To all of you in pozhealth:
I would like to take this opportunity to thank all of you who help each other daily on this list. It amazes me that we have been sharing since 2002 with more than 30,000 emails in 7 years. We now have close to 3000 members!
I am also thankful that new drugs for multidrug resistance were approved this year and that 3 million people are now in treatment around the world, although 7 more million need it to survive. Hopefully we will see treatment spreading faster to help those who need it most and cannot afford them.
The cure of HIV is now part of the research conversation for the first time. I see the word "cure" more frequently now, although it may take years to get there.
Side effects seem to be decreasing with better drugs, and for that I am very thankful.
I am also thankful that Obama won and that hope is slowly being restored in our hearts. I hope that he does not let us down and that we can support him fully while hoping that evil does not attempt to destroy him in his mission.
I am thankful for all the sweet emails I have received from many of you through my hard times this year. Although most of us have not met face-to-face, the love I feel through the electronic lines can certainly reach my heart.
Yes, there is a lot to do and a lot we should have done to save lives in the world. But today, I am thankful that we are here helping each other while we remember our friends and family who are no longer in our presence, but they are in our hearts.
Regards,
Nelson Vergel
powerusa.org
-
The untold Side of the movie "Dallas Buyers Club"
The movie Dallas Buyers Club brings attention to a little-recognized part of the AIDS activist movement: ....
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Exhorbitant Price New Hepatitis C Drug
Fair Pricing Coalition Condemns Gilead Sciences on the High Price of New Hepatitis C Drug Sovaldi™...
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Six Promising HIV Drugs in the Pipeline (2013-2014)
What new HIV medications do we have to look forward to over the next few years? How will these newer drugs improve upon the older ones? To shed some light on these questions....
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What Can We Look Forward to in HIV Cure Research
TheBodyPRO.com's Nelson Vergel sat down with leading HIV cure research activist Richard Jefferys for an update on current important aspects, and controversies, in HIV cure research....
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What Supplements Can I take with HIV medications?
Is it ok to supplement with Creatine (Cell-Tech), and Protein (Nitro-Tech) along with Glutamine...
Wednesday, November 26, 2008
Monday, November 24, 2008
Do we know enough about lipodystrophy?
Do we know enough about lipodystrophy?
Aug 26, 2008
Dear Nelson,
I have a quick question that I feel you can best answer for being an hiv survivor for 25 years. Is the the war on lipo able to be won??? I mean will working out bring muscle back or will my time be wasted??? Also what supplements do you suggest a person take??? I am taking the mv k-pax single strength. Thank You
Response from Nelson
I would asnwer: "yes, partially"
We now know that a lot that we did not know a few years ago.
1- D4T and AZT are two drugs that are linked to fat loss under the skin (lipoatrophy). Tenofovir (Viread) does not cause lipoatrophy in most patients (only 11% had a loss of 20% or more of fat under the skin when used they used tenofovir/3TC with Kaletra or Sustiva in one study)
2- That some protease inhibitors can negatively affect the job of insulin to help store glucose in muscle as glycogen ( insulin resistance) which may increase triglycerides and fat cell size in some patients
3- We know that exercise helps to build lean body mass
4- we know that anabolic steroids like nandrolone and oxandrolone can help those having a difficut at regaining normal weight
5- Statins and fibrates work at reducing lipids in poz people but sometimes not good enough to have them reach normal levels
6- That supplements like Omega 3 fish oils and niacin can help statins and fibrates improve their job at lowering LDL, triglycerides and increasing good cholesterol (HDL)
7- That those who start HAART with low CD4 cells tend to be more prone to having increased belly fat when their CD4 cells increase
8- That there are products like Sculptra, Silikon 1000 and Radiesse in the United States that can help people restore a healthy face
9- That supplements like K PAX and others have some promising but limited data in HIV that requires more studies
10- That growth hormone (Serostim) works at reducing visceral fat but we cannot use it for lipodystrophy because the FDA did not like growth hormone's side effects. Another less effective but lower side effect product may be approved in the future
11- That switching first line patients from Kaletra to Reyataz does not improve their bodies. Other "switch" studies showed the same results.
Unfortunately, we do not data on lower glycemic index diets, good comparison data of what happens to visceral fat when different protease inhibitors or non-nucleosides are used with Truvada in naives with low and higher CD4 at baseline, diet/exercise combinations, and other supplements like carnitine and others. Stay tuned for my upcoming review of studies to be presented at the Lipodystrophy Conference in London on Nov 2008.
You can read more about where we are now here:
http://www.thebody.com/content/art45454.html
I hope this helped
And yes, single strength K PAX is great as a supplement since it includes all minerals and antioxidants you need.
Nelson
Aug 26, 2008
Dear Nelson,
I have a quick question that I feel you can best answer for being an hiv survivor for 25 years. Is the the war on lipo able to be won??? I mean will working out bring muscle back or will my time be wasted??? Also what supplements do you suggest a person take??? I am taking the mv k-pax single strength. Thank You
Response from Nelson
I would asnwer: "yes, partially"
We now know that a lot that we did not know a few years ago.
1- D4T and AZT are two drugs that are linked to fat loss under the skin (lipoatrophy). Tenofovir (Viread) does not cause lipoatrophy in most patients (only 11% had a loss of 20% or more of fat under the skin when used they used tenofovir/3TC with Kaletra or Sustiva in one study)
2- That some protease inhibitors can negatively affect the job of insulin to help store glucose in muscle as glycogen ( insulin resistance) which may increase triglycerides and fat cell size in some patients
3- We know that exercise helps to build lean body mass
4- we know that anabolic steroids like nandrolone and oxandrolone can help those having a difficut at regaining normal weight
5- Statins and fibrates work at reducing lipids in poz people but sometimes not good enough to have them reach normal levels
6- That supplements like Omega 3 fish oils and niacin can help statins and fibrates improve their job at lowering LDL, triglycerides and increasing good cholesterol (HDL)
7- That those who start HAART with low CD4 cells tend to be more prone to having increased belly fat when their CD4 cells increase
8- That there are products like Sculptra, Silikon 1000 and Radiesse in the United States that can help people restore a healthy face
9- That supplements like K PAX and others have some promising but limited data in HIV that requires more studies
10- That growth hormone (Serostim) works at reducing visceral fat but we cannot use it for lipodystrophy because the FDA did not like growth hormone's side effects. Another less effective but lower side effect product may be approved in the future
11- That switching first line patients from Kaletra to Reyataz does not improve their bodies. Other "switch" studies showed the same results.
Unfortunately, we do not data on lower glycemic index diets, good comparison data of what happens to visceral fat when different protease inhibitors or non-nucleosides are used with Truvada in naives with low and higher CD4 at baseline, diet/exercise combinations, and other supplements like carnitine and others. Stay tuned for my upcoming review of studies to be presented at the Lipodystrophy Conference in London on Nov 2008.
You can read more about where we are now here:
http://www.thebody.com/content/art45454.html
I hope this helped
And yes, single strength K PAX is great as a supplement since it includes all minerals and antioxidants you need.
Nelson
How Can I Lower Cholesterol Without Drugs?
Lower cholesterol without drugs
Jun 6, 2008
My cholesterol levels have crept above 200 after three years on Reyataz & Epzicom. I'm in good condition with my aerobic exercise routine, take supplements that should help my cholesterol (like omega-3s and green tea extracts), and have a small glass of red wine most evenings with dinner. I avoid fried and overly-processed foods for the most part. How much can I reasonably expect my eating and exercise habits to be effective in lowering my cholesterol? Is there anything you recommend I add to my supplements to help (e.g. l-carnitine)?
Response from Mr. Vergel
It seems that you are doing everyting you can to lower cholesterol but I have a few suggestions:
Just make sure that you are taking at least 3000-4000 mg a day of Omega 3 capsules, that you sweat while doing cardio for at least 20 min a day, that your sweet consumptions is low, that you are eating oatmeal daily , and that you do not exceed two glasses of wine a day. L-Carnitine at 2000 mg a day can also help bring triglycerides and cholesterol down, specially taken with Omega 3 fatty acids. Niacin has also been shown to be effective decreasing cholesterol. In some studies, niacin at daily doses of 2-3 grams can lower LDL and total cholesterol by approximately 20-30%, lower triglycerides by 35-55%, and increase HDL cholesterol by 20-35%. It can cause "flushing" of the skin in some patients for 20-30 minutes that may make it uncomfortable for them to take it. Slow adjustment of the dosage, administration with food, and giving a baby aspirin before niacin may minimize these reactions. Niacin is available as an over-the-counter supplement and also as a prescription drug called Niaspan.
Some people do all they can to lower cholesterol naturally but are yet to get down to recommended levels. There are genetic factors involved in many cases. For those, taking lipid lowering meds is a good idea.
Keep up with the great work!
Nelson
Jun 6, 2008
My cholesterol levels have crept above 200 after three years on Reyataz & Epzicom. I'm in good condition with my aerobic exercise routine, take supplements that should help my cholesterol (like omega-3s and green tea extracts), and have a small glass of red wine most evenings with dinner. I avoid fried and overly-processed foods for the most part. How much can I reasonably expect my eating and exercise habits to be effective in lowering my cholesterol? Is there anything you recommend I add to my supplements to help (e.g. l-carnitine)?
Response from Mr. Vergel
It seems that you are doing everyting you can to lower cholesterol but I have a few suggestions:
Just make sure that you are taking at least 3000-4000 mg a day of Omega 3 capsules, that you sweat while doing cardio for at least 20 min a day, that your sweet consumptions is low, that you are eating oatmeal daily , and that you do not exceed two glasses of wine a day. L-Carnitine at 2000 mg a day can also help bring triglycerides and cholesterol down, specially taken with Omega 3 fatty acids. Niacin has also been shown to be effective decreasing cholesterol. In some studies, niacin at daily doses of 2-3 grams can lower LDL and total cholesterol by approximately 20-30%, lower triglycerides by 35-55%, and increase HDL cholesterol by 20-35%. It can cause "flushing" of the skin in some patients for 20-30 minutes that may make it uncomfortable for them to take it. Slow adjustment of the dosage, administration with food, and giving a baby aspirin before niacin may minimize these reactions. Niacin is available as an over-the-counter supplement and also as a prescription drug called Niaspan.
Some people do all they can to lower cholesterol naturally but are yet to get down to recommended levels. There are genetic factors involved in many cases. For those, taking lipid lowering meds is a good idea.
Keep up with the great work!
Nelson
How do I get my insurance to pay for my facial wasting treatment?
How do I get my insurance to pay for my facial wasting treatment?
Jun 28, 2008
Hello Nelson-
I hope this finds you well. I wanted to check in with you to see if you were aware if there is any insurance coverage for silicone treatments for facial wasting. I have had several sessions, and it works great. It is not cheap, of course. I am in need of a refresher treatment. I should mention that my insurance is Medicare A,B and D. I receive my meds through a Blue Cross-Part D plan, backed up by ADAP.
Neal
Response from Mr. Vergel
Neal,
It is difficult to get reimbursement for Silikon 1000 since it is an off-label use for facial wasting, but you have nothing to lose and a lot to gain if you have your doctor write a medical necessity letter to send to your insurance company.
Here is a letter that Dr. Doug Mest wrote for my web site facialwasting.org for Sculptra. You can have your doctor use this letter as a template and also to use these scientific references. You can also visit the wonderful resource guide that TheBody.com has created for trying to get coverage for facial lipoatrophy reconstruction options from your insurance:
http://www.thebody.com/lipo/insurance.html
References for silicone and facial lipoatrophy:
http://findarticles.com/p/articles/mi_m0PDG/is_2_4/ai_n13559216
SAMPLE LETTER:
Insurance Co Name
Insurance Co Address
Patient Name
Subscriber #
Date
To Whom It May Concern:
This letter is written in regards to the medical necessity of restorative treatment for the facial deformities this patient suffers from secondary to HIV-Associated Lipoatrophy. Facial fat loss is the most devastating aspect of this condition as it can not be disguised by clothing or other means. Although the exact underlying mechanism of HIV-Associated Lipoatrophy is unknown (1), the devastating effects of this condition are known (2,3). Patients suffering from this condition are at an increased risk of depression, socially withdrawn and potentially suicidal. Furthermore, patients have even stopped their life saving HAART therapy without consultation with their physician in an attempt to stop this side effect. The implications for viral mutations, increasing viral load and worsening of patients underlying condition requiring more expensive treatments cannot be stressed enough. Treatment of HIV-Associated Lipoatrophy with Sculptra (Poly-L-Lactic Acid) has been shown to improve anxiety and depression scores (4) as well as improve patient's quality of life as measured by visual analogue scale (5). The use of Sculptra is clearly indicated as a reconstructive procedure; that is, repair of abnormal facial structure caused by HIV or its treatment, in order to create a normal appearance.
The safety and efficacy of Sculptra in restoring the normal facial contours of patients suffering from HIV-Associated Facial Lipoatrophy has been evaluated by the US FDA (6). Based on the available scientific evidence (4,5), the FDA granted approval of Sculptra as a restorative medical device for the specific indication of HIV-Associated Facial Lipoatrophy in August 2004.
For your information. the ICD9 diagnosis code for lipodystrophy is 272.6. HIV-related lipodystrophy syndrome consists of lipo-hypertrophy (fat accumulation in the visceral area and dorsocervical pad) and lipoatrophy (subcutaneous fat loss in the face, extremities and buttocks).
Due to the medical necessity of this treatment and the availability of a safe and effective treatment option, pre-approval is hereby requested for treatment of this patient's HIV-Associated Facial Lipoatrophy with Sculptra.
As this approval is relatively recent, I would be happy to further educate your company on this issue in any way that you might deem helpful. Please feel free to contact me at the above office with any questions you may have.
Sincerely,
References:
1) Montessori, V. CMAJ. 2004;170:229-238.
2) James J, Carruthers, A. Dermatol Surg. 2002;28:979-986.
3) Martinez, E. Drug Saf. 2001;24:157-166.
4) Moyle, GJ. HIV Medicine. 2004;5:82-87.
5) Valantin, M. AIDS. 2003;17:2471-2477.
6) FDA Scientific Advisory Panel 3/25/2004 Washington DC
Jun 28, 2008
Hello Nelson-
I hope this finds you well. I wanted to check in with you to see if you were aware if there is any insurance coverage for silicone treatments for facial wasting. I have had several sessions, and it works great. It is not cheap, of course. I am in need of a refresher treatment. I should mention that my insurance is Medicare A,B and D. I receive my meds through a Blue Cross-Part D plan, backed up by ADAP.
Neal
Response from Mr. Vergel
Neal,
It is difficult to get reimbursement for Silikon 1000 since it is an off-label use for facial wasting, but you have nothing to lose and a lot to gain if you have your doctor write a medical necessity letter to send to your insurance company.
Here is a letter that Dr. Doug Mest wrote for my web site facialwasting.org for Sculptra. You can have your doctor use this letter as a template and also to use these scientific references. You can also visit the wonderful resource guide that TheBody.com has created for trying to get coverage for facial lipoatrophy reconstruction options from your insurance:
http://www.thebody.com/lipo/insurance.html
References for silicone and facial lipoatrophy:
http://findarticles.com/p/articles/mi_m0PDG/is_2_4/ai_n13559216
SAMPLE LETTER:
Insurance Co Name
Insurance Co Address
Patient Name
Subscriber #
Date
To Whom It May Concern:
This letter is written in regards to the medical necessity of restorative treatment for the facial deformities this patient suffers from secondary to HIV-Associated Lipoatrophy. Facial fat loss is the most devastating aspect of this condition as it can not be disguised by clothing or other means. Although the exact underlying mechanism of HIV-Associated Lipoatrophy is unknown (1), the devastating effects of this condition are known (2,3). Patients suffering from this condition are at an increased risk of depression, socially withdrawn and potentially suicidal. Furthermore, patients have even stopped their life saving HAART therapy without consultation with their physician in an attempt to stop this side effect. The implications for viral mutations, increasing viral load and worsening of patients underlying condition requiring more expensive treatments cannot be stressed enough. Treatment of HIV-Associated Lipoatrophy with Sculptra (Poly-L-Lactic Acid) has been shown to improve anxiety and depression scores (4) as well as improve patient's quality of life as measured by visual analogue scale (5). The use of Sculptra is clearly indicated as a reconstructive procedure; that is, repair of abnormal facial structure caused by HIV or its treatment, in order to create a normal appearance.
The safety and efficacy of Sculptra in restoring the normal facial contours of patients suffering from HIV-Associated Facial Lipoatrophy has been evaluated by the US FDA (6). Based on the available scientific evidence (4,5), the FDA granted approval of Sculptra as a restorative medical device for the specific indication of HIV-Associated Facial Lipoatrophy in August 2004.
For your information. the ICD9 diagnosis code for lipodystrophy is 272.6. HIV-related lipodystrophy syndrome consists of lipo-hypertrophy (fat accumulation in the visceral area and dorsocervical pad) and lipoatrophy (subcutaneous fat loss in the face, extremities and buttocks).
Due to the medical necessity of this treatment and the availability of a safe and effective treatment option, pre-approval is hereby requested for treatment of this patient's HIV-Associated Facial Lipoatrophy with Sculptra.
As this approval is relatively recent, I would be happy to further educate your company on this issue in any way that you might deem helpful. Please feel free to contact me at the above office with any questions you may have.
Sincerely,
References:
1) Montessori, V. CMAJ. 2004;170:229-238.
2) James J, Carruthers, A. Dermatol Surg. 2002;28:979-986.
3) Martinez, E. Drug Saf. 2001;24:157-166.
4) Moyle, GJ. HIV Medicine. 2004;5:82-87.
5) Valantin, M. AIDS. 2003;17:2471-2477.
6) FDA Scientific Advisory Panel 3/25/2004 Washington DC
Are Creatine Supplements Effective to increase muscle?
Creatine Supplement
Jul 29, 2008
I workout six times a week, take a teaspoon of creatine before each workout with some juice. Is there a problem taking this supplement pratically everyday. I noticed that on my recent labs that my creatine number was 1.4H, I've been taking this supplement for about 6 weeks.
Response from Nelson
Creatine is the most popular bodybuilding supplement out there. It has been shown in non HIV studies to increase lean body mass and strength. I have taken it once in a while and definitely feel more pumped and a little stronger. There are concerns about loading up the kidneys, however. Your creatinine blood level is higher than normal, so I would probably be careful if I was you.
We have some pilot data in HIV presented by Dr. Sakkas at the Lipodystrophy Workshop in Dublin in 2005. It was a placebo controlled study of the use of creatine or placebo plus exercise.
Strength did not differ much between the creatine arm and the placebo arm. But men taking creatine had a significant jump in triglycerides, a risk factor for heart disease. I am not sure if the creatine supplement used had sugar in it, which may explain the increase in triglycerides.
Lean body mass index rose in both groups, but significantly more with creatine (2.3 versus 0.9 kg, P = 0.01). Thigh muscle cross-sectional area also increased more with creatine, but not significantly more than with placebo (12.2 versus 9.3 cm2, P = 0.34).
What are your triglycerides? Talk to your doctor since you may have some reduction in kidney function that may not make you a good candidate for this supplement.
You may want to try Juven, another supplement that has arginine, HMB and glutamine that may not have a negative effect on the kidneys.
Reference:
G.K. Sakkas, K. Mulligan, MI. DeSilva, et al. Creatine supplementation fails to augment the benefits derived from resistance exercise training in patients with HIV infection. 7th International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV. November 13-16, 2005. Dublin. Abstract 6.
Jul 29, 2008
I workout six times a week, take a teaspoon of creatine before each workout with some juice. Is there a problem taking this supplement pratically everyday. I noticed that on my recent labs that my creatine number was 1.4H, I've been taking this supplement for about 6 weeks.
Response from Nelson
Creatine is the most popular bodybuilding supplement out there. It has been shown in non HIV studies to increase lean body mass and strength. I have taken it once in a while and definitely feel more pumped and a little stronger. There are concerns about loading up the kidneys, however. Your creatinine blood level is higher than normal, so I would probably be careful if I was you.
We have some pilot data in HIV presented by Dr. Sakkas at the Lipodystrophy Workshop in Dublin in 2005. It was a placebo controlled study of the use of creatine or placebo plus exercise.
Strength did not differ much between the creatine arm and the placebo arm. But men taking creatine had a significant jump in triglycerides, a risk factor for heart disease. I am not sure if the creatine supplement used had sugar in it, which may explain the increase in triglycerides.
Lean body mass index rose in both groups, but significantly more with creatine (2.3 versus 0.9 kg, P = 0.01). Thigh muscle cross-sectional area also increased more with creatine, but not significantly more than with placebo (12.2 versus 9.3 cm2, P = 0.34).
What are your triglycerides? Talk to your doctor since you may have some reduction in kidney function that may not make you a good candidate for this supplement.
You may want to try Juven, another supplement that has arginine, HMB and glutamine that may not have a negative effect on the kidneys.
Reference:
G.K. Sakkas, K. Mulligan, MI. DeSilva, et al. Creatine supplementation fails to augment the benefits derived from resistance exercise training in patients with HIV infection. 7th International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV. November 13-16, 2005. Dublin. Abstract 6.
Provigil for Fatigue?
Provigil...what is your opinion?
Aug 4, 2008
I suffer from severe fatigue and my doctor wants me to try Provigil. What is your opinion? Thanks guru man
Response from Nelson
PROVIGIL is a prescription medicine used to improve wakefulness in adults who experience excessive sleepiness (ES) due to one of the following diagnosed sleep disorders: obstructive sleep apnea (OSA), shift work sleep disorder (SWSD), or narcolepsy.
It is used in HIV off label to treat fatigue. A pilot study done by Dr Judith G. Rabkin in NYC showed good results in increasing energy levels and mood in people with HIV. There is a larger study now recruiting :
http://clinicaltrials.gov/ct2/show/NCT00118378?intr=%22Modafinil%22&rank=32
I have taken Provigil for three years on and off and absolutely love it. I take a very small dose of 100 mg at morning time when I am too fatigued to work. I have mild sleep apnea and did not enjoy using a CPAP machine. I experience mood elevation also.
Two bad thing: it is expensive and many insurance companies do not wan to pay for it, and it is metabolized in the P450liver enzimatic path, so there may be interactions with HIV medications that use the same path. So far we have no interaction data since many pharmaceutical companies do not include this drug in their "normal" list of drugs to test.
Insurance companies that do not wan to pay for the drug argue that cheaper amphetamine-based products do the same thing. What they ignore is that Provigil is not an amphetamine and it has no habit forming properties. It is not classified as a Class II drug as amphetamines are. It also does not decrease appetite. The company has a patient assistance program (I have not audited it, however). You can have your questions about reimbursement answered by calling the PROVIGIL Reimbursement Assistance Hotline at 1-800-675-8415.
Some people are very sensitive to it and experience nervousness with it. I say if that happens try half a pill and build up from there.
Of course, Provigil is not a substitue for a good night sleep.
I hope this helps!
Nelson
Aug 4, 2008
I suffer from severe fatigue and my doctor wants me to try Provigil. What is your opinion? Thanks guru man
Response from Nelson
PROVIGIL is a prescription medicine used to improve wakefulness in adults who experience excessive sleepiness (ES) due to one of the following diagnosed sleep disorders: obstructive sleep apnea (OSA), shift work sleep disorder (SWSD), or narcolepsy.
It is used in HIV off label to treat fatigue. A pilot study done by Dr Judith G. Rabkin in NYC showed good results in increasing energy levels and mood in people with HIV. There is a larger study now recruiting :
http://clinicaltrials.gov/ct2/show/NCT00118378?intr=%22Modafinil%22&rank=32
I have taken Provigil for three years on and off and absolutely love it. I take a very small dose of 100 mg at morning time when I am too fatigued to work. I have mild sleep apnea and did not enjoy using a CPAP machine. I experience mood elevation also.
Two bad thing: it is expensive and many insurance companies do not wan to pay for it, and it is metabolized in the P450liver enzimatic path, so there may be interactions with HIV medications that use the same path. So far we have no interaction data since many pharmaceutical companies do not include this drug in their "normal" list of drugs to test.
Insurance companies that do not wan to pay for the drug argue that cheaper amphetamine-based products do the same thing. What they ignore is that Provigil is not an amphetamine and it has no habit forming properties. It is not classified as a Class II drug as amphetamines are. It also does not decrease appetite. The company has a patient assistance program (I have not audited it, however). You can have your questions about reimbursement answered by calling the PROVIGIL Reimbursement Assistance Hotline at 1-800-675-8415.
Some people are very sensitive to it and experience nervousness with it. I say if that happens try half a pill and build up from there.
Of course, Provigil is not a substitue for a good night sleep.
I hope this helps!
Nelson
What is better? Testosterone Injections or Gels?
What is better? Testosterone Injections or Gels?
Nov 6, 2008
I am currently on testosterone enanthate, one injection every two weeks. Is there an actual advantage to using testim, the gel? I have all options available to me. Ed
Response:
Dear Ed:
If you are used to the injections, you may not feel the same "lift" by the gels. The injections cost around $80 a month compared to $1100 a month for Testim or Androgel. Some people argue that gels are better to keep your testosterone blood levels more constant and to avoid "peaks and valleys"
Some people love the daily gels. I am an injection guy since I do not want to deal with daily application.
Some people cannot reach adequate testosterone blood levels (0ver 500 nanograms per deciliter of total testosterone) while using Testim or Androgel since these two only contain 1% testosterone. It is unfortunate that most people and their doctors do not know that you can get better and more concentrated (5%) testosterone gels from compounding pharmacies at around $60 a month. Some of the cheapest ones are apsmeds.com and newrx.com
More info on medibolics.com or our book Built to Survive, available at amazon.com
Nelson
Nov 6, 2008
I am currently on testosterone enanthate, one injection every two weeks. Is there an actual advantage to using testim, the gel? I have all options available to me. Ed
Response:
Dear Ed:
If you are used to the injections, you may not feel the same "lift" by the gels. The injections cost around $80 a month compared to $1100 a month for Testim or Androgel. Some people argue that gels are better to keep your testosterone blood levels more constant and to avoid "peaks and valleys"
Some people love the daily gels. I am an injection guy since I do not want to deal with daily application.
Some people cannot reach adequate testosterone blood levels (0ver 500 nanograms per deciliter of total testosterone) while using Testim or Androgel since these two only contain 1% testosterone. It is unfortunate that most people and their doctors do not know that you can get better and more concentrated (5%) testosterone gels from compounding pharmacies at around $60 a month. Some of the cheapest ones are apsmeds.com and newrx.com
More info on medibolics.com or our book Built to Survive, available at amazon.com
Nelson
Feeling bloated everyday What to eat?
Feeling bloated everyday What to eat?
Oct 28, 2008
I have an ongoing daily problem with bloatedness where I feel my stomach never empties properly ,and I never approach a meal feeling hungry.I have accumulated visceral fat as a pot belly through lipoatrophy and have been trying to eat well- high protein/calorie diet to build a bit of muscle tone on my arms and legs in particular.Can you advise me how to get some relief from the bloating,the fat accumulation around the gut, and how to maintain the weight I have?. Many thanks for any help. Regards John
Dear John:
I tell you, your problem is my main problem also.
I have researched options for ten years. Eating smaller meals that do not contain milk products or sweets seeem to help. I avoid beans and brocolli also. I take four pills of Beano before meals and that helps sometimes. Eating yogurt twice a day gives me relief also.
Try to snack instead of having three large meals. Be really aware of any food allergies you may have, particularly milk and whey protein products. Drink lots of water also.
I have also tried Ultrase, a prescription digestive enzyme taken before meals. That seems to help a lot. Glutamine at 15 grams a day seems to be helping a lot of people (I have problems with adherence with powder products that require several doses a day)
The problem comes and goes for me without reason. I really think that keeping a healthy gut flora is key, and avoiding gas producing foods. Sometimes I wonder if binders used in HIV medications have an effect on our guts. It has also been shown by certain studies that our gut integrity is impaired after years of HIV, so who knows if that is also a factor in bloating and that "full feeling" that many of us have.
I have also noticed that my bloating gets worse when I take pain killers like ibuprofen. They have been shown to decrease gut motility, so that may be a factor.
Some patients have insisted to their doctors that they want a one slice CT scan at the L4 L5 level to see how much visceral fat they have. I am not sure if this is something that insurance companies would pay for and what the use would be to have such information. It is my belief that visceral fat can push on our intestinal tissue and gives us that feeling of fullness, but this is just a speculation from my part.
Many of us are suffering from this problem. Many have gone through colonoscopies, endoscopies, etc without any clear answers. Unfortunately, I know of no researcher looking into this problem.
I would work out three to four times a week to try to decrease fat accumulation. Do not go crazy with so much protein intake that counteracts the effects of exercise. Too many calories, no matter if they come from protein, will end up stored as fat if your energy expenditure is not high enough to compensate for the extra food intake. As I said, small 300-400 calorie snacks 6 times a day, lots of water, and exercise should be your basic program to start with.
I hope this helped some. It has become one of the hottest topics in this column so stay tuned since I usually do not let go of a problem until answers are found somehow :)
Nelson
Oct 28, 2008
I have an ongoing daily problem with bloatedness where I feel my stomach never empties properly ,and I never approach a meal feeling hungry.I have accumulated visceral fat as a pot belly through lipoatrophy and have been trying to eat well- high protein/calorie diet to build a bit of muscle tone on my arms and legs in particular.Can you advise me how to get some relief from the bloating,the fat accumulation around the gut, and how to maintain the weight I have?. Many thanks for any help. Regards John
Dear John:
I tell you, your problem is my main problem also.
I have researched options for ten years. Eating smaller meals that do not contain milk products or sweets seeem to help. I avoid beans and brocolli also. I take four pills of Beano before meals and that helps sometimes. Eating yogurt twice a day gives me relief also.
Try to snack instead of having three large meals. Be really aware of any food allergies you may have, particularly milk and whey protein products. Drink lots of water also.
I have also tried Ultrase, a prescription digestive enzyme taken before meals. That seems to help a lot. Glutamine at 15 grams a day seems to be helping a lot of people (I have problems with adherence with powder products that require several doses a day)
The problem comes and goes for me without reason. I really think that keeping a healthy gut flora is key, and avoiding gas producing foods. Sometimes I wonder if binders used in HIV medications have an effect on our guts. It has also been shown by certain studies that our gut integrity is impaired after years of HIV, so who knows if that is also a factor in bloating and that "full feeling" that many of us have.
I have also noticed that my bloating gets worse when I take pain killers like ibuprofen. They have been shown to decrease gut motility, so that may be a factor.
Some patients have insisted to their doctors that they want a one slice CT scan at the L4 L5 level to see how much visceral fat they have. I am not sure if this is something that insurance companies would pay for and what the use would be to have such information. It is my belief that visceral fat can push on our intestinal tissue and gives us that feeling of fullness, but this is just a speculation from my part.
Many of us are suffering from this problem. Many have gone through colonoscopies, endoscopies, etc without any clear answers. Unfortunately, I know of no researcher looking into this problem.
I would work out three to four times a week to try to decrease fat accumulation. Do not go crazy with so much protein intake that counteracts the effects of exercise. Too many calories, no matter if they come from protein, will end up stored as fat if your energy expenditure is not high enough to compensate for the extra food intake. As I said, small 300-400 calorie snacks 6 times a day, lots of water, and exercise should be your basic program to start with.
I hope this helped some. It has become one of the hottest topics in this column so stay tuned since I usually do not let go of a problem until answers are found somehow :)
Nelson
Vitamin Research in HIV- anything exciting now?
Vitamin Research in HIV- anything exciting now?
Nov 12, 2008
I have been reading your emails about supplements and HIV and you seem to be concerned that the research has slowed down. My question is: what is being studied right now, if any?
Thanks
Tony
Dear Tony
I am glad you asked this question. I have done a search on clinical trials.gov and have actually found some really interesting studies that are currently enrolling:
Micronutrient Supplemented Probiotic Yogurt for HIV/AIDS and Other Immunodeficiencies
http://clinicaltrials.gov/ct2/show/NCT00517803?term=HIV&recr=Open&rank=441
Effects of Mixed Exercise Regime and L-Carnitine Supplementation in HIV Patients
http://clinicaltrials.gov/ct2/show/NCT00572429?term=HIV&recr=Open&rank=54
Chromium Picolinate to treat HIV related diabetes
http://clinicaltrials.gov/ct2/show/NCT00109746? term=HIV&recr=Open&rank=340
A Trial of Vitamins and HAART in HIV Disease Progression
http://clinicaltrials.gov/ct2/show/NCT00383669?term=HIV&recr=Open&rank=124
The Prevalence of Vitamin D Deficiency and Effects of Vitamin D Supplementation
http://clinicaltrials.gov/ct2/show/NCT00306410?term=HIV&recr=Open&rank=410
Acupuncture for Nausea in HIV
http://clinicaltrials.gov/ct2/show/NCT00624793?term=HIV&recr=Open&rank=390
So, I guess I was not 100% correct when I said there is little research on nutritional and complementary therapies in HIV
I encourage everyone to call these sites and support these studies
Nelson Vergel
Nov 12, 2008
I have been reading your emails about supplements and HIV and you seem to be concerned that the research has slowed down. My question is: what is being studied right now, if any?
Thanks
Tony
Dear Tony
I am glad you asked this question. I have done a search on clinical trials.gov and have actually found some really interesting studies that are currently enrolling:
Micronutrient Supplemented Probiotic Yogurt for HIV/AIDS and Other Immunodeficiencies
http://clinicaltrials.gov/ct2/show/NCT00517803?term=HIV&recr=Open&rank=441
Effects of Mixed Exercise Regime and L-Carnitine Supplementation in HIV Patients
http://clinicaltrials.gov/ct2/show/NCT00572429?term=HIV&recr=Open&rank=54
Chromium Picolinate to treat HIV related diabetes
http://clinicaltrials.gov/ct2/show/NCT00109746? term=HIV&recr=Open&rank=340
A Trial of Vitamins and HAART in HIV Disease Progression
http://clinicaltrials.gov/ct2/show/NCT00383669?term=HIV&recr=Open&rank=124
The Prevalence of Vitamin D Deficiency and Effects of Vitamin D Supplementation
http://clinicaltrials.gov/ct2/show/NCT00306410?term=HIV&recr=Open&rank=410
Acupuncture for Nausea in HIV
http://clinicaltrials.gov/ct2/show/NCT00624793?term=HIV&recr=Open&rank=390
So, I guess I was not 100% correct when I said there is little research on nutritional and complementary therapies in HIV
I encourage everyone to call these sites and support these studies
Nelson Vergel
Can Gardasil actually remove mild warts?
Question:Can Gardasil actually remove mild warts or is it only for preventing
infection in the first place? I was also wondering if a woman can take
Gardasil and the infection can be eliminated.>>
Answer:
Gardasil is a preventive vaccine, not a therapeutic vaccine, so it can't eliminate the infection once you have it. But since people can be coinfected with multiple types of HPV (some cause warts, some cause cancer) it can prevent you from acquiring additional HPV types you don't already have. Gardasil is a quadrivalent vaccine--meaning it prevents infection from 4 types of HPV--two causing warts, and two that cause the majority of cancers. Since most people with HIV are by definition sexually active, they've already been exposed to HPV--how many types depends on the extent of sexual activity, and how old you are. So in theory it could prevent you from being infected by the HPV types you don't already have, but it's hard to know what kinds you have since I don't think those tests are commercially available (they're only done as part of research)
Sorry I couldn't give you a simpler answer. So whether you should take the vaccine becomes a personal choice--mostly determined by whether you're willing to spend the money (I think it's about $300? Don't quote me on that) and it's a series of shots, not a one time deal.
The far more important thing to do is to get a regular PAP smear of your rectum (and cervix, if you have one) If the results come back abnormal (as they often do--esp in HIV positives) it's imperative that you follow it up with an anoscopy (or colposcopy for the cervix) and a biopsy of any suspicious areas. If the results come back grade 2 or higher they must be removed (don't let anyone convince you otherwise--HIV+ people are at much higher risk of rapid progression to cancer) Women know all about HPV and the cervix, and for the past 40 yrs PAP smears and followup testing have drastically lowered the cancer incidence & deaths. You need to be proactive and make sure you and your doctor do the same for your butt. For a list of certified anal PAP smear practitioners, go to http://www.analcancerinfo.ucsf.edu/
Hope this helps.
Jeff in Palm Springs
infection in the first place? I was also wondering if a woman can take
Gardasil and the infection can be eliminated.>>
Answer:
Gardasil is a preventive vaccine, not a therapeutic vaccine, so it can't eliminate the infection once you have it. But since people can be coinfected with multiple types of HPV (some cause warts, some cause cancer) it can prevent you from acquiring additional HPV types you don't already have. Gardasil is a quadrivalent vaccine--meaning it prevents infection from 4 types of HPV--two causing warts, and two that cause the majority of cancers. Since most people with HIV are by definition sexually active, they've already been exposed to HPV--how many types depends on the extent of sexual activity, and how old you are. So in theory it could prevent you from being infected by the HPV types you don't already have, but it's hard to know what kinds you have since I don't think those tests are commercially available (they're only done as part of research)
Sorry I couldn't give you a simpler answer. So whether you should take the vaccine becomes a personal choice--mostly determined by whether you're willing to spend the money (I think it's about $300? Don't quote me on that) and it's a series of shots, not a one time deal.
The far more important thing to do is to get a regular PAP smear of your rectum (and cervix, if you have one) If the results come back abnormal (as they often do--esp in HIV positives) it's imperative that you follow it up with an anoscopy (or colposcopy for the cervix) and a biopsy of any suspicious areas. If the results come back grade 2 or higher they must be removed (don't let anyone convince you otherwise--HIV+ people are at much higher risk of rapid progression to cancer) Women know all about HPV and the cervix, and for the past 40 yrs PAP smears and followup testing have drastically lowered the cancer incidence & deaths. You need to be proactive and make sure you and your doctor do the same for your butt. For a list of certified anal PAP smear practitioners, go to http://www.analcancerinfo.ucsf.edu/
Hope this helps.
Jeff in Palm Springs
Monday, November 10, 2008
An Anti-frailty Pill For Seniors? New Drug Increases Muscle Mass In Arms And Legs Of Older Adults
I bet this could compete with Theratecnologies/Serono's Tesamorelin eventually. But Merck is smart going after baby aging boomers
An Anti-frailty Pill For Seniors? New Drug Increases Muscle Mass In Arms And Legs Of Older Adults
ScienceDaily (Nov. 5, 2008) — Researchers at the University of Virginia Health System report that a daily single oral dose of an investigational drug, MK-677, increased muscle mass in the arms and legs of healthy older adults without serious side effects, suggesting that it may prove safe and effective in reducing age-related frailty.
Published in the November 4, 2008 issue of Annals of Internal Medicine, the study showed that levels of growth hormone (GH) and of insulin-like growth factor I (IGF- I) in seniors who took MK-677 increased to those found in healthy young adults. The drug restored 20 percent of muscle mass loss associated with normal aging.
"Our study opens the door to the possibility of developing treatments that avert the frailty of aging," explains Dr. Michael O. Thorner, a nationally recognized researcher of growth hormone regulation and a professor of internal medicine and neurosurgery at UVA. "The search for anti-frailty medications has become increasingly important because the average American is expected to live into his or her 80s, and most seniors want to stay strong enough to remain independent as they age."
Funded by the National Institutes of Health, the two-year, double-blind, placebo-controlled, modified-crossover study involved 65 men and women ranging in age from 60 to 81.
The study drug, MK-677, mimics the action of ghrelin, a peptide that stimulates the growth hormone secretagogue receptor (GHSR). Drug developers are focusing on GHSR because it plays an important role in the regulation of growth hormone and appetite. They think it may prove to be an excellent treatment target for metabolic disorders such as those related to body weight and body composition.
According to Dr. Thorner, the UVA research was a "proof-of-concept" study that sets the stage for a larger and longer clinical trial to determine whether MK-677 is effective in people who are frail and to assess its long term safety.
--------------------------------------------------------------------------------
University of Virginia Health System (2008, November 5). An Anti-frailty Pill For Seniors? New Drug Increases Muscle Mass In Arms And Legs Of Older Adults. ScienceDaily. Retrieved November 10, 2008, from http://www.sciencedaily.com /releases/2008/11/081104132902.htm
An Anti-frailty Pill For Seniors? New Drug Increases Muscle Mass In Arms And Legs Of Older Adults
ScienceDaily (Nov. 5, 2008) — Researchers at the University of Virginia Health System report that a daily single oral dose of an investigational drug, MK-677, increased muscle mass in the arms and legs of healthy older adults without serious side effects, suggesting that it may prove safe and effective in reducing age-related frailty.
Published in the November 4, 2008 issue of Annals of Internal Medicine, the study showed that levels of growth hormone (GH) and of insulin-like growth factor I (IGF- I) in seniors who took MK-677 increased to those found in healthy young adults. The drug restored 20 percent of muscle mass loss associated with normal aging.
"Our study opens the door to the possibility of developing treatments that avert the frailty of aging," explains Dr. Michael O. Thorner, a nationally recognized researcher of growth hormone regulation and a professor of internal medicine and neurosurgery at UVA. "The search for anti-frailty medications has become increasingly important because the average American is expected to live into his or her 80s, and most seniors want to stay strong enough to remain independent as they age."
Funded by the National Institutes of Health, the two-year, double-blind, placebo-controlled, modified-crossover study involved 65 men and women ranging in age from 60 to 81.
The study drug, MK-677, mimics the action of ghrelin, a peptide that stimulates the growth hormone secretagogue receptor (GHSR). Drug developers are focusing on GHSR because it plays an important role in the regulation of growth hormone and appetite. They think it may prove to be an excellent treatment target for metabolic disorders such as those related to body weight and body composition.
According to Dr. Thorner, the UVA research was a "proof-of-concept" study that sets the stage for a larger and longer clinical trial to determine whether MK-677 is effective in people who are frail and to assess its long term safety.
--------------------------------------------------------------------------------
University of Virginia Health System (2008, November 5). An Anti-frailty Pill For Seniors? New Drug Increases Muscle Mass In Arms And Legs Of Older Adults. ScienceDaily. Retrieved November 10, 2008, from http://www.sciencedaily.com /releases/2008/11/081104132902.htm
Sunday, November 09, 2008
A Cure for AIDS available now?
______________________________________________
The 'Cure' was NOT So Easy
attached is pdf of abstract from CROI 2008 conference.
You may have read a few days ago the story of a 40-year old HIV+ German man who had leukemia who received a bone marrow transplant and now they can't find HIV in him 600 days after the procedure. Well, this positive sounding headlines don't tell the whole story of what the patient had to go through. So here is some additional information and a link to the poster explaining more details.
Apparently, the patient had bad case of acute myeloid leukemia, was unresponsive to standard leukemia, so he had to get a bone marrow transplant. He had been undetectable (HIV viral load) for a long time on HAART. The German doctor found a matched donor who was CCR5 delta 32. they gave the German man ablative chemotherapy (tried to kill all the patient's cells) while on ART, then transplant delta 32 cells. ART was stopped. Now 600 days off ART there is no evidence of HIV, by standrad PCR and some other tests (DNA PCR, and HIV from PBMCs also negative).
Leukemia is still not totally gone, the patient is still cytopenic; unsure but he may still e getting chemo once in a while. There is graft vs host and graft vs tumor: that is the donor CCR5 delta 32 recognize any remaining patient cells as foreign and try to kill them whether or not these patient cells are normal or cancerous....this is the desired outcome in marrow transplant for cancer, and how it would clear cancer.
So, the results show a 'functional cure', but it seems that most people would not want to go through al this and you would have to find a matched donor who was CCR5 delta 32.
A number of researchers think there still is HIV remaining somewhere in this patients body but hasn't yet been found or surfaced. Of course this would be in line with the thinking that HIV reservoirs exist and they cannot be purged.
Jules Levin
Here is Wall Street Journal article
ovember 7, 2008, 8:35 am
Did a Bone Marrow Transplant Cure a Cancer Patient of AIDS?
Posted by Jacob Goldstein
A 42-year-old man who had both leukemia and AIDS received a bone marrow transplant — a common, late-stage treatment for that type of cancer. His doctor selected a bone marrow donor who had a rare genetic mutation that renders people virtually immune to HIV. The transplant appeared to cure the patient of AIDS.
We’re as wary as the next guy of inferring too much from a single case study. Maybe it was a fluke; maybe there were unknown factors at work. But this one is pretty intriguing.
The case was presented at a conference earlier this year (here’s the abstract), and written up in this morning’s WSJ.
As is common for bone marrow transplant recipients, the patient first had radiation and chemotherapy, which tends to kill off many of the immune cells that harbor HIV. After the transplant, the patient’s immune system was repopulated by cells created by the donor marrow.
The donor had a mutation, present in about 1% of Europeans, that creates immune system cells that lack a receptor molecule called CCR5. That receptor plays an important role in HIV’s ability to enter the cell. (Pfizer’s HIV drug Selzentry works by blocking CCR5.)
So the patient’s immune system was repopulated with immune cells that carried the mutation. And, nearly two years after undergoing the transplant, he shows no signs of having any HIV left in his body — despite the fact that he hasn’t taken any AIDS drugs since before the transplant.
Perhaps the most important caveat is just how risky bone marrow transplantation is: It’s given to cancer patients after other treatments fail, and it kills up to 30% of patients.
But researchers hope to apply the apparent lessons of this case to strategies using gene therapy (which carries its own risks) to try to induce the protective mutation in patients with HIV.
David Baltimore, who won a Nobel Prize for research on tumor viruses, has started a company to use gene therapy to target HIV. He calls this case “a very good sign” and a virtual “proof of principle” for gene-therapy approaches.
Image of HIV by C. Goldsmith via CDC
The 'Cure' was NOT So Easy
attached is pdf of abstract from CROI 2008 conference.
You may have read a few days ago the story of a 40-year old HIV+ German man who had leukemia who received a bone marrow transplant and now they can't find HIV in him 600 days after the procedure. Well, this positive sounding headlines don't tell the whole story of what the patient had to go through. So here is some additional information and a link to the poster explaining more details.
Apparently, the patient had bad case of acute myeloid leukemia, was unresponsive to standard leukemia, so he had to get a bone marrow transplant. He had been undetectable (HIV viral load) for a long time on HAART. The German doctor found a matched donor who was CCR5 delta 32. they gave the German man ablative chemotherapy (tried to kill all the patient's cells) while on ART, then transplant delta 32 cells. ART was stopped. Now 600 days off ART there is no evidence of HIV, by standrad PCR and some other tests (DNA PCR, and HIV from PBMCs also negative).
Leukemia is still not totally gone, the patient is still cytopenic; unsure but he may still e getting chemo once in a while. There is graft vs host and graft vs tumor: that is the donor CCR5 delta 32 recognize any remaining patient cells as foreign and try to kill them whether or not these patient cells are normal or cancerous....this is the desired outcome in marrow transplant for cancer, and how it would clear cancer.
So, the results show a 'functional cure', but it seems that most people would not want to go through al this and you would have to find a matched donor who was CCR5 delta 32.
A number of researchers think there still is HIV remaining somewhere in this patients body but hasn't yet been found or surfaced. Of course this would be in line with the thinking that HIV reservoirs exist and they cannot be purged.
Jules Levin
Here is Wall Street Journal article
ovember 7, 2008, 8:35 am
Did a Bone Marrow Transplant Cure a Cancer Patient of AIDS?
Posted by Jacob Goldstein
A 42-year-old man who had both leukemia and AIDS received a bone marrow transplant — a common, late-stage treatment for that type of cancer. His doctor selected a bone marrow donor who had a rare genetic mutation that renders people virtually immune to HIV. The transplant appeared to cure the patient of AIDS.
We’re as wary as the next guy of inferring too much from a single case study. Maybe it was a fluke; maybe there were unknown factors at work. But this one is pretty intriguing.
The case was presented at a conference earlier this year (here’s the abstract), and written up in this morning’s WSJ.
As is common for bone marrow transplant recipients, the patient first had radiation and chemotherapy, which tends to kill off many of the immune cells that harbor HIV. After the transplant, the patient’s immune system was repopulated by cells created by the donor marrow.
The donor had a mutation, present in about 1% of Europeans, that creates immune system cells that lack a receptor molecule called CCR5. That receptor plays an important role in HIV’s ability to enter the cell. (Pfizer’s HIV drug Selzentry works by blocking CCR5.)
So the patient’s immune system was repopulated with immune cells that carried the mutation. And, nearly two years after undergoing the transplant, he shows no signs of having any HIV left in his body — despite the fact that he hasn’t taken any AIDS drugs since before the transplant.
Perhaps the most important caveat is just how risky bone marrow transplantation is: It’s given to cancer patients after other treatments fail, and it kills up to 30% of patients.
But researchers hope to apply the apparent lessons of this case to strategies using gene therapy (which carries its own risks) to try to induce the protective mutation in patients with HIV.
David Baltimore, who won a Nobel Prize for research on tumor viruses, has started a company to use gene therapy to target HIV. He calls this case “a very good sign” and a virtual “proof of principle” for gene-therapy approaches.
Image of HIV by C. Goldsmith via CDC
Find out how much you can save on Medicare Part D
Everyone on Medicare Part D should check this out
I want to remind people that you can change providers starting Nov 15 until Dec 31
Go to this great comparison web site tool to type in your prescriptions to see how much you can save with different companies in your area.
medicare.giv/mpdpf
You can save your prescription list for later use. You can also see which meds require prior authorization
Medicare will soon add "star ratings" to each provider
I want to remind people that you can change providers starting Nov 15 until Dec 31
Go to this great comparison web site tool to type in your prescriptions to see how much you can save with different companies in your area.
medicare.giv/mpdpf
You can save your prescription list for later use. You can also see which meds require prior authorization
Medicare will soon add "star ratings" to each provider
Saturday, November 01, 2008
Doctors who work in lipodystrophy, and surveys from patients
SHARE YOUR EXPERIENCES WITH OTHERS ON
OPTIONS FOR LIPODYSTROPHY -
SURVEY RESULTS- OPTIONS USED BY PEOPLE WITH LIPODYSTROPHY -
http://www.surveymonkey.com/sr.aspx?sm=LYbzfgoEFlmgc1vkr3v_2bEWfscAbBPrjpRbaywPjqMqI_3d
DOCTORS AND PROVIDERS- COMMENTS FROM PEOPLE - Click on the "View" boxes for doctors' names
http://www.surveymonkey.com/sr.aspx?sm=rc8hHUnWoT5VVui7aS9Q_2fsfxahbyw7goBCGlfANmm4A_3d
IF YOU WANT TO ADD COMMENTS (POSITIVE OR NEGATIVE) ABOUT A PROVIDER THAT YOU HAVE USED FOR LIPODYSTROPHY -
http://www.surveymonkey.com/s.aspx?sm=dIXsY8YIuuh5f_2fMLZasLgA_3d_3d
Read our Newsletter
http://archive.constantcontact.com/fs020/1101823881298/archive/1101825972178.html
OPTIONS FOR LIPODYSTROPHY -
SURVEY RESULTS- OPTIONS USED BY PEOPLE WITH LIPODYSTROPHY -
http://www.surveymonkey.com/sr.aspx?sm=LYbzfgoEFlmgc1vkr3v_2bEWfscAbBPrjpRbaywPjqMqI_3d
DOCTORS AND PROVIDERS- COMMENTS FROM PEOPLE - Click on the "View" boxes for doctors' names
http://www.surveymonkey.com/sr.aspx?sm=rc8hHUnWoT5VVui7aS9Q_2fsfxahbyw7goBCGlfANmm4A_3d
IF YOU WANT TO ADD COMMENTS (POSITIVE OR NEGATIVE) ABOUT A PROVIDER THAT YOU HAVE USED FOR LIPODYSTROPHY -
http://www.surveymonkey.com/s.aspx?sm=dIXsY8YIuuh5f_2fMLZasLgA_3d_3d
Read our Newsletter
http://archive.constantcontact.com/fs020/1101823881298/archive/1101825972178.html
Comparative Analysis of HIV+ and HIV- Interaction with Testosterone on Bone Mineral Density
Thanks to Jules Levin for providing this paper
Comparative Analysis of HIV+ and HIV- Interaction with Testosterone on Bone Mineral Density
Reported by Jules Levin
ICAAC/IDSA Oct 28 2008 Wash DC
R.RAGHUNATHAN 1,2,J.SINACORE 2,K.RYCHLIK 2, J.FARANO 1,C.PACHUCKI 1,2,and N.AZAD 1,2
1 Edward Hines VA Hospital
Hines, VA 60141
2 Loyola University Health System,Maywood, IL 60153
AUTHOR CONCLUSIONS
In age-matched HIV-infected men, a lower free testosterone corresponds significantly to a lower T-score at the lumbar spine.
A normal free testosterone level was protective of bone mineral density in HIV-infected patients compared to the control population.
Among HIV-uninfected men, an increase in free testosterone level does not correspond to an increase in T-scores.
Further studies evaluating the interaction of low free testosterone and HIV infection need to be conducted to better understand the bone-related effects.
Background: Given an increasingly younger HIV population with osteopenia/osteoporosis a retrospective controlled study was conducted to investigate the effects of testosterone on bone mineral density (BMD) in HIV infected and HIV non-infected populations.
Methods: A chart review was done on a group of 80 male HIV patients and 154 male control patients. The following variables were obtained from the HIV group: age, race, employment status, smoking, body mass index (BMI), duration of HIV, CD4 levels, viral load, type of antiretroviral use, co-morbidities, use of prednisone, heroin, alcohol, methadone use, ever use of androgen, bisphosphanate use, calcium use, alpha reductase inhibitor use, phosphodiesterase inhibitor use, lipids, and biochemical markers. The same variables were obtained from the control group except those pertaining to HIV and employment status. T-scores were used in both HIV and control groups to evaluate BMD.
Results: A univariate analysis of variance was used controlling for the following factors: age, race, BMI, prednisone, heroin, alcohol, smoking, methadone, androgen use, alpha reductase inhibitor use, phosphodiesterase inhibitor use, bisphosphanate use, and calcium use.
Conclusions: A normal testosterone level was protective of bone mineral density in HIV-infected patients compared to the control population. At the L-spine, HIV patients with low testosterone had a lower bone mineral density (p < 0.05). Treatment of osteopenia/osteoporosis with testosterone in HIV patients needs further evaluation.
BACKGROUND
Prevalence of osteoporosis in HIV-uninfected hypogonadal men is reported to be 12.3% vs. 6.0% in men with normal testosterone levels1.
Among patients enrolled in the Study to Understand the Natural History of HIV and AIDS (SUN), 52% had osteopenia and 10% had osteoporosis. Among these patients 78% were men, 25% were black, and 80% of patients received antiretrovirals (ART)2.
Up to 70% of treatment-naive HIV-infected men are reported to have low free testosterone3.
Whether an isolated HIV-related hypogonadism interaction plays a role in developing osteopenia/osteoporosis is unknown.
It remains unclear how HIV itself or other known attributable factors (such as age, sex, race, duration of HIV, ART, hypogonadism, etc.) lead to the development of osteopenia/osteoporosis.
There is a renewed interest in the pathogenesis, diagnosis, and management of osteoporosis in this population.
HYPOTHESIS
We hypothesize that patients with HIV with low free testosterone levels have lower T-scores.
METHODS/STATISTICAL ANALYSIS
A retrospective chart review was performed on two groups: 80 HIV-infected men and 154 HIVuninfected men (see Table 1 for epidemiologic characteristics in each population).
HIV-specific information was obtained in those men who were HIV-infected with low and normal testosterone (see Table 2).
An analysis of covariance was done controlling for the following factors: age, race, BMI, smoking, and use of prednisone, heroin, cocaine, alcohol, methadone, androgen, alpha reductase inhibitor, phosphodiesterase inhibitor, bisphosphanate, and calcium (see Figs 1 – 3, Table 4).
The serum free testosterone (FT) levels were measured by Quest diagnostics (using dialysis method Wood Dale II). The normal FT ranges 35 – 210 pg/mL (see Fig 4 for free vs. total testosterone correlations in HIV-infected and HIV-uninfected patients).
REFERENCES
1. Fink H.A., Ewing S.K., Orwoll E.S., et al. Association of Testosterone and Estradiol Deficiency with Osteoporosis and Rapid Bone Loss in Older Men. The Journal of Clinical Endocrinology and Metabolism 2006; 91(10): 3908 – 3915.
2. Calza L., Tampellini L., Chiodo F., et al. Bone Mass Loss in Patients with
HIV Type 1 Infection. Infectious Diseases in Clinical Practice 2007; 15(3):
160 – 166.
3.Wunder D.M., Bersinger N.A., Furrer H., et al. Hypogonadism in HIV 1-infected men is common and does not resolve during antiretroviral therapy. Antiviral Therapy 2007; 12:261 – 265.
Comparative Analysis of HIV+ and HIV- Interaction with Testosterone on Bone Mineral Density
Reported by Jules Levin
ICAAC/IDSA Oct 28 2008 Wash DC
R.RAGHUNATHAN 1,2,J.SINACORE 2,K.RYCHLIK 2, J.FARANO 1,C.PACHUCKI 1,2,and N.AZAD 1,2
1 Edward Hines VA Hospital
Hines, VA 60141
2 Loyola University Health System,Maywood, IL 60153
AUTHOR CONCLUSIONS
In age-matched HIV-infected men, a lower free testosterone corresponds significantly to a lower T-score at the lumbar spine.
A normal free testosterone level was protective of bone mineral density in HIV-infected patients compared to the control population.
Among HIV-uninfected men, an increase in free testosterone level does not correspond to an increase in T-scores.
Further studies evaluating the interaction of low free testosterone and HIV infection need to be conducted to better understand the bone-related effects.
Background: Given an increasingly younger HIV population with osteopenia/osteoporosis a retrospective controlled study was conducted to investigate the effects of testosterone on bone mineral density (BMD) in HIV infected and HIV non-infected populations.
Methods: A chart review was done on a group of 80 male HIV patients and 154 male control patients. The following variables were obtained from the HIV group: age, race, employment status, smoking, body mass index (BMI), duration of HIV, CD4 levels, viral load, type of antiretroviral use, co-morbidities, use of prednisone, heroin, alcohol, methadone use, ever use of androgen, bisphosphanate use, calcium use, alpha reductase inhibitor use, phosphodiesterase inhibitor use, lipids, and biochemical markers. The same variables were obtained from the control group except those pertaining to HIV and employment status. T-scores were used in both HIV and control groups to evaluate BMD.
Results: A univariate analysis of variance was used controlling for the following factors: age, race, BMI, prednisone, heroin, alcohol, smoking, methadone, androgen use, alpha reductase inhibitor use, phosphodiesterase inhibitor use, bisphosphanate use, and calcium use.
Conclusions: A normal testosterone level was protective of bone mineral density in HIV-infected patients compared to the control population. At the L-spine, HIV patients with low testosterone had a lower bone mineral density (p < 0.05). Treatment of osteopenia/osteoporosis with testosterone in HIV patients needs further evaluation.
BACKGROUND
Prevalence of osteoporosis in HIV-uninfected hypogonadal men is reported to be 12.3% vs. 6.0% in men with normal testosterone levels1.
Among patients enrolled in the Study to Understand the Natural History of HIV and AIDS (SUN), 52% had osteopenia and 10% had osteoporosis. Among these patients 78% were men, 25% were black, and 80% of patients received antiretrovirals (ART)2.
Up to 70% of treatment-naive HIV-infected men are reported to have low free testosterone3.
Whether an isolated HIV-related hypogonadism interaction plays a role in developing osteopenia/osteoporosis is unknown.
It remains unclear how HIV itself or other known attributable factors (such as age, sex, race, duration of HIV, ART, hypogonadism, etc.) lead to the development of osteopenia/osteoporosis.
There is a renewed interest in the pathogenesis, diagnosis, and management of osteoporosis in this population.
HYPOTHESIS
We hypothesize that patients with HIV with low free testosterone levels have lower T-scores.
METHODS/STATISTICAL ANALYSIS
A retrospective chart review was performed on two groups: 80 HIV-infected men and 154 HIVuninfected men (see Table 1 for epidemiologic characteristics in each population).
HIV-specific information was obtained in those men who were HIV-infected with low and normal testosterone (see Table 2).
An analysis of covariance was done controlling for the following factors: age, race, BMI, smoking, and use of prednisone, heroin, cocaine, alcohol, methadone, androgen, alpha reductase inhibitor, phosphodiesterase inhibitor, bisphosphanate, and calcium (see Figs 1 – 3, Table 4).
The serum free testosterone (FT) levels were measured by Quest diagnostics (using dialysis method Wood Dale II). The normal FT ranges 35 – 210 pg/mL (see Fig 4 for free vs. total testosterone correlations in HIV-infected and HIV-uninfected patients).
REFERENCES
1. Fink H.A., Ewing S.K., Orwoll E.S., et al. Association of Testosterone and Estradiol Deficiency with Osteoporosis and Rapid Bone Loss in Older Men. The Journal of Clinical Endocrinology and Metabolism 2006; 91(10): 3908 – 3915.
2. Calza L., Tampellini L., Chiodo F., et al. Bone Mass Loss in Patients with
HIV Type 1 Infection. Infectious Diseases in Clinical Practice 2007; 15(3):
160 – 166.
3.Wunder D.M., Bersinger N.A., Furrer H., et al. Hypogonadism in HIV 1-infected men is common and does not resolve during antiretroviral therapy. Antiviral Therapy 2007; 12:261 – 265.
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