Benefits of the thyroid hormone T4

Synthetic forms of the thyroid hormone T4 are generally called levothyroxine, and they are considered the standard treatment for hypothyroidism. Though they are man-made, synthetic T4 hormones are exactly the same as the T4 that is produced and released by the thyroid gland.

Synthroid is the most commonly-prescribed brand of T4 for hypothyroidism. It delivers a steady, prolonged dose of T4. There is also a generic form of T4 available, which is more cost-effective than brand-name medications. Fortunately, it's also equally as effective. Synthroid (levothyroxine) is a replacement for a hormone normally produced by your thyroid gland to regulate the body's energy and metabolism. Levothyroxine is given when the thyroid does not produce enough of this hormone on its own.

Synthroid treats hypothyroidism (low thyroid hormone). Synthroid is also used to treat or prevent goiter (enlarged thyroid gland), which can be caused by hormone imbalances, radiation treatment, surgery, or cancer.

All the approved brands of T4 are bio equivalent. In other words, there is no significant difference in their composition. However, that does not mean that these brands are exactly the same. The bio availability of a given brand at a given time after ingestion might be different. That's why much of the endocrinology community—the American Association of Clinical Endocrinologists, The Endocrine Society, and the American Thyroid Association—believe that once you start with a brand, you should stick with it. If you change brands during treatment, you risk altering your hormone levels. That means your symptoms may return and you may need to adjust your dose. Changing brands may change the dose slightly, which in turn may change how you feel. Thyroid hormone controls the rate of metabolism. When the thyroid is under active, all body processes slow down and symptoms such as weight gain, fatigue, and decreased body temperature are experienced. Through supplementation of thyroid hormones, basal metabolic rate will be increased.

Thyroid hormones are essential to proper development of all cells in body. These hormones allow for the body to become more sensitive to all other hormones, in turn making them more effective. Thyroid hormones also regulate macronutrient (protein, fat and carbohydrate) metabolism, therefore increasing protein synthesis and ultimately energy. This allows for the body to burn more calories and use them more sufficiently. For this reason, thyroid hormones are commonly used as fat-loss drugs.

This medicine does not typically cause side effects as long as proper dosages are administered. However some drawbacks of Thyroid drug use are cardiac stress and possible loss of lean body mass. Negative feedback in the thyroid can decrease natural production of thyroid hormone, causing short term decrease of metabolic rate after use is discontinued.

Determining Dosage:
Finding your ideal T4 dosage is essential. The right dosage keeps hypothyroidism from interfering with your life. The wrong dosage can make it an even bigger problem than it was before you sought treatment.

Getting the right dosage is important, but don't expect the dosage you start out with to be the dosage that you eventually keep. Doctors often use weight as a guideline for determining dosage. Some use the formula of 1.6 micrograms of T4 for every 1 kilogram (or 2.2 pounds) of weight for a starting dosage. Others prefer a more conservative approach, starting patients at a very low dose (perhaps as low as 25 micrograms). Note the 1.6 micrograms is a full replacement dose. This means that if part of your thyroid still functions properly, you won't need this full dose because you will continue to make some of their own T4, in addition to the dose in the pill.

Because it's common for dosages to change at the start of treatment, your doctor will likely monitor your thyroid stimulating hormone (TSH) levels after two or three months (though some doctors check as soon as four weeks) from your first day of treatment. And since hormone replacement therapy is usually a lifelong treatment, you should get checked every year to make sure you're taking the right dose if you're on a stable dose. You should communicate with your doctor more frequently if your dose is being adjusted.

Doctors often err on the side of caution when prescribing starting dosages of T4 for a variety of reasons. For one, starting at a low dose and moving up lets your heart get used to the increased metabolism. Also, they don't want to induce hyperthyroidism—a condition caused by high levels of thyroid hormones. You can learn more about the symptoms of over-treatment below.

Even with a moderate dose of T4, some patients are susceptible to over-treatment symptoms. Elderly patients with weaker hearts and people with heart arrhythmias (irregular heartbeat) are especially sensitive to thyroid hormone. Generally, doctors like to start a slightly lower dose in these patients, in order not to cause or worsen irregular heart beats.

Be aware that when and how you take medication does influence its effectiveness. For example, thyroid medication should not be taken with calcium or iron. Both of these minerals bind with thyroid hormone and make it unavailable for your body's use.

Thus, you should avoid milk products two hours before and after taking thyroid medication. There are also some medications that alter T4 levels.

Aspirin, danazol and propanolol have been shown to increase T4 levels and furosemide, methadone, lithium, aluminum-containing antacids, colestipol, and rifampicin have been shown to decrease T4 levels.

There are also some unique interactions. Progesterone and estrogen are substances that can bind with T4, but also tend to increase T3 levels. Anabolic steroids tend to decrease thyroid hormone levels. Finally, thyroid hormone can suppress insulin, an important consideration for diabetics and bodybuilders using insulin.

Finally, if diagnosed with hypothyroidism, you will be taking medication for the rest of your life.

Below are some of the symptoms of over-treatment:
    Feeling hot and sweating more than normal
    Shaking (hand tremors)
    Heart palpitations
    Having difficulty falling asleep
    Having mood swings
    Experiencing mental "fuzziness" (forgetfulness, loss of concentration)
    Experiencing muscle weakness
    Losing weight
    Menstrual irregularities

If you experience any of these symptoms throughout the duration of your hypothyroidism treatment, talk to your doctor immediately. He or she will first check your blood tests, before deciding on a dose.

Aicar impressive drug for fat-loss

Professional bodybuilders often talk freely about their nutritional, training and supplementation programs, aspects of bodybuilding that are of critical importance to their success onstage. One subject that is not often discussed is the role anabolic/androgenic steroids play in "assisting" gains in muscle size and conditioning at the pro level.

Many pro bodybuilders are reticent about their association with various steroids and other anabolic substances, although the fans and administrators know these enhancers are widely used to the point where there is now, and has been for quite some time, a reliance on these drugs among users who desire competitive equality.

Given the lack of discussion on AA steroids, one might be led to think they are not entirely necessary for competitive success, that they don't have any special growth enhancing properties.

Aicar (5-aminoimidazole-4-carboxamide-1-β-D-ribofuranoside, 5-aminoimidazole-4-carboxamide ribonucleoside, acadesine) is each of several interesting things. First, it’s an important pharmacological research agent, used principally as an AMPK activator. It’s a compound which has shown extremely impressive fat-loss and endurance-enhancing effects in laboratory animals. Further, it has considerable mystique resulting from at least some use by elite European cyclists. And lastly, it’s readily available from research chemical sites and is being personally tried by many, though generally as part of stacks and combined with changes in training and diet. AICAR – full name  aminoimidazole carboxamide riboside (also with the drug name acadesine) is a drug under development and in clinical trials for various treatments.  The drug is a target for use in various metabolic disorders, obesity and possibly for use in heart operations to prevent damage to tissues.  During animal testing AICAR was evaluated for effects on endurance in mice.  The results showed an improvement of up to 44% in treadmill tests after 4 weeks using the drug without training!  Another study looked at whether GW1516 and AICAR combined was as effective at getting fit compared with GW1516 plus exercise.  The effects were very similar.  This means that gains can be made in fitness using GW1516 and AICAR without training!  This was dubbed ‘exercise in a bottle’ in the media a few years ago. The conclusion is that AICAR makes the body think it has exercised.  This trick is classed as ‘gene doping’ by WADA and AICAR is prohibited in all sports at all times.

Scientific study based on animal test subjects has detmined that AICAR can play a hand in boosting these processes because it contains the ability to penetrate cardiac cells and block the production of enzymes tied to regulating glucose intake and energy expulsion.  With these regulatory enzymes inhibited, the affected cells can in turn boost the amount of glucose that can be received, and it can also increase its level of energy conversion.  Additionally, the peptide’s presence has been determined to aid in lowering programmed cell death, a process that is also known as apoptosis.

Ultimately, all of these elevated processes combine to provide an animal test subject an easier time in which it can achieve a level of homeostasis.

Because of the way in which AICAR has been shown to function, scientific study based on animal test subjects has determined that the peptide can be responsible for the following elevated processes:

    - Increased endurance – Because AICAR has been shown to possess the ability to boost energy conversion and make the entire process happen more efficiently, scientific study based on animal test subjects allows for an animal test subject to experience a boosted level of activity for a much longer stretch of time.
    - Elevated rate of fat burning – Because AICAR causes an animal test subject’s cells to convert energy on a significantly elevated basis, scientific study has derived that the subjects’ bodies have a tendency to break down fat cells quicker as a means to balance out this efficiency increase.  That being said, these scientific studies have determined that this process is only effective in the event that animal test subject maintains a consistent diet and does not increase its intake of food.

According to scientific study that has been based on animal test subjects, it has been determined that AICAR possesses a positive link in combating insulin resistance.  This condition is physiological in nature, and is built on a cellular unit’s inability to respond to normal reactions brought about by secretions of insulin.  Studies have shown that the peptide has an ability to enhance a proper cellular response to insulin secretions.  The action of lowering insulin resistance within an animal test subject can be directly linked to AICAR’s faculty to promote the uptake of glucose; a process that is also vital for the overall growth and repair of muscular and skeletal tissue.

AICAR and Cardiac Arrest:
Scientific study based on animal test subjects has also determined that AICAR can play a key role in the prevention and treatment of cardiac arrest.  Because the presence of the peptide has been shown to promote a more efficient means of carrying glucose to cells, it is believed that this action can serve to counteract a deficiency in glucose carriage during an episode of cardiac arrest, a condition that is in part caused by a lack of fuel needed to convert the energy needed to provide homeostasis.  Furthermore, it has been deduced that these same abilities may allow the peptide to act as a stabilizing agent in the wake of cardiac arrest episode. Ultimately, AICAR is thought to be able to reduce the risk of cardiac arrest from occurring, or at the very least, minimizing the resultant damage if it does occur. Although there are tests available for AICAR in urine samples – published several years ago – it appears that no athletes have yet been caught using the drug. 

The method may not be in routine use as yet due to various difficulties in interpretation.  The drug is naturally present in urine, excreted by the kidneys, even if you have not used the drug.  There are various difficulties with this approach such as: the need to have a statistically significant sample for baseline evaluation; to ensure that there are not people who are naturally going to have very high levels (and be tested ‘positive’); to determine whether any illness or disease would increase the urinary excretion; to ensure those using the drug will be tested positive; and hopefully develop a second confirmatory method. A perfect candidate for this method would be isotope ratio mass spectrometry, which allows differentiation of naturally occurring compounds and pharmaceutical preparations and is currently used to detect testosterone administration.

The benefits of Testosterone Cypionate in bodybuilding life

Testosterone Cypionate is one of the most popular forms of testosterone the world over and the most commonly used testosterone in hormone replacement therapy. Testosterone Cypionate is an injectable steroid that is used as a hormone replacement therapy for males who do not make enough testosterone themselves. The controlled substance Testosterone Cypionate is sometimes also used by weight lifters to increase their strength, but it is not FDA-approved for this use. Testosterone Cypionate is injected into the gluteal muscles of the buttocks. The manufacturer of testosterone Cypionate, recommended dosage varies according to the man's size and specific medical condition. The drug is manufactured at a strength of 200 mg/ml. Men who take Testosterone Cypionate should be well aware of the risks of using the drug. One of the risks associated with this type of hormone treatment is a compromise of liver function. Cancerous and non-cancerous tumors and cysts may appear on the liver, especially if the treatment with Testosterone Cypionate is prolonged.

Higher-than-normal levels of calcium in the blood, a condition called hypercalcemia is a risk of using this form of androgen hormone. Hypercalcemia can cause muscle twitching and weakness, kidney stones, nausea, depression and bone pain. Paddock Labs states that patients who develop high blood calcium levels should stop using the medication. A very powerful anabolic and androgenic hormone, Testosterone Cypionate is equal in both regards and is one of the most efficient and effective hormones we can use for almost any purpose. To understand Testosterone Cypionate we only need to understand the hormone testosterone and once we do we can understand how the various esters available, in this case Cypionate affect its mode of action. 

Testosterone is a hormone naturally produced by both men and women responsible for a host of functions; most notably muscle and bone growth, regeneration and male sexual characteristics. While men produce nearly ten times as much testosterone as women both require adequate amounts of this androgen class hormone in order to maintain a proper endocrine system. For those who suffer from low levels of testosterone, as Testosterone Cypionate is a pure form of testosterone it is often used to combat this condition and return levels to a more suitable level. Those who suffer from low testosterone levels commonly find their libido to be reduced, fat gain and muscle loss to occur, as well as immune system deficiencies and even depression. As you can easily see testosterone is a very important hormone and with it's many functions, when we increase levels beyond a normal range, as is the purposes in performance enhancing we effectively increase the attributes associated with this powerful anabolic androgenic steroid.

The benefits of Testosterone Cypionate are truly immense and provide every trait one would be after through the use of anabolic steroids. By its mode of action Testosterone Cypionate has the ability to increase both strength and size to a large degree which is by-in-large the principle desire of any anabolic steroid user. Further, because increased lean tissue improves our metabolic rate and because Testosterone Cypionate affects muscle wasting hormones in a positive manner body-fat is often reduced when the steroid is used.

You need to understand, using Testosterone Cypionate will not automatically lead you to gaining massive amounts of muscle tissue on its own, if a large muscular physique is what you are after you have to feed it but by doing so in conjunction with testosterone therapy we increase the efficiency of the food we are eating which can lead to a more muscular physique. Further, in the same light yet in the opposite direction, those who are after a leaner physique find Testosterone Cypionate to be a perfect choice as its mode of action aids in preserving lean muscle mass when on a calorie restricted diet. Plus, when dieting, the more muscle mass we can hold onto the greater our metabolic rate will be, the greater our fat-loss will be and the more pleasing our physique will be in the end.

Doses of 200-100mg a week are common using Testosterone Cypionate, with excellent results found midway at about 500 mg or less for the first time user and between 500-1000mg weekly for the more advanced athlete. Testosterone stacks well with anything and is also great when used alone. When stacked with another anabolic-androgenic steroid, distinct androgenic effects may be seen. Using cypionate will improve regenerative capacity as well as training aggressiveness which results in significant increases in overall strength during the course of the cycle.

Testosterone Cypionate is a long acting, single ester testosterone product. It has a length of 8 carbons, and is stored mostly in the adipose tissue when injected intra-muscularly. It is slowly and steadily released in the body after it is injected. The blood levels of cypionate peak 24-48 hours after injection and then decline slowly. The blood levels reach a steady point 12 days after initial injection and stay there for over three weeks. Cypionate is normally injected once a week, which makes the very lowest dose higher than half the peak dose at any given time. Any testosterone, as the king of mass builders, are cost effective products and important for any steroid stack. Used alone, the user can expect to see some significant gains. The long acting nature of cypionate allows the user to inject less frequently while maintaining stable blood levels. Testosterone cypionate is a good choice for the first time steroid user. A simple cycle consisting of 500 mg of cypionate weekly for 10 weeks, with ancillaries on hand, and standard post cycle therapy makes a good first cycle and can create some excellent gains in muscle mass. Along with those gains will come some gains in fat as well as water rentention, but that is a standard part of bulking up and should be expected. Enanthate or cypionate are also normally preferred over sustanon for a first cycle, due to the inability to maintain stable blood levels of sustanon while at the same time minimizing injection frequency. For maximum efficiency, every day or every other day injections of sustanon are normally administered. This is unnecessary while using cypionate due to its extreme length of action.

Bodybuilding reduces lipodystrophy in patients with HIV

A common disease among HIV patients is lipodystrophy, which is characterized by irregular distribution of body fat, which causes the accumulation or loss of same in some areas. At the end of sessions, both lipodystrophy and high cholesterol and triglycerides showed improvement.

The author of the study, the physical educator Pedro Pinheiro Neto Paes says that nowadays, with the use of antiretroviral drugs, patients live longer and better with the AIDS virus, but prolonged use of medication has side effects such as lipodystrophy. Furthermore, it is common to high cholesterol and triglycerides. Because of lipodystrophy in the case of a maldistribution of body fat, the teacher thought the exercise as a way to combat the disease in order to verify the relationship between physical activity and negative variables altered by antiretroviral therapy.

Research volunteers for health education and physical activity in promoting quality of life of people living with HIV / AIDS conducted 36 training sessions spread over 12 weeks. Each session was made by heating, strength training and relaxation. At the end of the process, all variables showed a decrease negative. And besides, they also adopted a practice of regular physical activity that positively influenced the quality of life of this group of people. It was observed that lipodystrophy and triglycerides were the problems with most significant improvement.

What the author of the study highlights, however, is the improvement of self-esteem reported by them. The practice outside of our training sessions promoted the reintegration into society through physical activity, which was a great gain qualitative research. Although the quantitative effects have been very positive, the biggest complaint of them is still prejudice, which is decreased with this social integration. For the educator, it is important to encourage physical activity in this group because it shows an alternative therapy. That is, gives results and does not involve drugs.

When you think about losing fat, is usually the first association with aerobic exercises, including literature, but we went the other way: the strength training, says study author. He said this was one of the differentials of their study, who worked with high loads of strength: the patients came to lift more than 80% of its maximum capacity for each individual year, during the specific training.

Neto explains that aerobic exercises require much practice time for fat loss and ergogenic factor (calories burned) occurs mainly during the activity. Meanwhile, the activity of force causes the metabolic rate increases, and fat loss occurs throughout the day. And in addition to fat loss, there is still gain muscle mass.

Many note that water retention occurs due to the use of Deca Durabolin. This isn’t something you can do about, but the good news is that the total aromatase rate is just 20 percent of testosterone. You can limit the amount of water retention that occurs by using an anti-estrogen supplement. You may need to increase your anti-estrogen dose to limit the retention, but it could also mean that you are eating too many calories. Over-eating carbohydrates is common, and this leads to water holding. This happens with or without this anabolic steroid, so diet control remains extremely important. A remarkable property of Deca is its capability to develop collagen synthesis in addition to bone mineral content, which is an enormous benefit to athletes with joint maladies such as inflammation and connective tissue problems. Since it is a progestin, it aids the immune mediated anti-inflammatory process, and in so doing alleviates joint pain.

Deca results effectively stimulates weight gain in AIDS patients suffering from its wasting effect, athletes, and bodybuilders. Deca is the preferred anabolic steroid to use for cutting and bulking cycles. While the shorter estered version of Deca Durabolin or the chemical name of Nandrolone Phenylpropionate, is the preference to use for cutting cycles.

The fact that Deca Durabolin has a very long active life requires the administration of injections at intervals of one week, irrespective of total dose. Due to this fact, Deca Durabolin is routinely used for a period of no less than ten weeks, and customarily for twelve weeks.

Many users have noted they are dissatisfied when they first start taking Deca Durabolin. Despite being an anabolic steroid, you will not see large results straight away. The steroid just does not work that way. This is a slow process and you will need some patience. There are steroids out there that will do it quicker, but then there will also be more water retention rather than muscle mass. Dianabol and Anadrol over lead to weight gains of 20-30 pounds in a few weeks, but that is not going to be 20 to 30 pounds of muscle! Deca is stable and will lead to muscle mass increase instead of other weight, as long as you use it properly.

Side Effects:
Erectile dysfunction is considered one of the side effects that can result from Deca Durabolin. This can occur even when using testosterone supplements. Some individuals just believe that their bodies struggle to respond to this hormone, no matter how much they use. However, there are high chances that you are doing something wrong if you notice this issue with each use of the steroid. You could try to increase the amount of testosterone, but this can make the problem worse. You will now have more estrogenic activity in the body, which affects the dysfunction. Anti-estrogens can affect the sexual performance, especially those that are aromatase inhibitors.

It is extremely important to keep your estrogen to testosterone ratio at a healthy and correct level. Sexual dysfunction can occur if you have large testosterone doses without the aromatase inhibitors. The same effect can be gained from the exact opposite, while large amounts of aromatase inhibitors and large levels of testosterone can also cause the effect. You need to find the right balance for yourself.

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 anabolic steroids and Hepatitis C

The anabolic steroids have been studied as a treatment for wasting caused by HIV and have been shown to be safe and effective, helping the formation of lean muscle mass. To be most effective, anabolic steroid treatment should be combined with an exercise program of resistance (weight) training. Studies have mostly been restricted to men because of concerns about the side-effects of steroid treatment for women. It is estimated that as many as 40% of HIV-positive men who are ill because of HIV have low levels of testosterone (hypogonadism). Low testosterone can result in decreased appetite, depression, poor metabolism of food, and sexual problems, including the inability to obtain and maintain an erection.

A blood test can show if you have low levels of testosterone and your doctor may prescribe either a short course of oral testosterone replacement therapy, testosterone patches or testosterone gel. Although testosterone is usually considered to be the male sexual hormone, it also occurs naturally in women. Testosterone patches have been examined as a treatment for wasting caused by HIV in women. It was found that weight and quality of life improved for some of the women, and the development of male characteristics was not reported. Side-effects from testosterone replacement therapy are rare, but can include the shutting down of natural testosterone production, shrinking of the testicles, hair loss, increased sexual desire, and aggression. In women, male characteristics, such as the deepening of the voice, and facial hair may develop. Hepatitis C is usually transmitted through blood-to-blood contact. Needles, syringes and other equipment used to inject drugs, and equipment used to sniff drugs such as straws or banknotes, should never be shared.

The sexual transmission of hepatitis C is now an issue of concern. It used to be thought that this was very rare. However, there have been recent reports of increasing numbers of gay men testing positive for hepatitis C. Many of these men are HIV positive and their only risk activity appears to be unprotected anal sex. Sexual activity that carries a risk of contact with blood, such as rougher anal sex, use of sex toys and fisting, seems to have a particular risk of hepatitis C transmission. Group sex, especially in the context of drug use, is also an important risk factor. Using condoms correctly, every time you have sex, not sharing sex toys or washing them between use, and not sharing pots of lubricant can reduce the risk. Mother-to-baby transmission of hepatitis C is thought to be uncommon, but the risk is increased if the mother is also HIV positive. A high hepatitis C viral load increases the risk that a mother will pass on hepatitis C to her baby and, as with HIV, a caesarean delivery reduces the risk. It’s best not to share razors, hair and nail clippers, nail scissors or toothbrushes if you have hepatitis C.

Very few people experience symptoms when they are first infected with hepatitis C. When they do occur, symptoms include jaundice, diarrhoea and feeling sick. In the longer term, about 50% of people with hepatitis C will experience some symptoms. The most common ones are feeling generally unwell, extreme tiredness, weight loss, depression and intolerance of fatty food and alcohol. Although a small proportion of people infected with hepatitis C clear the infection naturally, about 85% will go on to develop chronic hepatitis C. About a third of people will develop severe liver disease within 15 to 25 years. The severity of disease can be affected by the strain of hepatitis C you are infected with. Men, people who drink alcohol, people who are infected with hepatitis C when they are already into middle age, and people with HIV seem to experience faster hepatitis C disease progression. Hepatitis C can cause liver fibrosis (hardening) and cirrhosis (scarring). This damages the liver to such an extent that it cannot work properly, causing jaundice, internal bleeding and swelling of the abdomen. Chronic infection with hepatitis C can cause liver cancer (hepatocellular carcinoma, or HCC). HCC is especially likely to happen in people with cirrhosis, particularly if they drink heavily. There’s also some evidence that smoking can speed up the rate of cirrhosis and increase the risk of liver cancer. Surgery is the most effective form of treatment for liver cancer, but  other options include chemotherapy and treatment with drugs.

You should be tested soon after your diagnosis with HIV to see if you are also infected with hepatitis C. Unlike hepatitis B, there is no vaccine against hepatitis C. If you are in a group at high risk of infection with hepatitis C, it’s recommended that you have regular tests to see if you have been infected. A test is available to measure hepatitis C viral load. Unlike the HIV viral load test, this is not an indicator of when to start treatment. However, it is used to show how effective treatment any hepatitis C is being and how long it should continue. Liver function tests can give an indication of the extent to which hepatitis C has damaged your liver. Liver ultrasounds and biopsies may also be used. People co-infected with HIV and hepatitis C are more likely to develop liver damage than people who are only infected with hepatitis C. However, hepatitis C does not increase your risk of becoming ill due to HIV or responding less well to HIV treatment.

HIV treatment can be used safely and effectively if you are co-infected with HIV and hepatitis C. HIV treatment that suppresses viral load and increases your CD4 cell count can slow the rate of HCV-related liver damage. However, you may be at greater risk of experiencing the liver side-effects which some anti-HIV drugs can cause, and you and your doctor should have this in mind when selecting which anti-HIV drugs to take. It also seems to be the case that people co-infected with HIV and hepatitis C are at greater risk of developing some of the metabolic disorders which anti-HIV drugs can cause (particularly insulin resistance and diabetes).

Drugs are available for the treatment of hepatitis C and you should receive your treatment and care from doctors who are expert in the treatment of both HIV and hepatitis C. This may mean that, as well as seeing an HIV doctor, you also need to see a specialist liver doctor. If you have both HIV and hepatitis C, you should be assessed to see if you would benefit from starting hepatitis C treatment. If you and your doctor decide that you will start hepatitis C treatment now, and your CD4 cell count is between 350 and 500, you should start hepatitis C treatment first, then start HIV treatment. If your CD4 cell count is between 350 and 500 and you don’t yet need treatment for hepatitis C, you should start HIV treatment. If your CD4 cell count is under 350, you should start HIV treatment before starting hepatitis C treatment. A number of anti-HIV drugs have interactions with drugs used to treat hepatitis C. The choice of anti-HIV drugs you take will need to be made with these possible interactions in mind.

Before you start treatment for hepatitis C, it is important to know which strain, or genotype, of hepatitis C you have been infected with, as this can predict your response to treatment and the amount of time you will need to take treatment for. There are several hepatitis C genotypes. Type 1 is most common in the UK, and unfortunately responds least well to the currently available treatments for hepatitis C. Genotype 4 is also harder to treat. People with genotypes 2 or 3 respond better to treatment. However, there are new HCV drugs available, and more in development, which should improve the chances of a cure for people with harder-to-treat genotypes.

Factors such as your age, gender, how long you have had hepatitis C, the degree of liver damage and whether cirrhosis has developed are also important in predicting if treatment is likely to be effective. Unlike HIV treatment, treatment for hepatitis C is not lifelong. It consists of 24 or 48 weeks of treatment, and the length of treatment you receive will depend on the hepatitis C genotype you are infected with. A test after twelve weeks of treatment can predict if you are going to respond to treatment. Drugs are available for the treatment of hepatitis C. The backbone of treatment consists is pegylated interferon and ribavirin. These are taken in combination with an anti-HCV protease inhibitor. This sort of triple combination has been found to be much more effective than dual therapy with pegylated interferon and ribavirin alone. The aim of hepatitis C treatment is to eradicate infection with hepatitis C completely. Other aims of treatment include normalising liver function, reducing liver inflammation and reducing further damage to the liver. If you are ill because of HIV, then the aim of hepatitis C treatment is likely to focus on improving your tolerance of anti-HIV drugs, reducing the risk of death from liver problems and improving your overall quality of life. Hepatitis C treatment can have unpleasant side-effects, including a high temperature, joint pain, weight loss, nausea and vomiting and depression. Other side-effects include disturbances in blood chemistry.

Arthritis and HIV-infected patients

Musculoskeletal syndromes that occur in HIV-infected patients include manifestations of drug toxicity, reactive arthritis, Reiter's syndrome, infectious arthritis, and myositis. Principles to keep in mind when evaluating an HIV-infected patient with a musculoskeletal syndrome include the following:

Any musculoskeletal syndrome in non-HIV infected patients can occur in HIV-infected patients, such syndromes may not be related to the HIV infection.
HIV infection can alter clinical presentation and course. Reactive arthritis, inflammatory arthritis, or musculoskeletal infections may be more severe in presentation and course in HIV-infected persons. In some cases, musculoskeletal infections may be more insidious and subtle in onset.
Ruling out or correctly diagnosing infections is especially important to prevent the spread of infection in an immunocompromised patient.
The probability of an opportunistic infection as a cause for a musculoskeletal complaint depends on the stage of the patient's HIV disease. At early stages (CD4 count above 300), opportunistic infections are unlikely, although resistance to common bacterial pathogens may be reduced.
Generally, diagnostic tests and treatment regimens for musculoskeletal syndromes are the same as when the syndromes occur in non-HIV infected patients, except that the patient's HIV-related medications may cause side effects and interactions that impact differential diagnosis and limit therapeutic options, and there should be a very high threshold to using immunosuppressive drugs.

Some risk factors for HIV infection are also risk factors for other conditions that may present as musculoskeletal syndromes. Examples include injection drug use and arthritis associated with hepatitis B virus infection or endocarditis, sexual promiscuity and the arthritis syndromes associated with sexually transmitted infections such as gonorrhea and chlamydia, and hemophilia and hemarthrosis. Clinicians need to examine HIV-infected patients who present with acute or subacute musculoskeletal pains for evidence of infection in the joints and muscles. Careful examination of the skin may reveal a fungal infection that has spread to the joints. Septic arthritis may be difficult to differentiate from reactive arthritis, but cultures of the synovial fluid and blood will be sterile in cases of reactive arthritis. Septic arthritis in HIV-infected injection drug users (IDUs) is most commonly due to Staphylococcus aureus and usually responds well to treatment. In patients with advanced HIV disease who are not IDUs, clinicians must always consider opportunistic infections in joints, bones, and muscles. HIV-infected patients with muscle pain and weakness must be evaluated for idiopathic polymyositis, myositis secondary to zidovudine (AZT) toxicity, and infectious pyomyositis. Although many clinicians believe that HIV infection predisposes patients to musculoskeletal infections and has a negative impact on the outcome of the therapy, this hypothesis is not yet proved.
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Both Reiter's syndrome and septic bursitis can cause a monarticular arthritis in an HIV-infected patient. Evaluation of synovial fluid is necessary to rule out infection and make a diagnosis. Clues to help the clinician differentiate between infectious and reactive arthritis in patients with HIV disease include a history of urethritis, cervicitis, diarrhea, or conjunctivitis, and findings of psoriasiform lesions, nail changes and enthesopathy (inflammation of tendinous insertions), as these may accompany a reactive arthritis.

The onset of reactive arthritis in HIV-positive patients usually occurs in the foot and ankle, and the common types of inflammation are enthesopathy (involving the Achilles tendon, plantar fascia, or anterior and posterior tibial tendons) and multidigit dactylitis. Synovitis is rare but may occur in joints of the lower extremities. In the upper extremities, dactylitis and enthesopathy occur in the tendinous insertions in the lower part of the arms. Cutaneous symptoms include psoriasiform rashes, keratoderma blennorrhagicum, and onychodystrophy.

In reactive arthritis, the synovial fluid is usually inflammatory, with a few thousand white blood cells and a synovial glucose level that is at least two thirds the serum glucose level. Gram stain or culture of synovial fluid is the only reliable way to make the diagnosis of a septic arthritis or bursitis. If the diagnosis is entertained, aspiration and culture should be performed immediately. If the synovial fluid is purulent, it may be prudent to initiate broad antibiotic coverage while waiting for the results of definitive synovial fluid cultures. Also, if the synovial fluid is initially unobtainable (as in axial joint infection), it is prudent to initiate antibiotic coverage. Blood cultures should be obtained during the work-up of the arthritis, as they may become positive before the synovial fluid cultures. HIV-infected patients who are at high risk for septic arthritis include IDUs and hemophiliacs. Clinicians must always consider and rule out acute infectious synovitis in these patients.

Gram-positive bacteria, such as S. aureus and Streptococcus pneumoniae, commonly found in non-HIV infected patients with septic arthritis and bursitis, are causative factors in most reported cases of septic arthritis and bursitis in HIV-infected persons. Infections with organisms not common to the skin have also been reported. One report described osteomyelitis in HIV-infected patients, but usually it results from direct extension from a septic joint. Clinicians must frequently re-examine HIV-infected patients treated for septic arthritis for evidence of worsening or unchanging symptoms and signs. If bone pain and fever continue despite antibiotic coverage, extension of the infection to the surrounding bone should be considered, surgical debridement may be necessary.

In most HIV-infected patients with acute joint or bursa infections, broad antibacterial coverage to cover common skin organisms (including staphylococcal and streptococcal infections) should be initiated. Patients with advanced HIV disease occasionally have opportunistic joint infections, such as sporotrichosis, cryptococcosis and Mycobacterium avium intracellulare. Often these patients have extraarticular features suggestive of such infections, including typical skin lesions. These opportunistic infections often present with a more indolent course than that of a bacterial septic arthritis. If extra articular features of fungal infection are present or hyphae or budding yeasts are seen on direct synovial fluid examination, the patient should receive standard doses of intravenous amphotericin B.