Steroids and HIV Infection

The connection between injection drug use and HIV infection is well known. Sharing injection equipment such as needles and syringes presents a real risk of transmitting HIV as well as Hepatitis C. However, the injection of steroids is often overlooked as a risk behaviour.

Unlike mood-altering drugs, steroids are not perceived as having any health risks and, therefore, the user does not think he/she is in any danger.
Who Uses Steroids?

The majority of users are high school students. Other users may include strip dancers, wrestlers, weight lifters, military personnel and prisoners. The use of anabolic steroids for cosmetic purposes far exceeds their use by athletes for competition. The preferred method of use is by injection rather than by mouth.

Steroid use is a short cut to self-esteem. It needs little investment in energy and its reinforcing results are almost immediate. In a society that places so much value on body image, steroids are seen as a quick and easy response to that pressure.
What Are The Risks?

Most of the negative effects of steroids are due to overuse or misuse. The side effects may include: liver damage, sexual difficulties, aggressive behaviour, depression, acne, muscle spasms and interference with normal growth. Some of the effects are reversible after discontinuing the steroid use. However, the very real health risks are from:

    sharing needles, syringes and vials
    improper injection site
    failure to clean injection site
    failure to ensure the needle is not in a vein or artery

Steroid users must be given the opportunity to decide for themselves the negative aspects of steroid use. Until they are ready to quit, it is essential to help our young people stay alive. Any discussion of HIV/AIDS should ensure that use of steroids is included as a risk behaviour. In addition, information on the proper use of injection equipment must be readily available.

When Are Steroids Indicated In Epstein-Barr Virus Infections?

Infectious mononucleosis, caused by Epstein-Barr virus, is generally characterized by a triad of pharyngitis, fatigue, and cervical lymphadenopathy. Fever and splenomegaly are also common in presentation. These are symptoms primarily manifested by the host response rather than direct viral infection. The severity and duration of symptoms are variable and most commonly resolve by 2 to 3 months postinfection. However, some such as lymphadenopathy and fatigue may persist. Treatment is generally supportive and con- sists of rest (although strict bed rest is not necessary), over-the-counter symptomatic relief for fever and throat pain, and avoidance of contact sports until the patient is asymptomatic and, if splenomegaly is present, you are no longer able to palpate the spleen.

The use of steroids for treatment of infectious mononucleosis has long been controversial.  The lack of clear evidence of benefit has led to universal recommendations indicating that steroids have no role in the routine use of treatment of infectious mononucleosis. However, despite this, steroids continue to be used somewhat liberally in uncomplicated cases, perhaps to hasten return to school and normal activities because of persistent symptoms, patient demand, or the physician’s personal experience, clinical judgment, or training. Steroids are not without adverse effects. Rare case reports have linked the use of steroids for routine mononucleosis with myocarditis, mostly mild and asymptomatic, but causing supraventricular tachycardia in one case,  and neurologic complications including meningoencephalitis, seizures, and brachial plexus palsy.

Most patients with an acute EBV infection have a self-limited course and recover without sequelae. Rarely, however, severe complications can occur in both healthy and immonocompromised patients. It is during these times that the use of steroids may, indeed, be warranted. Airway obstruction or impending airway obstruction is due to tonsillar hypertrophy and occurs in approximately 3.5% of patients but has been reported to occur in as many as 25% of cases.9 Massive splenomegaly and splenic rupture are the other most commonly feared complications. Although mild splenomegaly is quite a common finding in acute mononucleosis, found in approximately 50% of patients, serious splenic complications are very rare, occurring in less than 1%. Splenic rupture usually is found to occur during the second and third weeks of illness, at the peak of splenomegaly. Neurologic complications occur in less than 1% of patients. Two of the most common neurologic complications are encephalitis and cranial nerve palsies. Other neurologic complications that have been reported are aseptic meningitis, acute disseminated encephalomyelitis, transverse myelitis, Guillain-Barré syndrome, optic neuritis, and Alice-in-Wonderland syndrome (a perceived distortion of object size).10  Other life-threatening complications reported include myocarditis, fulminant hepatitis, and liver failure, and hematologic manifestations such as hemolytic anemia, idiopathic thrombocytopenic purpura, and hemophagocytic lymphohistiocytosis. These, and other life-threatening complications, are all indications for use of steroid therapy. Steroids have been used anecdotally and in small case series for these indications, but no rigorous studies have been performed to confirm the benefit of steroid use in these situations. Nevertheless, it is expert opinion that steroids may be useful for these potentially life-threatening complications of EBV infection.

Steroids to Treat Arthritis

What Conditions Are Treated With Steroid Injections?

Steroids often are injected directly into joints to treat conditions such as rheumatoid arthritis, gout, or other inflammatory diseases. They also can be injected into an inflamed bursa or around tendons near most joints in the body.

Some people report relief from osteoarthritis when steroids are injected directly into swollen or painful joints.

What Are the Expected Benefits of Steroid Injections?

Steroid injections into a specific area are generally well tolerated and are less likely than other forms of steroid drugs to produce serious side effects. Also, the injections may help avoid the need for oral steroids or increased doses of oral steroids, which could have greater side effects.

What Role Do Steroid Injections Play in an Overall Treatment Program?

Steroid injections can be added to a treatment program that may already include anti-inflammatory pain medications (NSAIDs), physical therapy, occupational therapy, or supportive devices such as canes and braces. Whether one or more of these treatment methods are used depends on the nature of the problem.

For example, in an otherwise healthy person, tendinitis may be adequately treated with only a steroid injection into the inflamed area. However, in a person with rheumatoid arthritis, injections are generally a small part of a multifaceted treatment approach.

When Should Steroid Injections Not Be Used?

Steroids should not be injected when there is infection in the area to be targeted or even elsewhere in the body because they could inhibit the natural infection-fighting immune response. Also, if a joint is already severely destroyed, injections are not likely to provide any benefit.

If someone has a potential bleeding problem or is taking anticoagulants (often referred to as blood thinners), steroid injections may cause bleeding at the site. For these people, injections are given with caution.

Frequent steroid injections, more often than every three or four months, are not recommended because of an increased risk of weakening tissues in the treated area.

How are viral diseases treated?

Treatment of viral infections varies depending on the specific virus and other factors. General treatment measures are aimed at relieving your symptoms so that you can get the rest you need to keep up your strength and recover without developing complications.

General treatments for viral infections include:

    Acetaminophen (Tylenol) or ibuprofen (Motrin, Advil) for fever, body aches, and pain

    Drinking extra fluids

    Getting extra rest and sleep

    Maintaining good nutrition

Depending on the type of viral infection and the presence of complications, a wide variety of other treatments may be needed. For example, a human papillomavirus (HPV) infection that leads to cervical dysplasia can be treated by surgical removal of the abnormal cells on a woman’s cervix.  

In general, it is recommended that children younger than age six not use cold or cough medications because of the risk for serious side effects. In addition, people with a viral disease should not use aspirin or products that contain aspirin because of the risk of developing a rare but life-threatening condition called Reye syndrome. Reye syndrome has been linked to taking aspirin during a viral illness, such as a cold or the flu.
Prescription medications used to treat viral diseases

In some cases, certain medications may be prescribed to treat viral diseases:

    Antiretroviral medications, which can help people with HIV/AIDS lead longer lives. Antiretroviral medications hinder the ability of HIV to reproduce, which slows the spread of HIV in the body.

    Antiviral drugs, which minimize the severity and length of some viral infections, such as the flu and shingles, especially in people who are at a high risk for serious complications. For example, the drugs oseltamivir (brand name Tamiflu) and zanamivir (brand name Relenza) may be prescribed for some cases of flu. These drugs are not appropriate for all people with the flu.

Antibiotics, which are not prescribed for viral diseases because they are ineffective in the treatment of viral infections, may be prescribed if a person with a viral disease develops a secondary bacterial infection, such as bacterial pneumonia, bacterial bronchitis, or encephalitis.
Complementary treatments

Complementary and traditional treatments will not cure a viral disease but may help to increase comfort, promote rest, and minimize symptoms of viral diseases. 

10 Steps to Staying Healthy With HIV

If you have HIV, it's essential to maintain your health so your immune system stays strong. Use these tips to get started.

People who have been infected with the human immunodeficiency virus (HIV) need to be especially vigilant about keeping their immune systems strong and healthy. The HIV virus kills white blood cells of the immune system called CD4 lymphocytes, or T cells. In people who have HIV, the T-cell count can fall to dangerously low levels, which eventually leads to acquired immune deficiency syndrome (AIDS). Because of this, it’s challenging — yet essential — to stay healthy. Following smart lifestyle practices can help you maintain your health with HIV.

Eat a Healthy, Well-Balanced Diet

Maintaining a well-balanced, nutritious diet is crucial for people with HIV. A healthy diet can help keep the immune system strong, help prevent illness, and also help slow the progression of HIV. According to research from the Tufts University School of Medicine in Boston, a nutritious diet can make it easier for the body to process the many medications that people with HIV often take, and may even help ease common symptoms of HIV, such as diarrhea, nausea, and fatigue.

Avoid Alcohol and Drugs

Alcohol and recreational drugs can weaken the body’s immune system, which is particularly hazardous for people with HIV. Alcohol and drugs can also interfere or dangerously interact with the medications that are necessary to keep HIV in check. Substance abuse can also lead to poor nutrition and to forgetting to take HIV medications. Channel your energy into more positive ways of spending your time, such as visiting with friends or working on hobby.

Pay Attention to Oral Health

Dental health problems are common in people with HIV, affecting more than one-third of patients. A compromised immune system and HIV medications can lead to conditions such as oral warts, fever blisters, oral thrush, and canker sores. Many people with HIV and AIDS also experience dry mouth, which can increase the risk of cavities. They are also more likely to develop gum disease that can quickly worsen and lead to other problems, such as heart disease, according to the American Academy of Periodontology. HIV patients should brush and floss regularly and see their dentist at least every six months.

Find Ways to Reduce Stress

Reducing stress is an essential part of managing HIV. The chronic stress of living with HIV can take a toll on a person’s health. According to the University of California, San Francisco, research has shown a clear link between stress and reduced immune system function; stress can cause lack of appetite, interfere with sleep patterns, and cause other negative impacts on your health. Some effective ways to manage stress include yoga, meditation, exercise, and counseling. For best results, talk to your doctor before starting any exercise program.

Consider Acupuncture

Many HIV patients opt for complementary and alternative medicine (CAM) such as acupuncture to treat symptoms of the disease and the side effects of HIV medications, including fatigue and stomachaches. Acupuncture, the practice of inserting very thin needles into specific points in the body, has also been shown to boost immune function. One way acupuncture may do this is by reducing stress. In one study done at the Boston University School of Public Health, HIV patients who were treated with acupuncture reported feeling more relaxed, peaceful, and calm.

Travel With Caution

Because people with HIV have weakened immune systems, they have to be especially careful about the food and water they ingest when traveling. While food-borne illnesses can be unpleasant and even dangerous for people who don’t have HIV, they can lead to severe complications and even death in people with HIV or AIDS. It’s best to avoid visiting developing countries where food and water safety can be more difficult to ensure and rates of transmittable diseases are higher. And be sure to talk to your doctor before you travel anywhere to get extra supplies of your HIV medications as well as medical advice.

Watch Your Skin

Skin problems are often among the earliest signs of HIV infection — HIV patients frequently have simultaneous or persistent skin infections. According to the American Academy of Dermatology, common skin conditions in those with HIV include psoriasis, hives, shingles, and impetigo, to name just a few. Kaposi's sarcoma, a rare form of skin cancer, can also affect people with AIDS.

See Your Gynecologist Regularly

HIV raises a woman’s risk of developing cervical cancer, so women with HIV should have regular Pap smears to test for any signs of the condition. Currently, the American College of Obstetricians and Gynecologists suggests that women with HIV get two Pap smears in the year right after an HIV diagnosis and then one Pap smear every year after that. Women with HIV are also more likely to develop recurrent and more aggressive forms of yeast infections and pelvic inflammatory disease.

Take Your Medication on Time

Many studies have shown a link between adherence to antiretroviral therapy (ART) — taking prescribed HIV medications on schedule and as prescribed by a doctor — and an increase in T cells. Other studies have shown that adherence to ART is second only to T-cell count in predicting an HIV patient’s prognosis. Skipping doses of medication or not taking HIV medication on time has been shown to increase the likelihood of hospitalization, the progression of HIV to AIDS, and even death. Work with your doctor to come up with the right combination of medications for your current needs.

Learn All You Can About HIV

Empower yourself and take control of your condition by learning as much as you can about HIV and AIDS. There are many resources available: Start by talking to your doctor. Check out government Web sites such as the Centers for Disease Control and Prevention and the National Institutes of Health: AIDS Info. Your doctor may also be able to refer you to support groups to talk to other HIV patients in your area, and there are online HIV support groups as well. 

Experimental Treatment May Help Fight Deadly Ebola Virus

Therapy led to recovery in nearly half of study animals up to 5 days after infection

 An experimental treatment for the deadly Ebola virus proved effective in about half of monkeys with disease symptoms, findings that show promise for the development of therapies for humans, according to researchers.

The death rate for people infected with the Ebola virus is as high as 90 percent, and the virus has caused numerous deaths in Africa over the past several years. In addition to being a health concern, the virus is also considered a potential bioterrorism threat.

In this study, researchers gave the treatment, called MB-003, intravenously to monkeys 104 to 120 hours after they were infected with the Ebola virus and had developed symptoms. Forty-three percent of the monkeys recovered, according to the study published online Aug. 21 in the journal Science Translational Medicine.

The MB-003 "cocktail" is made up of so-called monoclonal antibodies, which are able to recognize infected cells and trigger the immune system to destroy them, explained study first author James Pettitt, of the U.S. Army Medical Research Institute of Infectious Diseases, and colleagues.

No side effects of the antibodies were observed in the surviving monkeys, the study authors noted in an institute news release.

In previous research, the same team found that the treatment provided 100 percent protection when given one hour after Ebola exposure, and protected two-thirds of monkeys who were treated 48 hours after exposure.

The next step in the drug development process would be more extensive testing of the safety of the antibodies in animals. After that, the safety of the antibodies would need to be assessed in people.

Currently, there are no approved vaccines or drugs to treat or prevent Ebola virus infection. And while the findings of the new study are promising, scientists note that research involving animals often fails to produce similar results in humans.

Flu Virus May Trigger Diabetes

Italian researchers have discovered that the flu virus may trigger the onset of type 1 diabetes.

Type 1 diabetes, once known as juvenile diabetes, affects as many as 3 million Americans, most of them diagnosed as children. Type 1 diabetes develops when the body’s immune system attacks and destroys insulin-producing cells found in the pancreas. The condition is genetic, but an environmental trigger is also necessary for it to appear.

Researchers have suspected the flu virus might provide this trigger since the 1970s, because type 1 diabetes often sets in after an infection.

Study author Ilaria Capua and her team from the World Organization for Animal Health infected turkeys with the flu to test their theory that it could trigger diabetes. They conducted the study on turkeys because they knew birds with the flu often have an inflamed pancreas, according to New Scientist. They found that many of the turkeys infected with flu virus developed severe pancreatic damage, as well as diabetes.

The researchers then infected human pancreatic tissue with two common flu viruses and found that both viruses grew well in the tissue. The flu virus in the pancreatic cells triggered production of inflammatory chemicals that are central to the autoimmune reactions that lead to type 1 diabetes.

Normally, in humans, the virus attacks the lungs and gut, but not typically the pancreas. But it can sometimes get into the blood and travel to the pancreas, researchers said.

Capua is now testing the dibates-producing effects of the flu on mice, according to the New Scientist.

“Our findings indicate that influenza infection may play a role as a causative agent of pancreatitis and diabetes in humans and other mammals,” the study authors concluded in their report.