contact sports. However, the manner of physical contact—for example, repeated banging of the forehead of one fighter against the face and forehead of the other in a vigorous street fight—is less likely in typical sports settings. HIV cannot be transmitted through normal body contact such as touching and sharing sports equipment or using facilities such as locker rooms or bathrooms or contact with contaminated surfaces such as wrestling mats or toilet seats.

Anabolic Steroid and HIV treatment

An important aspect of providing care for HIV-infected patients is obtaining a baseline history that includes the most detailed information possible regarding patients’ health, ongoing health risks and previous HIV treatment. Because of the complexity of a comprehensive history, as well as the complexity of ongoing HIV care, effective communication between the patient and provider is essential. Patients should receive information that is well organized and easy to understand. All members of the healthcare team should use vocabulary that optimizes patient education and patient-provider communication.

Patients should be informed about the importance of the baseline history for establishing a framework for their ongoing HIV care. This may also include asking a patient to repeat back information in his/her own words to identify areas requiring increased health literacy.  When language or hearing barriers exist, clinicians should use an interpreter. For patients who have received HIV care from previous providers, past medical records should be obtained whenever possible. A member of the healthcare team may encourage patients to bring their past medical records; however, clinicians should be aware that patients may not wish to disclose to their previous providers that they are changing providers, and fees may be associated with such requests.

Anabolic steroids are a collection of drugs that feature testosterone to treat conditions such as impotence, delayed puberty or low muscle tone due to illness and HIV. When taken by healthy individuals, the substance can have serious side effects and lead to dependency. For users of steroids, a steroids addiction treatment program can increase the chances of successfully stopping the usage.

Unlike many other drugs used non-medically, steroids do not provide a physical high for the user. There is no euphoric response after taking steroids, or any other immediate reaction to the drugs. The exact reasons behind steroids use vary with each individual, but there are a few common reasons given by users for starting the drugs. Many users entering into a steroids addiction treatment facility report utilizing steroids as a physical performance enhancer. When taken for this reason the steroids improve muscle tone and makes building up additional muscle mass throughout the body easier and quicker than if it were done without the use of steroids. Because of the increase in the ease in muscle development when using steroids other users have claimed their use as a way of enhancing their physical appearance. Regardless of the reasons behind steroid use, long-term usage of the drugs can result in serious physical issues. To avoid these issues, finding steroids addiction treatment as soon as possible is an important step towards returning health.

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.

The workout regimen for people with HIV

People who have been living with HIV don’t have to worry about injury or illness as much as the side effects of the disease getting in the way. "The long-term survivors, have issues like more inflammation, more joint aches. Vergel said. "Some of us may have neuropathy, which is pain in the hands and feet." There are three categories Nelson Vergel, the founder of PoWer USA an HIV-wellness non-profit organization, puts HIV-positive people into when he discusses weight training. Himself HIV-positive for 30 years, Vergel breaks it down to: those whose health is failing; long-term survivors; and those whom Vergel calls the"newbies." If you’re not in good health, or you’re not reacting positively to various drug cocktails, you need to engage in exercise only under medical supervision.

The workout regimen for "newbies" can usually be the same one as anyone else’s. People who contracted HIV today have the additional advantage of not being exposed to the toxic drugs that once were the only way to try to prevent full-blown AIDS. "We used to treat people early and hard, with toxic drugs," Vergel said. "Now we’re treating people with better drugs that aren’t as toxic. So for the young generation, life is a little easier, and they can have an undetectable viral load and work out and move on with their lives." That said, HIV and the meds that fight its spread can bring with them side effects that impact a solid workout regimen, like joint ache, fatigue, and pain and weakness in the feet in hands. The key is learning the difference between soreness and injury. Soreness is a part of any weight training, especially at the beginning. Pain that endures and affect your daily routine means you’ve overdone it. The best cure is usually a few days off. Anyone planning on hitting the gym needs to keep safety first. Stacking the barbells with so much weight that your form is terrible won’t impress anyone. Instead, concentrate on low-impact workouts: more reps, less weight, which focuses on gaining muscle tone. Fatigue is another potential side effect of HIV and its attendant meds. A jolt of caffeine may be enough to get you going. Aside from a Starbucks grande, there are plenty of "energy drinks" whose basic ingredient is caffeine to give you a proverbial shot in the arm. As for supplements, Vergel recommends vitamin D. It’s key for bone density, which can help ward off workout injuries. And some HIV meds reduce the vitamin D in your body.

Whey is a great source of protein, and studies have shown it can increase the body’s production of T-cells. Many commercial protein powders use whey as their base. Taking creatine, a naturally occurring substance in the human body, in powder or pill form has become increasingly popular in recent years as a legal and effective bodybuilding supplement. But know that at least one study suggests it has no benefits for people living with HIV. You should also be aware that the Food and Drugs Administration does not regulate protein powders, energy drinks and supplements. A controversial new comprehensive study found that many supplements not only contain only trace amounts of what is claimed on the label, but also some contain none at all and some even contain substances that are harmful.

Because of possible interactions with meds and for a host of other reasons, all pozzers need to consult their doctors before using any supplement. And, even if you’re healthy and your viral load is undetectable, you should probably still discuss it if you haven’t lifted weights for a long time. Chances are, your doctor will probably encourage you, because he knows that most people cannot only weight train safely and effectively but also derive a host of benefits from it, physical and mental. Today, there’s no reason why having HIV should prevent having the body you want.

Actions of Testosterone and signs of testosterone deficiency

The actions of testosterone in peripheral tissues are mediated by the action of DHT on androgen receptors. Testosterone accounts for sexual differentiation and maturation and the development of secondary sex characteristics at puberty. In addition to its action on the hypothalamic-pituitary axis, testosterone acts on the cerebral cortex. Many of the behavioral characteristics that we associate with maleness are, to some extent, the result of the action of either testosterone or DHT on the brain. For example, in the limbic system, testosterone and DHT stimulate libido. These hormones also increase skeletal muscle mass, cardiac muscle mass, and the formation and mineralization of bone, and they stimulate erythropoiesis. In short, testosterone and DHT have far-reaching effects, which extend beyond sexual differentiation and fertility.

It follows, then, that the symptoms and signs of testosterone deficiency, whether associated with AIDS or with other chronic diseases, include decreases in:
- Energy.
- Sense of well-being.
- Libido
- Muscle strength.
- Muscle mass.
- Erythropoiesis.
- Bone mineralization.

Early in the course of the AIDS epidemic, these symptoms were considered to be manifestations of AIDS, but some astute investigators recognized that they could be associated with a deficiency of testosterone.

About 60% of testosterone in the circulation is bound to sex hormone-binding globulin (SHBG); 38% is bound to albumin; and only 2% is unbound, or free. Testosterone that is bound to SHBG does not easily dissociate, but that bound to albumin can dissociate.

The laboratory assay for free testosterone is more expensive than that for total testosterone. Thus, many laboratories determine only the latter unless they are specifically requested to assay the former. The normal serum value for total testosterone in males is 280 to 1100 ng/dL (9.7 to 38.2 nmol/L); the normal serum level of free testosterone is 50 to 210 pg/mL (174 to 729 pmol/L).

Hypogonadism in HIV-Infected Patients:
Male hypogonadism is defined as the failure of spermatogenesis and the failure of synthesis of normal levels of testosterone by the testes. Two principal types of man hypogonadism -- primary (testicular failure) and secondary (failure of the hypothalamic-pituitary axis, also called central hypogonadism) exist. The differentiation between primary and secondary hypogonadism is relatively simple but is not made on the basis of the level of testosterone. In both conditions, the serum levels of testosterone will be low. Instead, measurement of the levels of the gonadotropins FSH and LH can help differentiate between primary and secondary hypogonadism. Serum levels of both FSH and LH will be normal or reduced in secondary hypogonadism but increased in primary testicular failure.
The early studies of HIV-infected patients indicated that most patients who had hypogonadism had secondary, or central, hypogonadism. Only rarely found to be a result of prime testicular failure, hypogonadism usually occurred because of opportunistic infection. In a study of 70 HIV-sure men seen at a Johns Hopkins University clinic, 19 were asymptomatic, 42 had AIDS, and 9 had what used to be called AIDS-related complex. Of the 42 patients who had AIDS, 66% reported decreased libido, 33% had erectile dysfunction, and 50% were found to have low serum levels of testosterone. Even asymptomatic, HIV-positive patients were establish to have decreased serum levels of testosterone. Seventy-five percent of the hypogonadal men had hypogonadotropic hypogonadism.

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.

Changes in absorption

Even when nutriment is available, it may be poorly engaged in patients with HIV and AIDS. Intestinal malabsorption and nutrient loss is common. While severe diarrhoea and malabsorption may be due to opportunistic infections or intestinal parasites such as cryptosporidiosis, some of the altered absorption appears to be a consequence of HIV infection itself. The virus has been shown to destruction the intestinal villi, and redness can damage gut tissue and reduce absorption.

Frequently small bowel movement time is accelerated, particularly among children with severe diarrhoea. Enzymes in the intestinal mucosa involved with metabolism and absorption can also be less active.

These changes in the gut seem to attack the body’s aptitude to utilise dietary fat and carbohydrates. A number of studies have reported that people with HIV have high levels of foe-cal fat that is distinct to fat intake or, in one study in children, the proximity of any intestinal infection other than HIV itself.

Anabolic steroids are another experimental treatment for lipodystrophy

Anabolic steroids are another experimental treatment for lipodystrophy as well as a sample treatment for HIV-related wasting. French researchers reported on a man receiving treatment with AZT/3TC who developed a buffalo hump and insulin resistance nine months after start treatment. He received intramuscular testosterone cypionate biweekly for four months and lost abdominal fat and gained lean muscle mass. Furthermore, studies have establish that anabolic steroids make weight and lean corpse mound increases in people with HIV-related wasting. Steroids may disguise the visible signs of dystrophy rather than terminate or reverse loss of fat tissue.

A randomized study of oxymetholone treatment in 92 individuals with weight loss due to HIV wasting or lipodystrophy establish that the anabolic steroid had no impact on totality cadaver fat after 16 weeks of follow-up, although weight and muscle increased.

Human immunodeficiency virus

Hepatitis B virus (HBV) and human immunodeficiency virus (HIV) are blood borne viruses transmitted primarily through sex contact and injection medication use. Because of these shared modes of transmission a tall proportion of adults at danger for HIV infection are also at danger for HBV infection. HIV-positive persons who become infected with Hepatitis B virus (HBV) are at increased risk for developing chronic HBV infection and should be tested. In addition, persons who are co-infected with HIV and HBV can have serious medical complications, including an increased risk for liver-related morbidity and mortality. To prevent HBV infection in HIV-infected persons, the Advisory Committee on Immunization Practices recommends universal Hepatitis B vaccination of susceptible patients with HIV/AIDS. About one quarter of HIV-infected persons in the United States are also infected with Hepatitis C virus (HCV). HCV is a blood borne virus transmitted through manage conjunction with the blood of an infected person. Thus, confection with HIV and HCV is common (50%–90%) among HIV-infected injection drug users. HCV is one of the most significant causes of chronic liver disease in the United States and HCV infection progresses more rapidly to liver damage in HIV-infected persons. HCV infection may also impact the course and management of HIV infection.

HIV virus

HIV has long been difficult to diagnose with no consistent or obvious symptoms. However in some cases a rash will develop that can help indicate the existence of the HIV virus, while in others it may be the result of the drugs used to control the condition.
The significance of the HIV rash is - b that it can indicate the presence of HIV in combination with other symptoms and - that it indicates the start of the sere-conversion which means a patient is more likely to test positive for the illness. For all these reasons a HIV rash will significantly increase your chances of diagnosis. Those other symptoms will mostly be flu-like symptoms along with fever, diarrhea, enlarged lymph nodes, headaches, oral thrush (which looks like white spots in the mouth) and neuralgia (muscle ache). In a recent study of 258 people screened for HIV it was shown that a fever in combination with a rash was the best clinical guide to HIV, presenting the best chance of an accurate diagnosis. Rashes caused by the HIV medication however are slightly different. These ‘drug eruptions’ will see the patients experience raised reddish lesions that look like rashes which will cover the whole body. This is often a reaction to Cotrimoxazole which is used to treat the PCP pneumonia in HIV sufferers. Many doctors recommend Retrovir. Retrovir (Zidovudine) is an antiviral medication that prevents human immunodeficiency virus (HIV) cells from multiplying in your body.
If you already have HIV then and you develop a rash similar in description to those described here then this is likely the HIV rash, though you should see your doctor to make sure. If you get one of these rashes and you are not HIV positive as far as you are aware, but have reason to suspect you could be and this coincides with fever and flu like symptoms, then you may be suffering from HIV and should see a doctor immediately.