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Is extra muscle mass needed
Jul 23, 2006

One reason "I was told" for using steroids was "to right" the imbalance that HIV causes between the typical fat and protein metabolism. This imbalance has nothing to do with lypodystrophy, but rather reflects the variety of ways HIV messes up our body's chemistry. As I understood it, HIV increases the body's natural tendency to store fat all the time, and lowers the lowers the priority in regards to protein tissues like muscle. During times of illness this reprogramming is even more intense, and HIVers can lose tremendous amounts of protein/muscle tissue even from minor illnesses. Once fully recovered, the original metabolic reprogramming prevents the body from restoring the muscle mass lost during illness. These things acting together over a period of years, can cause the HIV person to respond to much more poorly and recover much more slowly from even common, non-severe illnesses. I had understood taking steroids somewhat restores the balance between the fat and protein metabolisms, and HIVers should be encouraged through weight training to build up extra muscle mass to forestall harm from sickness major or minor. This should be in moderation of course say a 5-10% increase in weight due to mostly muscle gain. To be clear, I am NOT saying the goal is to be a bodybuilders. I am NOT trying to justify the steroid abuse we see in some parts of the HIV population. I'm trying to understand what was the original reason for giving HIVers steroids. Is this a medically valid theory, or is it totally bogus, or is it somewhere in between with some specialists seeing a benefit with moderate, sensible use of anabolic steroids in order to build up the normal muscle mass just to be safe?

Response from Dr. Pierone

Hello and thanks for posting.

I don't think there is good evidence of an HIV-induced imbalance in fat and muscle metabolism until immunosuppression develops. Hence, the routine use of an anabolic steroid such as nandrolone or an androgenic steroid like testosterone is not warranted in HIV infection. Most HIV-infected individuals do not have hypogonadism or loss of muscle mass and do not need preventive steroids. These medications, even in modest dosages, have potential side effects which cannot be glossed over.

For HIV-infected patients with loss of muscle mass anabolic steroids can by useful to help with recovery. For HIV-infected men with low testosterone levels, hormone replacement therapy is entirely appropriate.



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