Anabolic steroids help AIDS patients

My hope is by sharing my story (which I’ve told to only a few friends) you also might be encouraged to document and share your own story about AIDS. It is our stories that are the heart and soul of the history of AIDS.  None should be forgotten. Ever.

It was in 1988 that a friend of mine introduced me to Dr. Walter Jekot, an HIV doctor practicing in Los Angeles. Dr. Jekot knew I was semi-retired at 24 and asked if I’d consult with him to help market his sports medicine practice in West Hollywood. The bulk of his patients were gay men, mostly bodybuilders and a few athletes. Why not, I thought. Partying every night was starting to get kind of boring anyway.

One Saturday afternoon, a couple of months into working with Dr. Jekot, two men wearing suits came into his office and closed the door. They stayed for more than three hours. After they left, I went in to ask Dr. Jekot what was going on. As I asked my first question, he just looked up and stared at me. He was ghost white. “What’s wrong,” I asked. “Sit down, Dave,” he replied. “There is something I have to tell you.”

He said the men were his attorneys. “I am being prosecuted by the federal government for what they say is the illegal distribution of anabolic steroids and growth hormone,” he explained. Then he told me his story.

After the 1988 Olympics in Los Angeles, scandal hit the sports world. Ben Johnson, a Canadian sprinter and gold medal winner that year, was to appear at a court hearing that would be broadcast live around the world. The government wanted to find out if Johnson could be prosecuted for cheating because he allegedly took anabolic steroids during the 1988 Olympic Games. During the trial, Johnson’s doctor said that Dr. Jekot had dispensed anabolic steroids to the U.S. Olympic athletes during the same Olympic Games.

Within 15 minutes every news agency in the world was beating down Dr. Jekot’s door, trying to get a comment, demanding an interview. A week later, the assistant attorney general of the United States announced on live television that the Department of Justice was going after Dr. Jekot with every legal resource available to the federal government.

I sat there stunned. I felt betrayed. I got up and started to leave, but he blocked the door. “Wait,” he asked.  “There is something else.”

First, he apologized for not telling me sooner. He said he was scared and didn’t know whom he could trust, including his own attorneys. “Did you do it,” I asked. When he said no, I sat down again.

He wanted to tell me something, he said, about a discovery he made, but I had to promise not to tell anyone else. I declined.  He told me anyway:  “I have discovered that anabolic steroids and growth hormones can help AIDS patients by reversing the wasting process.”

Wasting is the involuntary loss of body weight the entire gay community had seen time and again.

Having a sports management background, I had spent years warning our athletes about the ills of steroids. I was skeptical. In fact, I didn’t believe him. Why should I?  But some strange force kept me in that chair listening. I wanted to know more about the discovery that might help AIDS patients.

A month later I asked for and received written permission to have access to the medical records of 13 AIDS patients who were being treated with anabolic steroids or growth hormones for AIDS-related wasting. I also asked to be permitted to interview each patient. All agreed.

It was 1989. After sitting down with each of the 13 patients, I became convinced anabolic steroid treatments worked. I had no idea why or how, but something was keeping these patients alive. They had energy and looked healthy and fit.

Thus began my quest to have the most unpopular and denounced drug in the world become accepted as the therapy to reverse wasting syndrome and bring people back to life. I believe this was, in fact, the first Lazarus Effect treatment. Within three years, anabolic steroids became standard treatment to reverse AIDS-related wasting.

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."

Steroid Can Restore Body Tissue in HIV-Positive People

The oral anabolic steroid Oxandrolone is effective in restoring muscle and fat tissue that many HIV-positive people lose, according to a  new study.  HIV-related wasting is a complication in which people lose a significant percentage of their normal weight, leaving them at risk for secondary infections.

Carl Grunfeld of the University of California-San Francisco and colleagues gave 262 HIV-positive men who had experienced weight loss greater than or equal to 10% to 20% of their body mass index either oxandrolone - in doses of 20 mg, 40 mg or 80 mg - or a placebo daily for 12 weeks. The men who took the steroid in all dose levels had gained weight and muscle tissue, researchers found.

The steroid also produced side effects, including an increase in LDL cholesterol, which is considered unhealthy cholesterol, and a decrease in HDL cholesterol, which is considered healthy cholesterol, the study finds. Some of the men also showed signs of liver toxicity, according to the study. Current therapies for tissue loss, including nutritional supplements and a drug called megestrol acetate, mostly increase body fat, and growth hormone therapies, which also can treat tissue wasting, increase muscle mass but decrease fat stores.

Anabolic steroids like oxandrolone restore both tissue and fat, Grunfeld said, adding that the benefits must be weighed against the side effects. Grunfeld also said that although oxandrolone is not specifically approved for HIV-related wasting, physicians may prescribe it to treat the condition

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.

Testosterone replacement therapy in people with HIV

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 cypionate 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.

Steroid increases lean muscle mass in HIV-positive men, but has side-effects

Use of the steroid oxandrolone is associated with significant gains in weight and body cell mass in HIV-positive men who had experienced HIV-related wasting, according to an American study.  However, although the steroid increased muscle mass, it did not improve endurance and caused side-effects, including an increase in levels of ‘bad’ LDL cholesterol and elevations in liver enzymes.

Unintentional loss of just 3% of body weight has been associated with poorer survival in HIV-positive individuals. Although the use of antiretroviral therapy has led to a significant decrease in the prevalence of unintended weight loss, it is still common, even amongst people taking HIV treatment.

Diet and appetite stimulation can help increase weight in people affected by HIV-related wasting, but most of the gains of weight occur in the form of fat, and stores of body fat are not correlated with improved survival in HIV-positive individuals. Some small studies have shown that anabolic steroids can increase body weight and muscle mass in HIV-positive patients. To further investigate the benefits of treatment with anabolic steroid therapy, investigators designed a double blind placebo controlled trial in which men with HIV-associated wasting were randomised to receive a placebo or one of a 20mg, 40mg, or 80mg daily dose of the oral steroid oxandrolone. The investigators measured changes in the patients’ weight, body composition, endurance, and also conducted laboratory tests to assess the safety of steroid treatment. For the first twelve weeks, the men were provided with blinded treatment. At the end of this period, all the men were given the option of receiving an open-label 20mg daily dose of oxandrolone for a further twelve weeks.

The study was conducted between the autumn of 1996 and the summer of 1998. Treatment with antiretroviral drugs was not a prerequisite for entry to the study, but if an individual was taking anti-HIV treatment, they were required to have been taking a stable regimen for at least six weeks. The investigators do not state how many patients were taking anti-HIV therapy, nor do they analyse their results according to the use of antiretrovirals, making it difficult to determine the applicability of these results in patients experiencing HIV-related wasting despite antiretroviral therapy.

A total of 262 men were recruited to the study. CD4 cell count was comparable across the four arms of the study at approximately 250 cells/mm3, as was viral load at approximately 120,000 copies/ml.

Body weight increased significantly in all arms of the study, including the placebo arm during the double blind phase (p < 0.014). Body cell mass also increased in all arms of the study during this phase. However, when the investigators subjected their results to further analysis, they found that patients who took the 40mg dose of oxandrolone had significantly greater increases in body weight at weeks two, four, eight and twelve than those individuals who received a placebo (p < 0.004). Although patients receiving the 80mg dose of oxandrolone had significantly greater weight gains than patients on the placebo at weeks four and eight, this was not the case at weeks two or twelve.

In addition, the investigators found that patients treated with the 40mg (p = 0.0049) and 80mg (p = 0.0002) doses of oxandrolone experienced significant changes in body cell mass compared to patients who received the placebo.

Treatment with the steroid did not, however, lead to any improvement in endurance.

The investigators noted that levels of AST and ALT liver enzymes increased during the first four to eight weeks in patients receiving the 40mg and 80mg doses of oxandrolone. What’s more, they found a dose-related increase in the incidence of moderate-to-severe liver abnormalities in people taking the steroid. This was diagnosed by laboratory tests looking at AST, ALT, bilirubin, and uric acid levels. Analysis also showed that people treated with the 40mg and 80mg doses of the steroid were significantly more likely than those taking the placebo to experience an increase in their ‘bad’ LDL cholesterol (p < 0.017).

On completion of the twelve-week double-blind phase of the study, all the patients were offered the option of remaining on the study for a further twelve weeks and receiving an open label 20mg oxandrolone dose a day. By the end of this period, there were no differences in weight between patients and liver function ceased to be significantly different from baseline.

“Oxandrolone treatment was associated with significantly greater body weight gain above baseline than with placebo. A major portion of this weight gain occurred in the lean body compartment”, comment the investigators, who note that theirs was “the largest randomized placebo-controlled trial of an androgen in patients with HIV-associated weight loss.”

Although the investigators note that treatment with the steroid was generally “well tolerated” they note that over 5% of patients had moderate or severe increases in levels of liver enzymes and that “LDL levels decreased and HDL levels increased.”

They recommend “further studies…to determine the efficacy of oxandrolone in improving muscle strength, physical function, and health-related quality of life in HIV-infected patients with weight loss.

Human Growth Hormone Being Used in AIDS patients

Serostim, a form of recombinant HGH  is being used to reverse the pernicious form of weight loss seen in later stage AIDS, called "wasting."

Wasting is different than the loss of weight and fat that comes from under eating, this wasting also occurs in later stages of cancer. Wasting is the unintentional loss of weight in which the lean muscle, the body mass, the bones and the body organs are all withering away. Many experts believe this loss of lean body mass contributes to immune dysfunction and makes it harder for AIDS patients to fight off life-threatening infections. The wasting process itself, if it goes beyond about 33% of ideal body weight, is incompatible with life, as was seen in concentration camp victims of World War II.

A number of medical centers took part in a study of 178 patients with AIDS-associated wasting, which is defined as having lost at least 10% of body weight. The patients who received growth hormone therapy gained an average of 6.6 pounds of lean body mass while losing an average of three pounds of fat after three months of treatment. The therapy also resulted in an improvement of their endurance and quality of life.

Dr. Schambelan, of UCSF says "At the moment there isn't another therapy in the late stages of AIDS that has had this kind of effect on the lean body mass." "There are therapies that can increase weight, such as an appetite stimulant called megestroacetate, but that weight gain tends to be primarily fat. The advantage of growth hormone is that it causes lean body mass to increase." Dr. Schambelan says that some of the patients are still coming in, even though the original study ended three years ago. "Obviously these are the people who are still alive and doing well and the people who didn't do well are no longer there, so you can't talk about the average effect. I think that the anecdotal experience is that for the people who continue to take the drug, who continue to eat, and don't get serious opportunistic infections, they have had a very robust response. The medication has increased the benefits. The gain in lean body mass they had in their three months of the study has doubled or tripled over the next year or two."

 Although human growth hormone does not cure AIDS, there is some evidence that it may lengthen the life of AIDS patients. The increase in lean body mass may make the AIDS patient less vulnerable to infections. When given with antiviral agents such as AZT, human growth hormone did not cause any increase in the amount of HIV. In fact, human growth hormone has been shown to stimulate the formation of new red blood cells, which are depleted by AZT.

Even more exciting, human growth hormone also appears to reduce the incidence of AIDS associated infections, such as polycystic pneumonia and Kaposi's sarcoma. It can rejuvenate the immune system; if it can actually strengthen the ability of HIV+ patients to resist infectious diseases it may improve both the quality and the quantity of their lives.

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.