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
-
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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...
Monday, November 24, 2008
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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