Tolerating, not fighting, viruses a viable survival strategy

In ecology, disease tolerance is defined as a host strategy not to fight a pathogen tooth and nail, but rather tolerate it to live (and survive) better in the long term. One key feature of tolerance is that the disease only progresses very slowly - if at all - even if the host carries a high pathogen load.

Roland Regoes, a senior scientist at ETH Zurich's Institute of Theoretical Biology, has now transferred this approach to HIV. He set about investigating whether there are infected people who are more tolerant of the HI virus than others and if so which factors this tolerance depends upon.

Regoes came up with the idea for the study during his postdoctoral stay in Atlanta, where he was working with researchers from a large primate centre. They studied sooty mangabeys (Cercocebus atys) infected with SIV, an HIV-like virus that affects primates. Although a large amount of the SI virus was found in their blood, some of the monkeys did not become ill. "The infection in this primate species is one of the best examples of disease tolerance," says the researcher. He and his co-authors -- all medical doctors -- are now interested in whether the concept of tolerance can also be carried over to human diseases. In order to determine which factors are linked to tolerance, the scientists evaluated the data from the Swiss HIV Cohort Study statistically.

Their analyses revealed that certain patient groups are more tolerant of HIV than others. For instance, the twenty-year-old group is more tolerant than sixty-year-olds, with the disease developing 1.7 times more rapidly in older patients than in their younger counterparts.

The same goes for the group of patients whose HLA-B genes come in two different variants. HLA-B genes are a group of genes which facilitate immunity to the HI virus. Every person has two copies of every gene, which do not have to be identical. If they are not, this is referred to as heterozygosity. If both HLA-B variants are identical, i.e. homozygotes, the tolerance of the virus is considerably lower.

Certain HLA-B variants are known to facilitate an immune defence against the virus geared towards its destruction. These variants are not responsible for tolerance. Instead, tolerance is linked to combinations of other HLA-B variants.

Regoes and his co-authors did not find any difference in tolerance between genders. The ETH-Zurich researcher recorded roughly the same high values in women and men, although on average women exhibit lower initial viral loads than men.

For his analyses, Regoes used the number of particular immune cells, the CD4+ cells, on the one hand and the viral load during the asymptomatic phase on the other. The latter is a key quantity in HIV infection. As soon as the virus infects someone, it multiplies rapidly and heavily before the immune system reduces its number to a certain level. From then on, the immune system keeps the pathogen relatively well under control for a long time. However, the number of CD4+ cells drops continuously until it reaches a critical level. If the number of these immune cells falls below 200 per millionth of a litre of blood, AIDS breaks out. The researchers calculated the tolerance of HIV sufferers to the virus from the correlation between the rate at which the CD4+ cells decreased and the viral load during the asymptomatic phase.

Tolerance and resistance are alternative but complementary defence strategies deployed by a host to combat pathogens. In the case of tolerance, it is not the destruction of the adversary and thus the reduction of the viral load that is the priority, but rather the alleviation of the negative effects of the infection for the host. This is not tantamount to capitulation. Instead, the strategy ensures that the evolutionary race between the parties cools off. "It is heading in the direction of commensalism," says Regoes -- a kind of ceasefire between two disparate partners. However, the two strategies have different evolutionary consequences: while tolerance tends to suppress the emergence of adaptations, resistance challenges the adaptability of viruses, which results in an evolutionary arms race with the adversaries.

"In the long run, one could try to use this ceasefire therapeutically," says the ETH-Zurich researcher. Tolerance-based therapeutic strategies could constitute interesting alternatives as they are not expected to lead to treatment-resistant pathogens.

What Are The Real Chances Of Finding Cure For HIV?

Human Immunodeficiency Virus (HIV) is behind the largest and deadliest pandemic in the recent human history. In 2011, 34 million people were living with HIV worldwide. In our age of advanced medicine, the situation when infectious disease spreads seemingly out of control is very rare. For the majority of common infectious diseases we have either medicine capable of curing them, or at least, medication making them manageable. Also, preventive measures such as vaccinations allow to put most infections under control. But effective therapeutic management is now available. HAART (Highly Active AntiRetroviral Therapy) helps to eliminate the most of virus from the body of infected person, thus reducing to the minimum his or her chances to develop AIDS and suffer any other infection-related health problems. In fact, people receiving the antiretroviral therapy can now expect to live almost normal life, and their average life expectancy is almost the same as in the healthy population.

Advantages And Problems Of Modern Antiretroviral Therapy

Modern drugs effectively reduce the level of virus in the blood (viral load) to almost undetectable level. The decrease in viral load not only improves the immune system of the patient but also decrease the risk of HIV transmission to healthy people. The price to pay - take a pill every day. Like any other chronic disease, HIV needs to be treated by drugs on a daily basis. And there is always a danger of developing drug resistance thus making the medicines ineffective. On top of this, drugs do have both short-term and long-term side effects that in some cases can be severe.

Finally, the newest and most efficient drugs are costly and often unaffordable. The price of unsubsidized drug bill can easily reach $30,000 per year.
The problems of living with HIV make the development of cure very desirable. Lots of research is being done worldwide in the pursuit of this goal. But how achievable is this target? Can we expect any real breakthrough that is so eagerly anticipated by millions of infected people? Although modern HAART therapy is hailed as a great success, the cure of HIV remains an elusive goal. There were, however, several reports of so-called functional cure of HIV infection in several individuals.

One HIV-positive patient received the bone marrow transplant from a donor with a rare natural genetically programmed resistance to HIV infection. The monitoring of this patient so far did not reveal any signs of disease return. He was declared completely free from HIV thus making him the first ever person to be cured of the disease.

Another very recent report described the case of a newborn baby who got infection from mother. Therapeutic intervention with HAART has started almost immediately after the baby was born and seemed to be successful in completely elimination of virus.

Obviously, the above strategies are not viable for the overwhelming majority of patients. Something else has to be done.

Complete Cure For HIV Is Difficult But Not Impossible To Achieve - The problem lies with the mechanism of drug action: all modern drugs are active only against the actively replicating virus. The virus does become silenced in some situation. For example, the host cells of immune system can become dormant and shut down almost all replication mechanisms. In such cells virus can stay without showing any activity for very long time. As a result, this virus remains completely insensitive to all drugs. Once the cell wakes up, the virus starts to reproduce as well and easily replenish its population in the body if the drugs were discontinued.

There are also so-called anatomical reservoirs of the virus. HIV can hide at different anatomic locations such as gastrointestinal tract and brain of the patients receiving antiretroviral therapy. These sites have various kind of barriers limiting the ability of antiretroviral drugs to reach the infected cells. Again, when the treatment is stopped the virus from these places could cause re-infection. Some researchers hypothesize that HIV can infect certain non-immune cells and survive there in dormant stages for many years.

The logical answer to the problem of latent viruses lurking somewhere in the safe heavens around the body is to get them out of their hiding places. Two major strategies are currently being developed by researchers working in this field. First strategy aims to activate the latent cells of immune system. Activation would also turn on the replication process of the virus .With the virus replicating inside the cell, the cell will ultimately die, and the released viruses could be get rid of using the traditional and highly effective antiretroviral therapy. There are different agents which could potentially help in activating the latent T cells. One such agent, Interleukin-7 (IL7) is currently undergoing clinical trials. Prostratin is another compound that could do this but at present time only limited data is available for its safety profile and efficiency in humans. It will take several years to get enough data and see if these drugs serve the purpose.

The second strategy relies on turning on the HIV genes within the latent cells infected by virus. Histone deacetylase inhibitors (HDACI) seem to be able to do exactly this. These drugs could turn on the gene expression in the viruses present inside the silent T cells thus making them vulnerable for antiretroviral drugs. Further studies are needed to evaluate the efficiency of these drugs.

With the pace of developments in the HIV research, many scientists now believe that the cure for HIV is only few years away. The infection has already proven itself as a very difficult target to treat. Many drugs previously developed with curative intent have failed to their promises.

But this time the level of confidence among scientists and observers is higher than ever. Let’s hope that they are right.

The Use of Human Growth Hormone in the treatment of HIV / AIDS

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.

Wasting
Like cancer cachexia, advanced stages of AIDS are characterised by severe muscle wasting and weakness. The reasons for this are because the patient often has a very poor appetite and food intake, as well as there being direct wasting effects from the HIV and some associated diseases which the patient may have, e.g. pneumonia. The patient then enters a downward cycle with diminished strength, poor food intake and further wasting, and it's often this which leads to eventual death.

Both anabolic steroids and rHGH therapy are used clinically to both slow the effects of wasting and to help improve appetite. Both have been shown to prolong life significantly and improve quality of life in advanced stages of AIDS.

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 defence 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  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 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.

Also, these increases in thymus size (together with increases in both thymus density and volume) related to marked increases in naïve CD4+ cells (69% increase among those taking rHGH during the first year compared to only 9% increase for those only on anti-HIV therapy), but not naïve CD8+ cells. This was further associated with more pronounced increases in total CD4+ cell counts (19% increase among those on rHGH versus 1% increase among those only on anti-HIV therapy).

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 AIDS Clinical Trials Group (ACTG) conducted a larger 60-person study. One group was given anti-HIV therapy and 1.5mg (4.5IU) rHGH a day for 48 weeks. A second group took anti-HIV therapy alone for 24 weeks, followed by 3mg (9IU) rHGH a day for 24 weeks. By the end of 48 weeks, both groups showed notable increases in naïve and total CD4+ cell counts. The first group took rHGH for a longer period of time but were on a lower dose that took longer to result in CD4+ cell increases. However, people in the lower dose group showed more pronounced increase by week 48 in another measure of recent thymic activity called TREC (T cell receptor excision circles). Seven out of 11 people in the lower dose rHGH group showed increased thymus mass after 24 weeks while seven out of nine showed the same effect after 24 weeks on the higher dose.

Researchers at Imperial and Chelsea and Westminster Hospital in London (2006) administered rHGH therapy in chronic HIV patients in an attempt to reconstitute HIV specific CD4+ and CD8+ T-cell responses. While viral load and CD4+ and CD8+ counts remained unchanged, T-cell maturation and differentiation were significantly enhanced.

In all of these studies, using rHGH related to increases in thymus size and CD4+ T cell counts. Taken together these studies are promising, but they are not studies of effectiveness. Many questions remain unanswered about using rHGH to treat immune suppression in HIV disease. It does seem that there may be little benefit in respect of the immune system when CD4+ level is still at a reasonable level, but when it goes below an acceptable reference range then rHGH therapy may be worth considering. Obviously a high percentage of newly diagnosed patients are already in more advanced stages of the disease as they only present to their doctor when they have symptoms, so these may already have reduced CD4+.

Acute Infections
HIV patients are often more prone to acute infections which may take longer to clear up than in non-HIV individuals. Sometimes these can be associated with poor appetite and weight loss. rHGH therapy may curb rapid weight loss often associated with acute infections in HIV positive people and may also reduce length of infection. Far more research is needed here though.

Fasting lipid profile
HIV patients have been shown to have elevated serum lipids, and dyslipidaemia, i.e. high LDL (bad) cholesterol and low HDL (good) cholesterol with raised total cholesterol and triglycerides. This is associated with anti-HIV drug treatment especially later on in infection. This does increase risk of cardiovascular diseases, and rHGH treatment may improve lipid profiles.

Bone Building
HIV patients may have loss of bone density associated with wasting. Both treatment with rHGH and growth hormone releasing factor (GHRF) have indicated improved bone mass in HIV patients.

Side effects of rHGH treatment
Although we have focused on the promising benefits for rHGH treatment in HIV infection, consideration of possible side effects is important in ensuring an informed decision can be made. Side effects of rHGH therapy include possible joint pain (arthralgia), abnormal growth of the body's extremities and impaired glucose intolerance, increasing the risk of type 2 diabetes.

Caution is also advised against using over-the-counter or faddy internet products that claim to contain human growth hormone. Some of them claim to contain plant-derived growth hormone, others claim to contain cow or goat growth hormone, and still others claim to contain substances that increase the body's production of GH. There is no evidence that any of these products contain either a relevant product or a dose needed to induce the types of effects seen in studies. Over-the-counter and internet sales of these 'growth hormone' products are a major source of health fraud.

Certainly rHGH has shown benefits in treating wasting syndrome in advanced stages of HIV disease or AIDS, and its approval as a treatment for body lipodystrophy is encouraging. However, it's important that larger studies confirm these early findings. They can tell us whether or not increases in thymus size and CD4+ cell numbers, associated with rHGH use, ultimately benefit people living with HIV and result in better quality of life and longer life. Treatment with GH in HIV is encouraging and exciting, but far more research is still required.

Barriers to HIV testing in older children

Concerns about guardianship and privacy can discourage clinics from testing children for HIV, according to new research from Zimbabwe. The results of the study, by Rashida A. Ferrand of the London School of Hygiene & Tropical Medicine and colleagues, provide much-needed information on how to improve care of this vulnerable population.

More than three million children globally are living with HIV (90% in sub-Saharan Africa) and in 2011 an estimated 1000 infant infections occurred every day. HIV acquired through mother-to-child transmission around the time of birth is often unsuspected in older children, and the benefits of treatment are diminished in children who develop symptoms of immune system failure before infection is discovered.

Provider-initiated HIV testing and counseling (PITC) involves health care providers routinely recommending HIV testing and counseling when people attend health care facilities. To investigate the provision and uptake of PITC among children between 6 and 15 years old, the researchers collected and analyzed data from staff at 6 clinics in Harare, Zimbabwe.
Among 2,831 eligible children, about three-quarters were offered PITC, of whom 1,534 (54.2%) consented to HIV testing. The researchers diagnosed HIV infection in about 1 in 20 (5.3%) of the children tested, highlighting the need for more effective PITC. HIV infection was also found in 1 out of 5 guardians who tested with a child.

The main reasons that health-care workers gave for not offering PITC were perceived unsuitability of the accompanying guardian to provide consent for HIV testing on behalf of the child, and lack of availability of staff or HIV testing kits. Children who were asymptomatic, older, or attending with a male or a younger guardian were less likely to be offered HIV testing. Male guardians were less likely to consent to their child being tested.

In interviews, health-care workers raised concerns that a child might experience maltreatment if he or she tested positive, and showed uncertainty around whether testing of the guardian was mandatory and whether only a parent (if one was living) could legally provide consent. When parents were alive but not present, seeking consent from another adult raised ethical concerns that a positive HIV test in a child would disclose the HIV status of a parent who hadn't provided consent.

The study, which was funded by the Wellcome Trust, did not explore the reasons for refusal of HIV testing by clients. Also, because the relationship of the child to the accompanying adult was not available, the appropriateness of the guardian could not be independently ascertained.

Lead author Dr. Rashida Ferrand from the London School of Hygiene & Tropical Medicine said: "The fear of the stigma faced by the child and their family seems to be discouraging caregivers from testing children for HIV. However, with improved clarity of guidelines, engagement with staff, and organisational adjustments within clinics, it should be possible to harness the commitment of health-care workers and properly implement HIV testing and counseling."

In an accompanying Perspective, Mary-Ann Davies and Emma Kalk of the University of Cape Town, who were uninvolved in the study, point out that "The fact that >90% of infected children had a previous missed opportunity for testing indicates suboptimal pediatric PITC coverage in most routine settings," and call for "clear HIV testing policies for children and guidance on guardianship, together with training of [health-care workers] on such policies."

Sustanon 250

Sustanon 250, a strong anabolic with pronounced androgenic activity, is considered by many as one of the most powerful combinations of testosterone.

Originally developed by the international drug firm Organon as an alternative to hormone replacement therapy (HRT), this anabolic androgenic steroid contains four different testosterone esters: Testosterone propionate (30 mg), testosterone phenylpropionate (60 mg), testosterone isocaproate (60mg), and testosterone decanoate (100 mg) that stimulate a fast yet extended release of testosterone.

Sustanon 250 has the chemical name of 17ß-hydroxyandrost-4-en-3-one and can be detected over a period of 2-3 months. This steroid has an active life of nearly 2-3 weeks and the molecular formula of Sustanon 250 is C19H28O2.

Sustanon 250 is one of the most commonly recommended drugs for the development and maintenance of reproductive tissues such as the prostate, epididymis, seminal vesicles, testes, and penis even at low doses. Sustanon 250 also has the ability to prevent degeneration of existing muscles in wasting diseases and is prescribed to individuals diagnosed with HIV/AIDS. Sustanon 250 can easily promote muscle function, muscle size, body strength, and nitrogen retention gains and also has the potential to improve plasma concentrations of Testosterone, Dihydrotestosterone, Oestradiol (estrogen hormone), and Androstenedione. Most athletes and bodybuilders use this steroid to experience improvements in the level of sexual function, such as libido and erectile function and reduction in the levels of serum LDL-C, HDL-C, and triglycerides.

When used as per medical advice, Sustanon 250 can even stimulate improvements in levels of hemoglobin and Hematocrit without resulting in any clinically relevant changes in liver enzymes and PSA. Sustanon 250 is commonly used by athletes as a bulking drug that leads to exceptional strength and muscle mass gains. Sustanon 250 does convert to estrogen but it is slightly more tolerable than testosterone cypionate or enanthate. This is primarily because blood levels of testosterone build slowly with the use of this steroid and it means that side effects do not happen fast.

The Effects of HIV on the Body

What does human immunodeficiency virus (HIV) look like?

Though symptoms can go undetected for some time, eventually the disease takes its toll on the body by damaging a person’s immune system, paving the way for numerous diseases to move in. While many of the diseases and infections that strike people with HIV are common, others are unusual and their presence is what often leads to a diagnosis of acquired immune deficiency syndrome (AIDS) — the final stage of HIV disease.

HIV: Early Symptoms

The earliest symptoms of HIV can resemble the flu and they generally clear up within a month or two. These symptoms may include fever, headache, fatigue, and swelling in the lymph nodes, particularly those in the neck and groin. However, not everyone who acquires HIV will experience these symptoms. Similarly, for several years, perhaps as long as a decade, a person with HIV may not have any symptoms at all. During that time, though, the virus is still multiplying and it's possible to transmit HIV to someone else.

HIV progresses differently for each person affected. The course of the disease is determined by the specific infections or complications a person with HIV develops. HIV complications can affect different parts of the body: Some are localized to the mouth, others in the brain, and others result in total body changes like losing body weight. Skin conditions are also common.

HIV: Skin Effects

Several of the main skin conditions that affect people with HIV are caused by viruses most people already have in their bodies. However, these viruses typically do not cause disease in people whose immune systems are healthy. Some of the more common dermatological, or skin, effects of HIV include:

• Varicella zoster virus (VZV) infection. VZV is a herpes virus that causes both chicken pox (varicella) and shingles (herpes zoster). Most adults have already been exposed to this virus. HIV-infected individuals may develop new skin sores from either of these diseases. HIV patients who didn’t have chicken pox earlier in their life may develop the condition, which in some cases can affect their organs and become life-threatening. Shingles can be localized to one area or it can spread over large areas of the skin. Shingles lesions can become infected and even lead to the development of encephalitis (brain inflammation) in people with HIV.
• Herpes simplex virus (HSV). HSV was one of the first diseases identified in people with advanced HIV disease and is now considered one of the AIDS-defining diseases by the U.S. Centers for Disease Control and Prevention. HSV causes open sores that may look like a cluster of blisters. They pop and crust over before healing completely; this process takes about 7 to 10 days in otherwise healthy individuals, but in people with advanced HIV disease, the sores may enlarge to 2 to 10 centimeters in diameter, becoming crusted and painful.
• Kaposi’s sarcoma (KS). KS is a cancer caused by a herpes virus called Kaposi sarcoma herpes virus. Healthy individuals may be infected with Kaposi sarcoma herpes virus without developing the cancer. However, as HIV-infected people become sicker, KS may develop. KS tumors grow from cells that line blood vessels and lymph nodes. The cells form tumors on the skin that appear as brown, purple, or red splotches, called lesions. In some cases, the lesions look worse than they are, as they may cause no other symptoms. Other people with KS may experience painful swelling, particularly around the eyes, in the legs, or in the groin. Although less common, KS lesions can also form in organs, like the liver, digestive system, or the lungs, which could be deadly.

HIV: Oral Health Problems

HIV infection can also cause oral health problems that are rare in uninfected people, including:

• Candidiasis. Candidiasis is a fungal infection that HIV patients often get as their CD4+ cell count decreases. One of the most common types associated with HIV, thrush (or pseudomembranous candidiasis), appears as white patches in the mouth or pharynx.
• Periodontal disease. HIV-positive individuals very often have periodontal disease caused by bacterial infections even if they do not have any other symptoms of HIV. At first, the periodontal disease is characterized by the sudden and rapid loss of soft tissue and jaw bone. As the disease progresses, the person may also develop gingivitis with ulcers that leave crater-like crevices after healing.
• Herpes simplex virus. HSV can also cause sores in and around the mouth. Typically, HSV-1 causes ulcers in the mouth and HSV-2 causes genital herpes. However, oral infection with HSV-2 and genital infection with HSV-1 can occur — this infection is usually spread during oral sex. The symptoms of both types are identical.

Kaposi’s sarcoma and shingles can also cause ulcers in the mouth. Kaposi’s sarcoma oral lesions are very similar to the skin lesions. Shingles lesions in the oral tissue may merge into large ulcers instead of crusting over as they do on the skin. Shingles oral ulcers often get into the gum tissue, causing tooth pain.

HIV: Neurological Effects

Although HIV does not appear to infect nerve cells, it does somehow affect their ability to function normally. People with HIV can experience:

• AIDS-related dementia
• A decrease in the ability to think properly and process information
• Brain tumors that either begin in the brain or spread to the brain from elsewhere in the body
• Progressive multifocal leukoencephalopathy (PML), which is caused by a virus most people are already infected with, but does not cause disease in people with healthy immune systems. Symptoms include difficulty walking and talking, weakness in the limbs, and seizures.

Other neurological complications such as headaches, fever, nausea, and dizziness may occur as a result of HIV treatments.

HIV: Weight Effects and Wasting Syndrome

A big concern for people who have HIV that has progressed to AIDS is AIDS wasting syndrome, which is defined as any unintentional weight loss of 10 percent or more of your body weight. HIV patients may lose muscle as well as fat, and once lost, the weight is difficult to regain. The person may also have diarrhea and a slight fever. These symptoms are usually accompanied by a complete loss of appetite. AIDS wasting syndrome is extremely dangerous for HIV-infected people but it can largely be prevented by eating a healthy, nutrient-rich diet (including such foods as peanut butter, eggs, cheeses, and legumes) and regular exercise to maintain muscle mass.

While HIV infection can lead to a variety of very serious complications, advances in treatments have significantly improved the outlook for people with HIV infection. In fact, a study found that only about 10 percent of people with HIV die of one of the conditions that defines AIDS. Since HIV-infected individuals are now living longer, they are more likely to die from other causes.

Human growth hormone and HIV/AIDS

Human growth hormone (HGH) is a natural hormone produced in the pituitary gland, which promotes normal growth and development in the body. It activates protein production in muscle cells and the release of energy from fats. It is typically used to stimulate growth in children with hormone deficiency, or to treat people with severe illnesses, burns or infection where destruction of human tissue and muscle occurs.

A genetically engineered or ‘recombinant’ version of HGH has been produced (rHGH). Test tube experiments have shown that it can stimulate immune cells such as natural killer (NK) cells, which are related to tumour control and T-cells. rHGH is also known as somatrem or somatotropin. One form of HGH is made by Serono under the brand name Serostim, although other forms are made by other manufacturers. It is given as an injection under the skin.

rHGH is a licensed treatment that can be prescribed on the National Health Service for children with short stature as a result of growth hormone deficiency. However, it is not licensed for prescribing to people with HIV in Europe. rHGH is also very expensive to produce, casting doubt on the feasibility of its introduction into routine HIV care.

There has been some concern that the use of human growth hormone in people with HIV would stimulate viral replication and lead to increased viral load. However, recent evidence suggests that individuals who add growth hormone to their anti-HIV combination are likely to experience a small drop in viral load.

In HIV disease, HGH is best known as a treatment for HIV-related wasting, although it is not an approved treatment for this condition in Europe. High doses of HGH have been found to increase weight and lean body mass in people with AIDS wasting.  An increase in lean body mass is thought to be important in HIV disease because the loss of lean body mass is the form of wasting most closely related to an increased risk of death.

In August 1996, HGH was granted accelerated approval in the United States for the treatment of AIDS wasting. Studies of up to twelve weeks in duration have found that the drug may stabilise weight or reverse weight loss in people with HIV, although no improvements in survival were seen. The long-term safety and tolerability of HGH are unknown. In the European Union, HGH has been granted orphan drug status for the treatment of AIDS wasting, which means that Serono will have exclusive rights to market the product for this purpose in Europe, even though other companies also have their own versions of the treatment.

In a recent meta-analysis of treatments for wasting, rHGH was found to have similar efficacy to the other two major treatments, testosterone and anabolic steroids, with all three showing a significant benefit over placebo. However, rHGH may have advantages in terms of increasing muscle function and quality of life.

Clinical studies, including two randomised trials, have confirmed that HGH can reduce abdominal fat and increase muscle mass in people taking anti-HIV treatment. These improvements in body composition are paralleled by increases oxygen uptake, the ability to carry out moderate physical exercise, and the capacity for high-intensity exercise.

Reductions in ‘buffalo hump’ and breast size have also been reported, although breast development in men has been noted as a side-effect of rHGH. Improvements may reverse on stopping rHGH and may be more likely among individuals with mild body fat abnormalities.

The benefits of rHGH seem to be limited to boosting muscle and decreasing fat accumulation. It has no effect on fat loss in the face and limbs.

In addition to its possible beneficial effects on wasting and fat redistribution, recent studies have suggested that rHGH may improve CD4 cell counts in patients on antiretroviral therapy. In one randomised study addition of 1.5mg rHGH daily to antiretroviral therapy for 48 weeks increased CD4 cell counts by a median of 55 cells/mm3, while a shorter course of 3mg daily for 24 weeks improved CD4 cell counts by the same amount. Around half of this increase was in naive CD4 T-cells and it was coupled with an increase in the size and function of the thymus gland, the organ under the breastbone that produces new naive T-cells.

Further research is needed to establish whether these effects are paralleled by an improved ability to fight infection.

Side-effects of HGH can include headache, muscle pain, joint pain, salt and water retention and rare instances of carpal tunnel syndrome (pain or tingling in the first three or four fingers of the hand). Children treated with the drug over the long term develop antibodies to it, but these do not seem to have any harmful effects.

A large-scale study of rHGH in people with AIDS wasting identified several serious side-effects which were thought to be associated with rHGH. These included skin cancers, gastrointestinal bleeding, inflammation of the arteries, and breast development in men. Elevated triglycerides and the development of diabetes have also been reported among individuals taking rHGH with antiretroviral therapy-related body fat changes. In a randomised study of several HGH doses to treat AIDS wasting, glucose levels rose modestly in 28% of patients receiving a daily dose and 18% of patients receiving doses on alternate days. There was one case of new onset diabetes and two cases of hyperglycaemia amongst the 646 patients who received HGH for up to 24 weeks.

For some, steroid use builds hope

A few years after his HIV diagnosis, Nelson Vergel began wasting away. No matter how much he ate, no matter how many protein shakes he added to his diet, no matter how much iron he pumped, the chemical engineer could not regain 25 pounds the virus had stripped from his 5-foot-7 frame. He watched as dozens of HIV-infected friends progressively lost body fat and muscle, and, ultimately, their lives. "Either I have to do something," Vergel thought, "or I'll be the next one." Then he found anabolic steroids.

For more than a decade, Vergel has been among the chronically ill patients who take anabolic steroids - legally - for the same fundamental reason some athletes use them on the sly: to build up their bodies. A storm of attention has been paid of late to illicit use of steroids among athletes, who forever want to run faster and hit balls farther. But at the same time, a quiet movement is under way to discover what legitimate role the drugs can play in mainstream medicine.

For years, doctors have prescribed anabolic steroids for those with HIV or AIDS, kidney disease, cancer and other illnesses that cause malnutrition or muscle wasting that can leave patients dangerously thin. And, although the long-term side effects of anabolics aren't fully known, even at low doses, some physicians see definite therapeutic benefits.

"Not only do they help rebuild muscle, they make you feel better," said Dr. Bruce Rashbaum, a Washington internist who has prescribed anabolic steroids to HIV and AIDS patients for 15 years. "It's not as if these patients are going to become Hercules, because they aren't going to be."

Not all doctors think the benefits of prescribing anabolic steroids for chronic conditions outweigh the potential risks, however. What's more, they say, simply adding muscle to a frail body isn't necessarily going to help someone who is dying from a disease anyway. But given the difficulty physicians have had in helping severely malnourished people gain lean muscle tissue -- as opposed to fat - scientists are continuing to study whether steroids might be among the answers.

Said Rashbaum: "Everyone has this notion that these drugs are taboo, and they don't even entertain the idea of learning about it. I really think in the short and long run the benefit certainly outweighs the risk for those patients that really need them."

In 1999, Dr. Kirsten L. Johansen, director of dialysis at the San Francisco VA Medical Center, led a study of 29 patients with kidney failure. Over six months, they were either injected with an anabolic steroid or given a dummy pill. Those in the drug group gained an average of nearly six pounds more in lean body mass - and reported less fatigue - than those taking the placebo. Johansen has been following up on that research to determine whether the patients' boost in weight was attributable to muscle and whether it translated into better physical function and quality of life.

"We know that people who lose muscle mass tend to die sooner," she said. "But what we really don't know is: If we build muscle mass, are we helping them? These patients are really debilitated. For some of them, that's just such an issue that they really might benefit from this."

Anabolic steroids date to the 1930s, when scientists created a synthetic form of the male hormone Testosterone. They were targeting hypogonadism, a condition in which the testes don't produce enough testosterone for normal growth and sexual function. Soon, researchers discovered that the drug aided the growth of skeletal muscle, too.

But not without a price: Anabolic steroids have been linked to side effects ranging from acne and aggression to cardiovascular disease and liver cancer. This type of steroid, which differs chemically from the corticosteroids commonly used to treat inflammation - is available legally in the United States only by prescription. And athletes typically take doses considerably higher than those prescribed for medical purposes.

Dr. Marc K. Hellerstein, professor of medicine at the University of California, San Francisco, said modest doses of anabolics, combined with weight training -- if patients are well enough to exercise - yield the best result.

He has used that approach for patients with HIV and AIDS. In a 1999 study he led, 22 men lifted weights and received testosterone by injection. Half also took an oral anabolic steroid.
Both groups increased their lean body mass, weight and strength. But those in the steroid group had significantly larger gains. "It was not just cosmetic; this was useful muscle," Hellerstein said. Even at low doses, anabolic steroids can have unpleasant or dangerous side effects, including liver damage and prostate cancer, and doctors who prescribe them have to monitor their patients closely.

In Hellerstein's study, those side effects included a drop in HDL (the "good" cholesterol), as well as irritability and overly aggressive behavior. In general, some patients don't like steroids because the drugs can cause sleep problems or make them more likely to pick fights with their partners. But others thrive on them.

Dr. Adrian S. Dobs, an endocrinologist at the Johns Hopkins School of Medicine, said she believes there's a limited role for anabolics in medicine, including with HIV and AIDS patients. But in other cases, she says, the long-term risks - which are still unknown - might be too great. "I just don't think there's good data to say it's really worth doing, with the exception of a few disease states," she said. "Increasing muscle mass per se is not a benefit. ... Are you doing any good? What's going on with the underlying disease?"

Vergel, who has been taking anabolic steroids since 1994, credits them with helping him through a difficult period before the advent of effective antiviral treatments that helped reduce chronic wasting. During his first four months injecting anabolics, Vergel put on 35 pounds, enough to push him up to 175, more than he weighed when he was healthy. The 46-year-old, who lives in Houston, kept up with the drug regimen and saw his white blood cell count climb. His energy and appetite improved. "I was looking great," he said. "For the first time, I was looking like I was not HIV-positive. I just felt like a superman. I just thought, 'Maybe I'll survive.'"

Vergel, who still takes a regular course of anti-HIV drugs, weighs 190 pounds and looks like a bodybuilder, founded a nonprofit group called PoWeR - Program for Wellness Restoration.

He eventually left his job and wrote a book outlining a health plan for HIV-positive people based on steroids, exercise and nutrition. Anabolics, he says, are only a part of the equation.
A doctor supervises his use of the drugs, regularly checking for changes in liver function and blood pressure and screening for prostate cancer. "When you're sick, the risk-to-benefit ratio changes in your mind,"

Vergel said. "I have no doubt that my quality of life and my life have been extended."

Anabolic Steroids Help People with HIV Gain Weight

People with HIV who are treated with anabolic steroids to prevent AIDS wasting may realize modest gains in weight and muscle mass, a new review shows.

The review covered 13 studies of adults age 24 to 42 with HIV, 294 of whom received anabolic steroids for at least six weeks and 238 of whom received placebo. The average weight increase in those taking anabolic steroids was nearly three pounds.

“The magnitude of weight gain observed may be considered clinically relevant,” said lead author Karen Johns, a medical assessment officer from the agency Health Canada. “One hopes there would be greater weight gain with the long-term use of anabolic steroids; however, this has not been proven to date in clinical trials.”

AIDS wasting, which leads to significant weight loss in people with HIV, causes severe loss of weight and muscle and can lead to muscle weakness, organ failure and shortened lifespan. Researchers have long sought to reverse this common, destructive effect of HIV with mixed success.

The wasting stems from loss of the body’s ability to grow muscle and from low levels of testosterone.

Anabolic steroids are synthetic substances similar to the male sex hormone testosterone that promote growth of skeletal muscle and the development of male sexual characteristics.

Although most recently in the news for their misuse by professional athletes, anabolic steroids have legitimate medical application for men with low testosterone and people with certain types of anemia. Two anabolic steroids available in the United States, nandrolone decanoate and oxandrolone, have been used to help increase weight and muscle mass in small studies of people with wasting.

Conversely, anabolic steroid use has been associated with increased rates of HIV in those who share needles or use nonsterile needles when they inject steroids.

In the review studies, anabolic steroids were administered to patients either orally or by injection. The main side effects were mild and included abnormal liver function tests; acne; mild increase in body hair; breast tenderness; increased libido, aggressiveness and irritability; and mood swings — all common side effect of anabolic steroid use.

“The 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, M.D., 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.

Use of Androgens in Patients Who Have HIV/AIDS

Of the 3 orally active anabolic steroids, oxandrolone has been studied in HIV-infected patients more extensively than has oxymetholone. Stanozolol is used for the treatment of hereditary angioedema and has not been used for its anabolic effect in this patient population to any great extent.

One of the earlier studies of oxandrolone in HIV-infected patients was begun before the introduction of the PIs. Sixty-three HIV-infected men with a loss of body weight greater than 10% were randomized to receive placebo; oxandrolone, 5 mg/d; or oxandrolone, 15 mg/d. The patients who received 15 mg/d of oxandrolone gained weight throughout the 16-week period, whereas those who received 5 mg/d of oxandrolone maintained their weight. In contrast, the patients who received placebo continued to lose weight.

In a follow-up study, which has not yet been published, patients were randomized to placebo or to 1 of 3 dosages of oxandrolone -- 20 mg/d, 40 mg/d, or 80 mg/d (C. Grunfeld, unpublished data, 1998). The patients in the group who received 40 mg/d had the most statistically significant weight gain. However, both the patients in this group and those who received 80 mg/d showed significant increases in serum levels of liver transaminases.

A study sought to determine whether a regimen of supraphysiologic doses of androgen (testosterone) plus an anabolic steroid (oxandrolone) would improve the LBM and strength gains achieved with progressive resistance exercise in HIV-infected men who had experienced weight loss.  A second objective of the study was to determine whether antiretroviral therapy with a PI prevented lean body anabolism.

All subjects in the study participated in supervised progressive resistance exercise for 8 weeks. At the same time, they received testosterone, 100 mg/wk, by intramuscular injection. Twenty-four eugonadal men were then randomized to either placebo or oxandrolone, 20 mg/d. Twenty-two patients completed the study. The results indicated that compared with patients who received placebo, those who received oxandrolone experienced improved nitrogen balance ( P = .05); increased LBM ( P = .005); and increased muscle strength, as judged by either maximum weight lifted ( P = .02 to .05) or dynamometry ( P = .01 to .05). The results were similar regardless of whether the patients were taking a PI. However, compared with placebo, oxandrolone was associated with a statistically significant decrease in blood levels of high-den-sity lipoprotein (HDL) cholesterol ( P < .001).

Because all patients in the study participated in progressive resistance training and received testosterone, only an additive effect of Oxandrolone versus placebo was being determined. Therefore, the study appears to be valid even though the number of patients enrolled was small. On the other hand, had the design of the study called for dividing the patients into multiple groups, so that not all patients received testosterone or participated in progressive resistance exercise, the number of patients required to reach statistical significance would have been much higher -- on the order of 350.

The conclusions that can be drawn from the study are that oxandrolone -- 20 mg/d, added to a program consisting of both progressive resistance exercise and physiologic doses of testosterone -- improved the anabolic and functional responses in patients who showed HIV-related weight loss.

Only one study of oxymetholone in HIV-infected patients has been reported. Patients were randomly assigned to receive either oxymetholone (14 patients) or oxymetholone plus ketotifen (16 patients). Ketotifen is an H 1-receptor antagonist (ie, antihista- mine) that has been shown to block tumor necrosis factor a. The patients receiving the medications under study were compared with 30 matched control patients who met the same inclusion criteria, such as advanced HIV infection and chronic cachexia.

At entry into the study, all patients had experienced significant weight loss (greater than 12 kg [26.4 lb]). The average weight gain by the patients who received oxymetholone was 8.2 kg (18 lb), a 14.5% increase over weight at entry ( P < .001). The average weight gain by the patients who received combination therapy was 6.1 kg (13.4 lb), a 10.9% increase over weight at entry ( P < .005). The untreated control patients lost an average of 1.8 kg (4 lb).

Both groups of treated patients showed improvement in the ability to perform activities of daily living (the Karnofsky Index) and in several quality-of-life variables.

Although this study was not a double-blind clinical trial, the investigators believed that the results suggested the need for a randomized, double-blind, placebo-controlled, multicenter trial.

Anabolic steroids for the treatment of weight loss in HIV-infected individuals

Anabolic steroids may be beneficial in the treatment of weight loss in HIV-infected individuals. Anabolic steroids include testosterone and its derivatives. One of the functions of testosterone is to help build muscle. Testosterone has been demonstrated to increase muscle mass and lean body mass in testosterone-deficient but otherwise healthy men. Individuals with HIV infection often lose weight and have low blood levels of testosterone; thus, the use of anabolic steroids in the treatment of weight loss in individuals with HIV infection may be beneficial.

The purpose of this review was to evaluate anabolic steroids as a means of treatment of weight loss in individuals with HIV infection. The review includes 13 randomized clinical trials in the primary analysis. The results suggested that anabolic steroids increased both lean body mass and body weight.

However, the results were not consistent among individual trials and the average increase was small and may not be clinically relevant. Furthermore, the results need to be interpreted with caution as this meta-analysis was limited due to small sample sizes; short duration of treatment and of follow-up; and heterogeneity of the study populations, the anabolic interventions, and concomitant therapies.

HIV causes structural heart disease

Researchers from Spain have shown that HIV causes structural heart disease. These findings support the introduction of cardiovascular screening for all HIV patients, particularly those who have a positive viral load.

"It is well known that patients with HIV have a high incidence of structural heart disease (mainly diastolic dysfunction and pulmonary hypertension) as measured by echocardiography but the reason is not clear. We decided to conduct a study to evaluate whether the stage of HIV or the detectable blood viral load were related to the degree of heart disease."

The Centers for Disease Control and Prevention (CDC) estimates that there are 1,144,500 people aged over 13 living with HIV in the US.

For the study, researchers analyzed data from 65 HIV patients, with an average age of 48. All the participants reported shortness of breath - dyspnea - which was graded as greater than class II on the New York Heart Association (NYHA) scale.

According to the Heart Failure Society of America, the NYHA scale is used by physicians to determine the stage of heart failure in patients and focuses on the patient's symptoms in relation to their daily activities and quality of life.

It ranges from class I with mild symptoms through to IV, where symptoms are severe and patients are unable to perform any physical activity without discomfort. This study focuses on classes III and IV, where patients display moderate to severe symptoms.

Participants' HIV stage was determined by the CD4 (T-cells) count, their susceptibility to opportunistic diseases and their viral blood load, tested by determining the number of virus particles, or copies, within a milliliter of blood.
AIDs.gov explains that while there is no "normal" viral load, as people who are not infected have no viral load, it is considered "undetectable" if the test measures are less than 40-75 copies in 1 milliliter of blood.

Patients were also given a transthoracic echocardiogram to see if they had structural heart disease (ventricular hypertrophy, systolic or diastolic dysfunction or pulmonary hypertension). Cardiovascular risk factors, such as diabetes, hypertension, smoking status and renal failure, were also assessed.

The researchers found that almost half of the patients (47%) had some type of structural heart disease, usually left ventricular hypertrophy, left ventricular dysfunction, pulmonary hypertension and signs of right ventricle failure.

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

People with HIV who are treated with anabolic steroids to prevent AIDS wasting may realize modest gains in weight and muscle mass, a new review shows.
The review covered 13 studies of adults age 24 to 42 with HIV, 294 of whom received anabolic steroids for at least six weeks and 238 of whom received placebo. The average weight increase in those taking anabolic steroids was nearly three pounds.

“The magnitude of weight gain observed may be considered clinically relevant,” said lead author Karen Johns. “One hopes there would be greater weight gain with the long-term use of anabolic steroids; however, this has not been proven to date in clinical trials.”

AIDS wasting, which leads to significant weight loss in people with HIV, causes severe loss of weight and muscle and can lead to muscle weakness, organ failure and shortened lifespan. Researchers have long sought to reverse this common, destructive effect of HIV with mixed success.

The wasting stems from loss of the body’s ability to grow muscle and from low levels of testosterone.

Anabolic steroids are synthetic substances similar to the male sex hormone testosterone that promote growth of skeletal muscle and the development of male sexual characteristics.

Although most recently in the news for their misuse by professional athletes, anabolic steroids have legitimate medical application for men with low testosterone and people with certain types of anemia. Two anabolic steroids available in the United States, nandrolone decanoate and oxandrolone, have been used to help increase weight and muscle mass in small studies of people with wasting.

Conversely, anabolic steroid use has been associated with increased rates of HIV in those who share needles or use nonsterile needles when they inject steroids.

In the review studies, anabolic steroids were administered to patients either orally or by injection. The main side effects were mild and included abnormal liver function tests; acne; mild increase in body hair; breast tenderness; increased libido, aggressiveness and irritability; and mood swings — all common side effect of anabolic steroid use.

“The 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, M.D., 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.

AIDS & HIV: Treatment & Prevention

While 1.1 million Americans currently live with HIV/AIDS, the incurable virus is no longer a quick death sentence and has become a chronic, manageable condition.

Symptoms & Complications

When a person is first exposed to HIV, they may show no symptoms for several months or longer. Typically, however, they experience a flu-like illness that includes fever, chills, headache, fatigue, muscle aches and enlarged lymph nodes in the neck and groin areas. This early illness is often followed by a “latency” phase where the virus is less active and no symptoms are present, according to the U.S. Department of Health and Human Services. This latent period can last up to a decade or more.

As HIV progresses into full-blown AIDS, it severely damages the immune system, causing a wide variety of symptoms such as:

• Rapid weight loss or “wasting”
• Extreme fatigue
• Recurring fevers and night sweats
• Prolonged gland swelling
• Prolonged diarrhea
• Sores in the mouth, genitals or anus
• Pneumonia
• Skin blotches
• Depression, memory loss and other neurological effects

According to the U.S. Centers for Disease Control (CDC), untreated HIV is also linked to serious conditions such as cancer, liver disease, cardiovascular disease and kidney disease. 

Diagnosis & Tests

Since HIV/AIDS can set off so many other illnesses, it may be difficult initially to pinpoint the source. Typically, however, these illnesses appear in clusters over a short period of time, cluing patients and doctors into the presence of the virus. According to NIAID, two types of blood tests can confirm HIV/AIDS infection:

• ELISA, or enzyme-linked immunosorbent assay, which detects disease-fighting proteins called antibodies that are specific to HIV; and

• Western blot, which detects antibodies that bind to specific HIV proteins

After someone is first infected it may take weeks or months for the immune system to produce enough detectable antibodies in an HIV blood test. Ironically, an infected person’s viral load may be very high during this time, making the infection exceptionally contagious. Because of this, the CDC recommends routine HIV testing for all adolescents, adults and pregnant women, and advises that everyone between the ages of 13 and 64 should be tested at least once.

Conventional HIV/AIDS tests are sent to a laboratory for analysis and may take a week or more for results. A rapid HIV test is also available that offers results in about 20 minutes, but positive results from either type of test are confirmed with a second test.

Prevention

More than 56,000 Americans become infected with HIV each year, according to the U.S. Department of Health and Human Services. While some AIDS patients have been infected through blood transfusions during medical procedures, preventing infection usually depends on avoiding risky habits or behaviors that lead to exposure to the virus, which can be transmitted through blood, bodily fluids such as semen and infected needles.

Prevention measures include:

• Knowing yours and your partners’ HIV status
• Using latex condoms correctly during every sexual encounter, whether gay or straight
• Limiting the number of sexual partners
• Abstaining from injectable drug use
• Seeking medical treatment immediately after suspected HIV exposure, since medications can sometimes prevent infection if started early

It’s just as important to know the ways HIV cannot be spread, such as by:

• Saliva, tears or sweat
• Water or air
• Casual contact such as closed-mouth kissing or shaking hands
• Insects, including mosquitoes

Early HIV Treatment a Win-Win

A cost-effective way to help patients stay healthy and prevent virus transmission. Providing early antiretroviral drug treatment for recently infected HIV patients and their uninfected sexual partners is a cost-effective way to help patients stay healthy and prevent transmission of HIV, a new study finds.

The study, looked at HIV patients in India and South Africa. Some of the patients received early antiretroviral therapy while the start of treatment was delayed for other patients. HIV is the virus that causes AIDS.

During the first five years of the study, 93 % of those who received early antiretroviral therapy survived, compared with 83 % of those whose treatment was delayed. Life expectancy was nearly 16 years for those in the early treatment group, compared with nearly 14 years for those in the delayed treatment group.

During the first five years, the potential costs of infections - particularly tuberculosis - prevented by early treatment of HIV patients in South Africa outweighed the costs of antiretroviral therapy drugs, suggesting that the early treatment strategy would reduce overall costs.

This was not the case in India, where the costs of treating HIV-related infections are less. Even so, early antiretroviral therapy in India was projected to be cost-effective according to established standards, the researchers said.

They also found that across patients' lifetimes, early antiretroviral therapy was very cost-effective in both countries. While most of the benefits of early treatment were seen in the HIV-infected patients -- fewer illnesses and deaths -- there were also added health care and economic cost savings from reducing HIV transmission, according to the study.

"By demonstrating that early HIV therapy not only has long-term clinical benefits to individuals but also provides excellent economic value in both low- and middle-income countries, this study provides a critical answer to an urgent policy question," study corresponding author Dr. Rochelle Walensky, of the Massachusetts General Hospital Division of Infectious Disease. "HIV-infected patients live healthier lives, their partners are protected from HIV, and the investment is superb," she added.

Walensky, a professor of Medicine at Harvard Medical School, said the findings point to a need to "redouble international efforts" to provide early antiretroviral therapy to any HIV-infected person who can benefit from it. Her colleague, Dr. Kenneth Freedberg, director of the Medical Practice Evaluation Center at Massachusetts General, agreed.

"Some people have questioned whether providing early [antiretroviral therapy] to all who need it would be feasible in resource-limited countries," he said in the news release. "We've shown that in countries like South Africa, where it actually saves money in the short-term, the answer is 'yes.' We believe that continued international public and private partnerships can make this true in other countries as well."

Freedberg said such an investment could bring about dramatic decreases in infections and illness that could save millions of lives over the next decade.

Multivitamins May Help Fight HIV Progression

But supplements tested only on those who hadn't started medications

New research from Africa suggests that basic multivitamin and selenium supplements might greatly lower the risk that untreated people with the AIDS virus will get sicker over a two-year period.

It's not clear how patients who take the vitamins and mineral might fare over longer periods. And the impact of the study in the United States will be limited because many Americans diagnosed with HIV, the virus that causes AIDS, immediately begin treatment with powerful medications known as anti-retroviral drugs. Those in the African study hadn't yet begun taking drugs to keep the virus at bay.

Still, "it is incredibly useful to find new strategies to delay the progression of HIV disease," said Dr. Jared Baeten, an associate professor of global health at the University of Washington in Seattle who's familiar with the findings. "Not every HIV-infected person is immediately willing, or able, to initiate anti-retroviral therapy. Inexpensive, proven treatments ahead of starting anti-retroviral therapy can fill an important role."

At issue: Do HIV-infected people benefit from nutritional supplements? Previous research has suggested that even well-fed people infected with HIV may not properly process nutrients in food, said study author Marianna Baum, a professor of dietetics and nutrition at Florida International University's Stempel School of Public Health.

The researchers wondered whether the immune system would get a boost if patients who hadn't yet begun anti-retroviral treatment took nutritional supplements. No study had looked at this before, Baum noted.

For the study the researchers divided nearly 900 HIV-infected patients in the African country of Botswana into several groups. Some took a placebo, a sugar pill with no active ingredients. Others took a multivitamin including B, C and E vitamins. Another group took the multivitamin along with supplements of the mineral selenium, and still others took only selenium.

None of the treatments had a noticeable effect except the combination of multivitamin and selenium. After adjusting their statistics so they wouldn't be thrown off by various factors, the researchers reported that those who took the combination were about half as likely to show signs over two years that their infection had progressed toward AIDS as those who took the placebo.

Overall, the risk that the disease would progress over the two years of the study was fairly low: 32 of the 217 who took the placebo suffered progression of the disease, she said, compared to 17 of the 220 who took the vitamin/mineral combination.

Baum didn't have information about the costs of the supplements, but she said they are low. In the United States, supplements that contain many vitamins and minerals can cost just pennies a day.

The supplements appeared to have no side effects, said Baum, who recommends that people newly diagnosed with HIV begin taking multivitamins. They seem to boost the immune system, she said. The selenium supplements, in particular, may provide enough of the mineral that the virus isn't able to hog it, she said.

Baeten cautioned that not just any multivitamin will do. "The results of this study appear to illustrate that it is not just any supplement," he said.

"Only the combination of vitamins plus selenium was effective," Baeten said. "For U.S. patients, this latter point is relevant, as there's a huge variety of supplements available. I would suggest talking with a doctor before taking any supplements."

He added that the study doesn't detract from the crucial importance of anti-retroviral drug treatment.

Researchers next want to see if the supplements help patients already taking anti-retroviral medications, study author Baum said.

Researchers Block Replication of AIDS Virus

A multidisciplinary team of scientists from Spanish universities and research centres, among which is the University of Valencia, has managed to design small synthetic molecules capable of joining to the genetic material of the AIDS virus and blocking its replication.

This achievement has been obtained for the first time in the world by a group of researcher led by José Gallego from Universidad Católica de Valencia "San Vicente Mártir." The University of Valencia, the Príncipe Felipe Research Centre, and the Instituto de Salud Carlos III have participated.

The newly designed synthetic molecules inhibit the output of genetic material of the virus from the infected cell nucleus to the cytoplasm, thus the virus replication is blocked and avoids the infection of other cells. The genetic material of the AIDS virus, or HIV-1, is formed by ribonucleic acid (RNA), and encodes several proteins that allow it to penetrate the human cells and reproduce within them. The new virus inhibitors, called terphenyls, developed by this group of scientists, were designed by computer to reproduce the interactions of one of the proteins encoded by the virus, the viral protein Rev.

In this way, the terphenyls join Rev's receptor in the viral RNA, preventing the interaction between the protein and its RNA receptor. This interaction is necessary for the virus genetic material to leave the infected cell nucleus and, thus, it is essential for the survival of HIV-1. The fact that the terphenyls block the virus genetic material output of the cell prevents the infection of other cells.

This discovery is the result of a close collaboration between three research groups throughout several years. Thus, the scientists of the Universitat Católica de Valencia were in charge of the computational design and verified experimentally that the terphenyls were capable of joining the Rev receptor in the viral RNA and inhibit the interaction between this RNA and the protein.
For its part, the molecules were synthesised in professor Santos Fustero's organic Chemistry laboratory in the Príncipe Felipe Research Centre and the University of Valencia. Also, through experiments with cells infected by the virus, the group of José Alcamí in the Instituto de Salud Carlos III demonstrated that the inhibitors block the replication of the HIV-1 and inhibit the function of the Rev protein, confirming this way the validity of the models generated by computer.

Traditionally, pharmaceutical companies have focused on the development of medicines that act on target proteins, as the approach to the receptors made out of RNA is considerably complex.

Although several natural antibiotics act at the bacterial ribosomal RNA level, up to now designing by computer a new synthetic chemical entity capable of joining RNA target and have a relevant pharmacological effect was not possible. The terphenyl structures identified in this research could open new ways to approach other therapeutic targets formed by nucleic acids.
On the other hand, the infection by HIV affected 34 million people worldwide in 2010, according to the World Health Organisation (WHO). The emergence of resistance to the current antiretroviral therapies and the lack of an effective vaccine highlight the necessity of identifying the new medicines that act on other virus targets. Rev protein constitutes one of this alternative targets, but so far they it has not been possible to develop antiviral agents based in their inhibition.

The results of this research have been the objectives of a patent application, and the three laboratories involved in the research keep their collaboration with the objective of improving the pharmacological properties of new Rev inhibitors.

Untreated HIV Carriers Transmit Resistant Viruses

Human-Immunodeficiency Viruses that resist AIDS medicines are primarily transmitted by people who are not actually undergoing treatment. In order to prevent a spread of the resistant viruses increased efforts in prevention and early diagnosis of new infections are needed, as concluded by the Swiss HIV Cohort Study that is supported by the Swiss National Science Foundation (SNSF).

Around one in every ten newly infected HIV carriers in Switzerland has viruses that are resistant to at least one of the three classes of drugs used to treat AIDS. Contrary to previously held assumptions, resistant viruses are primarily transmitted by people who are not yet receiving treatment, according to the reports in "Clinical Infectious Diseases" from the researchers headed by Roger Kouyos and Huldrych Günthard at Zurich University Hospital.

Reconstruction of transmission chains - In their molecular epidemiological analysis of 1674 male carriers of HIV who had sex with other men, the researchers demonstrated resistant viruses in 140 patients. The research group reconstructed the transmission chains of these viruses on the basis of the patients' estimated infection dates and the degree of genetic relatedness of their blood-borne viruses. Most of the transmission chains commence in HIV carriers who were not yet undergoing treatment at the time at which the resistant viruses were transmitted.

"We were astonished to note that the resistant viruses are primarily brought into circulation by untreated people," said Günthard. "Previously we had assumed that the resistant viruses came from patients for whom treatment had failed as resistances were produced while treatment was ongoing."

Early diagnosis is vital - The principal role of untreated HIV carriers in the transmission of resistant viruses means that combating these resistant strains is not solely reliant on optimised treatment, but also on preventing transmission by people who are not undergoing treatment. Prevention and early detection of newly infected persons are particularly vital in this respect. "In contrast to other tests, such as that for hepatitis, the HIV test requires that permission is obtained from the patient," explained Günthard. Since many doctors are reluctant to discuss their patients' sexuality with them openly, many infections are not discovered until much later than they could and should have been. While progress in medicine has robbed AIDS of its deadly effect, Günthard went on to stress, "there is still a great deal to be done."

The Swiss HIV Cohort Study - The aim of the study, which started in 1988, is to better understand HIV infection and AIDS, and improve the treatment of patients. All of Switzerland's specialist HIV clinics (Basel, Berne, Geneva, Lausanne, Lugano, St. Gallen and Zurich) collect data on treatment and the progress of the disease. Currently over 8,800 people are taking part in the Swiss HIV Cohort Study, of whom almost one third are women.

Aloe vera helps reverse cancer and AIDS

One of the best kept secrets in the nutritional field is aloe vera. Commonly recognized for soothing ulcers, hemorrhoids, sunburns, wounds and other skin ailments, many don't know the power pure raw aloe vera juice has for improving and even reversing serious diseases that baffle mainstream medicine.

That's because those claims are suppressed.

If a supplement or nutritional product promotes any kind of cure, the FDA and other agencies send their bootjack militia to raid them. A frightening example occurred in Tampa, Florida a couple of decades ago as research physician Ivan Danhoff MD was attempting to crash the medical mafia's cancer party. That's when his nutritional clinic was using aloe extracts and curing terminal cancer patients from hospice. Health agency thugs raided, pulling IVs out of patients whose condition had improved dramatically. Many died months later. The clinical trial was going by FDA guidelines to get the aloe extract approved

Improving on nature is probably unnecessary with aloe vera

The desire to modify or isolate ingredients from aloe vera to create an accepted medical model that is efficacious without side effects is commendable. But it appears Big Pharma and the cancer industry's good fellas want to protect their turf. Allowing an actual cure would even put the cancer cure fund raisers out of business. Most store shelf aloe vera juices don't do much beyond soothing the minor ailments mentioned earlier. Those juices are processed, heated, and diluted. That's not the case with all aloe vera products. The right aloe vera juice products are miracle healers

The most dramatic clinical proof of pure raw aloe vera juice comes from research done with AIDS patients. Almost all who were put on a regimen of daily aloe vera juice got better with white T cell counts skyrocketing. It's obvious that aloe vera is a potent immune booster, which implies it can be applied to other diseases.

One of the AIDS patients in this trial was diagnosed with advanced liver cancer and told he had less than two months to live. His liver was so tumor riddled it was four times its normal size. He continued with the juice, improved gradually, and within a year all his tumors were gone.

A doctor involved with this trial, pathologist H. Reginald McDaniel MD, was at first skeptical. But now he has seriously ill patients using aloe successfully. What turned him around was his own illness, a viral pneumonia for which conventional medicine had no answer. He was given a couple of cases of aloe juice, and his cure turned him into an aloe advocate.

Two short videos covering the aloe AIDS/cancer story are linked at the end of this paragraph. The last part of video 2 is censored, evidently to exclude information for ordering that particular juice. Promoting non-pharmaceutical AIDS and cancer cures is a no-no with the FDA. That data was probably pulled to protect them from FDA harassment

Aloe's healing power known for ages

The juice's power has been known by indigenous groups for ages. Franciscan Friar Romano Zago discovered how to make the juice from Brazilian Indians, used it with local villagers, and published his findings in the 1980s. He used their recipe based on the indigenous aloe arborescense plant . Father Zago's juice and others are from whole leaves. It's possible to get aloe juices without leaf skins (filleted) or reduced aloin content to minimize potential diarrhea side effects.