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Term Paper on Steroids

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“The term “steroid” refers to a family of hormones and drugs chemically related to the substance cholesterol. Probably the most commonly beneficial and medically accepted use of steroids are the sex hormones (estrogen and progesterone) contained in oral contraceptives. Other frequently used and medically beneficial steroids are relatives of cortisone, which is used to fight inflammation not caused by infection.” (Gold) Steroids are used in the cases with delayed puberty, impotence, for AIDS patients, osteoporosis, anemia and weight disorders. The use of steroids for medial purposes is regulated by the National Institute on Drug Abuse (NIDA). The use of steroids for medical purposes is limited now because of potential side effects.

The cases of steroids misuse of abuse are very frequent that make authorities to imply additional regulations for their use. Especially frequent are cases of steroid abuse in professional sports where they are used for quick mass-building.

Unfortunately steroids, such as testosterone, for example, can cause a lot of side effects for human health. Such health problems as cancer, high blood pressure, irregular heartbeat can be provoked by steroids. Steroids can have not only physical side effects. The can have negative impact on human psychics and emotional state as well. The use of steroids can cause mood swings, paranoia state and uncontrolled anger. The use of steroids also creates additional risks of becoming addicted on other drugs. So, steroids can become the trigger for the addiction from hard drugs.

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The use of steroids for patients with AIDS and HIV should be controlled by the doctors and don’t exceed prescribed doses. This will help to avoid side affects. Very often negative changes caused by the use of steroids can not be cured and damage can be more dangerous than the use. Steroids taken in large doses can be toxic and have the effect of the poison for human organism and thus be dangerous for liver and kidneys. Heart complications and different coronary diseases are very often among people who use steroids.

Fatigue, one of the most common and least studied symptoms of people with HIV. “Several studies suggest that most people with HIV/AIDS experience fatigue at some point during their illness, with estimates ranging from less than 50% to more than 80%. The prevalence (rate) of fatigue increases as HIV disease progresses.” (Highleyman) HIV infection in many cases becomes the reason of fatigue. The HIV viremia (the number of viruses in blood) has a direct connection with the level of fatigue. Many people have noticed positive changes concerning their fatigue after antiretroviral therapy. Latest research discovered new facts about the fatigue and viral suppression. The correlation is not always easy to discover. There are cases when people with excellent virological response still feel fatigue. So, controlling the virus does not give 100% guarantee of getting rid of fatigue. Anemia is named among the possible reasons of fatigue. Statistics shows, that anemia is a common disease for HIV/AIDS patients and that it can be a reason of fatigue. “Dr. Barroso’s recent study found that HIV positive people with low hematocrit, hemoglobin, and CD4 cell levels experienced more fatigue than those who had low levels on any one of the three measurements alone. Various studies have found that 60–90% of people with HIV have some degree of anemia at some time during the course of their illness, and that the incidence of anemia increases as HIV disease progresses to AIDS.” (Barroso) These findings prove the research made by Richard More, Patrick Sullivan and their colleagues from the Centers for Disease Control and Prevention. They also found out that anemia in HIV positive patients signifies the progress of the disease and means shorter survival.

The bone marrow damage is the most common cause for amnesia among people with HIV. Good nutrition becomes the part of the treatment in these cases. Nutrition can be supplemented by steroid, such as Epoge or Procrit, injections. These injections are used in order to stimulate blood cell production in bone marrow. This treatment is effective if the person has low level of Epogen or Procrit. This means such a treatment is effective in the cases with low level of blood production, but not with the high level of blood loss. The treatment usually lasts from four to six weeks. Unfortunately, this kind of treatment can have such side effects as high blood pressure, often headaches and joint pain.

Hormonal imbalance is anther possible cause of fatigue among people with HIV/AIDS. Low level of testosterone can be the cause of fatigue. Low level of testosterone or hypogonadism is the most widespread kind of hormonal imbalance among HIV positive patients. “An estimated 45% of men with untreated AIDS and 25% of asymptomatic, untreated HIV-infected men experience low testosterone levels.” (Breitbart) There is a problem in identifying the right level of testosterone for each individual.

Different individuals have different level of testosterone. Testosterone deficiency can be one of HIV disease symptoms. Low level of testosterone can be the reason of male fatigue. Hypogonadism is another cause of low testosterone level. Hypogonadism is usually treated with testosterone or androgens (synthetic anabolic steroids). They can be prescribed in the form of pills, injections, gels of patch. This type of steroids can reduce weight loss, relieve depression, and increase the level of energy. Androgens can cause such side effects as testicular atrophy, acne, fertility decrease, and increase of sexual activity. Fertility decrease can be explained that the use of androgens replaces natural components, responsible for fertilization and the production of these elements decreases. Androgens used in excessive doses, used in bodybuilding, for example, can cause the behavioral problems, heart diseases and kidney and liver damage. These negative effects do not appear when the androgens are used in small doses, which are used for the treatment of HIV patients.

It’s necessary to underline that androgens are commonly used for male HIV patients. Replacing male hormone testosterone, androgens are natural for males. The use of androgens for female patients can have such negative effects as undesirable virilizing masculinization, such as excessive hair growth, deepening of the voice and menstruation disorders. These negative effects can be irreversible even after the end of the use of androgens.

For women with fatigue other group of steroid is usually prescribed. This group of steroids is called oxandrolone or nandrolone. These are the replacements of testosterone used for women. In some cases the combination of estrogen and testosterone is used. This combination is called Estratest. The studies performed in many research institutions of the US prove positive impact of testosterone and other steroids on the fatigue treatment among patients with HIV/AIDS. The series of experiments, performed by Glenn Wagner, the doctor of philosophy in New York State Psychiatric Institute and his colleagues from Columbian University proved positive effect of testosterone on male HIV/AIDS patients. During the experiment they gave to 100 male HIV positive men intramuscular injections of testosterone. Injections were made twice a week during twelve weeks. After the end of the experiments 80 per cent of men noticed positive changes in their physical state. (Breitbart) Researchers were not completely sure if positive changes in the physical state of the patients were cased by the effect of testosterone on their physical state or the growth of energy level was partially explained by the overcome of depression symptoms. “Different anabolic steroids have different effects; for example, oxandrolone is good for treating wasting but less effective in reversing depression and fatigue. Sometimes experimentation may be necessary to determine which form is superior for treating fatigue in a specific individual. In addition to anabolic steroids, injections of human growth hormone (Serostim), which is used to treat HIV-related wasting, have also been shown in studies to increase energy levels. However, Serostim is extremely expensive.” (Capaldini, 87) The results of the experiments need detailed study but positive effect of steroid treatment for HIV patient is out of doubts.

Another reason of fatigue, peculiar to HIV positive patients can be explained by the adrenal insufficiency. Adrenal insufficiency is usually caused by the low level of glucocorticoid hormones and it can become the reason of sever fatigue. Glucocorticoid hormones play important role in the process of metabolism and some other important body processes. The low level of this hormone can cause the loss of weight, the decrease of blood pressure and dizziness. HIV causes serious damage to adrenal gland, which naturally leads to the decrease of glucocorticoid hormones production. “Adrenal insufficiency is diagnosed by means of an ACTH (adrenal corticotropin hormone, a pituitary hormone) stimulation test, in which synthetic ACTH is administered and cortisol levels are measured to determine whether the adrenal cortex is producing hormones in response to ACTH stimulation.” (Capaldini, 97) Adrenal insufficiency is usually treated with the therapy, where hydrocortisone or dexamethasone is replaced.

Lose wasting syndrome is a common problem for people with HIV. Two drugs have been developed for the treatment the weight loss caused by AIDS. Megace and marinol are used in order to increase appetite and make people gain weight. Unfortunately, these drugs influence only appetite of the patient and do not touch metabolic processes of the organism and the weight gain with their help is most fat. Steroids and TNF inhibitions can deal with metabolic changes. Ketotifen, a kind of TNF inhibitor can be used for treating of lose wasting. The number of tests has shown significant gain of weigh among the patients with wasting syndrome of unknown reasons.

Anabolic steroids are also used to stop weight loss. They are mostly used in order to increase muscle strength. Unfortunately, these testosterone therapy isn’t appropriate for men who have normal level of testosterone. It can’t be used for women either. For such cases a group of anabolic steroids has being developed. This group of steroids possesses less masculinizing qualities than testosterone. Nandrolone and methandrostenolone are two anabolic steroids, which are used to treat women. Anabolic steroids are comparatively cheaper than all other medicines which treat AIDS. That is one more reason, which makes them so popular in treating people with HIV. “However, despite the numerous anecdotal reports of steroid use in people with AIDS-related wasting, their long- term safety and efficacy have yet to be established in placebo-controlled studies. The American Federation for AIDS Research and the Community Consortium in San Francisco, are both considering placebo-controlled studies of anabolic steroids.” (Buda, 13) Deep study is necessary in order to create an alternative to expensive medicines, which are used for AIDS treatment.

At the moment steroids have proved to be an effective treatment of many HIV/AIDS related diseases. Smart dozing and breaks in their use can help to avoid negative effect and make essential progress in treating these diseases.

References:

Gold, J et al. Second International Congress on Drug Therapy and HIV Infection; November 1994;
Highleyman, Liz. Fatigue and HIV. San Francisc,2001
Barroso, J. A review of fatigue in people with HIV infection. Journal of the Association of Nurses in AIDS Care 10(5): 42–49. September 1999.
Breitbart, W. and others. A randomized, double-blind, placebo-controlled trial of psychostimulants for the treatment of fatigue in ambulatory patients with human immunodeficiency virus disease. Archives of Internal Medicine 161(3): 411–420. February 12, 2001.
Breitbart, W. and others. Fatigue in ambulatory AIDS patients. Journal of Pain and Symptom Management 15(3): 159–167. 1998.
Capaldini, L. Symptom Management Guidelines. HIV InSite Knowledge Base (hivinsite.ucsf.edu/InSite.jsp?doc=kb-03-01-06&page=kb-03). June 1998.
Buda, F.B. Sleep disorders in HIV-positive patients: Curable causes of daytime fatigue and sleepiness. XI International Conference on AIDS, Vancouver, Canada, July 7–12, 1996.
Herbarth L et al. Ninth International Conference on AIDS. June 1993.
Hengge UR et al. Ninth International Conference on AIDS. June 1993.

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