January 2003 Happy New Year to You All! I send my sincere wishes for a year of peace, harmony, and good health. Listed below are the highlights of Januarys E-newsletter.
1. Once Daily HIV Therapy is Here! It seems like just yesterday when HIV(+) patients were having to take their medications at least three times a day, some with food and some without, often with hard to tolerate side effects to boot. Fortunately we have now entered the era of once daily therapy!! Not only can several different antiviral combinations be taken once a day, HIV(+) individuals can do so without the fear of lower potency or any increase in side effects. In fact, several of the once daily antiviral regimens listed below are among the best tolerated of all. Id like to share with you what one of my patients wrote to me after I switched him to one of my favorite once daily HIV medication regimens:
The most frequent situation in which once daily therapy should be viewed as the current standard of care is in patients who are beginning antiviral medication for the first time (previously antiviral naïve). Once a baseline genotype resistance test is performed to confirm sensitivity to most of the necessary antiviral medications, the choice can be made as to which regimen below best suits your needs. As always, all medication decisions should be made in conjunction with your treatment practitioner to ensure that your program is individualized. For patients who have been on antiviral medications in the past, a resistance test (genotype or preferably a phenotype test) should always be performed prior to switching to a once daily regimen. You should make sure that your strain of virus is sensitive to all of the medications in the new combination before starting. Listed below are the medications that are currently prescribed as once a day by most HIV Specialists:
Listed below are several once daily antiviral combinations: Videx EC / Viread / Sustiva Videx EC / 3TC / Sustiva Viread / 3TC / Sustiva Videx EC / Viread / Viramune Videx EC / 3TC / Viramune Viread / 3TC / Viramune Viread / 3TC / Invirase/Ritonovir Viread / Videx EC / Invirase/Ritonovir Viread / 3TC / Kaletra Viread / Videx EC / Kaletra The following medications are soon to be released as once daily antiviral medications: Zerit XR (D4T), Atazanavir (a new once daily protease inhibitor), and FTC (similar to 3TC, but more potent). These new treatment options will certainly help many HIV(+) individuals achieve a more normal lifestyle and a better quality of life. Once again, all medication changes should be made in conjunction with your treatment practitioner to ensure that your program is individualized to best meet your needs. 2. Dr. Kaiser to Speak in the LA Area Jon Kaiser, M.D. will be speaking to the HIV patient and practitioner community in West Hollywood on Wednesday evening January 15th, 2003. A light dinner will be served. Admission is free and is open to all. For more information visit the following web link: 3. The HIV Micronutrient Study Update Integrative Health Consulting is currently performing a ground-breaking research study testing the use of high-dose antioxidant micronutrients as an adjunctive therapy for the treatment of HIV infection. This study is the first of its kind to test a high-dose combination of micronutrients, in conjunction with medications, as a primary treatment for a serious medical condition. Prior studies have usually only tested a single micronutrient at a time. The title of this research study is:
To be enrolled in this study an HIV(+) patients must meet the following criteria:
The study lasts for 12 weeks. All nutrients and lab work are provided and financial compensation is provided for study visits. Research sites are currently open in San Francisco, NYC, Los Angeles, and Philadelphia. If you, or someone you know, is interested in enrolling in this study, click on the following web link for more information: There is once again a brand new recipe on the Integrative Health Consulting website under the Education/Recipes section. It is called Barley/Beef Sloppy Joe. You can see this and other mouth watering recipes on my website at: Give them a try!! 5. Hormone Balancing For Immune System Support TestosteroneHormones and Body Cell Mass As described in detail in my book, maintaining your body cell mass (muscle tissue) at 100% of ideal levels, is an important way to optimize the functioning of your immune system. Maintaining your testosterone level within the optimal range (in both men and women) can help ensure that these body composition goals are met. Some physicians never test their patients testosterone level. Others give all of their patients regular testosterone injections whether they need them or not. As always, the key to maintaining good health is finding the right balance for each individual patients situation. Hormones that build body cell mass are classified as steroids. This term refers to the physical structure of the molecule and not its function. Steroid hormones are essential to good health and exert a multitude of positive effects on the body. Estrogens soften the skin and stimulate the growth of the breasts. Androgens, such as testosterone, have masculinizing effects that promote hair growth, enlargement of the genitalia, and a deepening of the voice. Steroid hormones that increase muscle mass are termed anabolic steroids. Natural anabolic steroids, produced by both men and women for this purpose, include testosterone and DHEA. Many of my patients (both men and women) have benefited tremendously by supplementing with natural testosterone to elevate the level of this hormone in their blood to the optimal level for health. I define this level as the hormone level found in a 25 to 35 year old adult at their peak of health. This is the optimal level for increased energy and healing to occur! If you are experiencing progressive weight loss or a declining body cell mass do not hesitate to use one or more supplemental anabolic hormones as part of your treatment program. They can greatly enhance both the quality and quantity of your future years. However, I do not support supplementing anabolic hormones just for the sake of appearance or for building body cell mass above 100% of ideal levels. Testosterone Testosterone is the hormone responsible for the masculinizing and tissue-building changes which occur in male adolescents. These include the maturing of the genitalia and the development of secondary sexual characteristics such as hair growth. Women also produce testosterone, though only at about 10% of the level produced by men. Several studies have shown that testosterone levels are frequently decreased in people with fatigue and immune deficiencies. Research performed by Marc Hellerstein and colleagues at the University of California Berkeley has shown that the mean testosterone level of healthy, asymptomatic HIV(+) men is significantly lower than that of HIV-negative controls. His data suggest that sub-optimal testosterone production in HIV(+) males is an extremely common occurrence. One might postulate from this and other studies that early hormone supplementation to restore an optimal testosterone level might play an important role in an HIV(+) individuals maintaining long term health and a high quality of life. Keeping your testosterone level in the optimal range is important for maintaining a healthful body cell mass as well as for preventing fatigue, depression, and diminished sex drive. As I previously stated, the optimal range for testosterone in HIV(+) men is not the same as the normal range commonly reported by most labs. The normal range for total testosterone in men is usually listed as 200-1000 ng/dl. The optimal range is 500-1000 ng/dl. This level is more effective at helping build and maintain body cell mass while still remaining within safe parameters. Finally, testing the free testosterone level, as opposed to the total testosterone level, is more expensive but also much more sensitive at picking up a borderline testosterone deficiency. It is more important when evaluating women patients to use the free testosterone test. Testosterone Delivery Systems Injectable Testosterone Injectable testosterone is commonly used to treat testosterone deficiency. The injectable form, usually injected deep into the gluteus muscle every two to three weeks, ameliorates the underlying testosterone deficiency but can initially cause very high levels of testosterone in the blood. An injection of intramuscular testosterone usually results in a peak level above the limit of normal for several days followed by a gradual decline during the next two weeks. This promotes an increased risk of side effects such as headaches, anxiety, insomnia, irritability, mood swings, aggressive behavior, muscle tension, and testicular atrophy (shrinkage). This pattern of testosterone release is different from the bodys normal testosterone release pattern which provides a fairly steady blood level throughout the day. That is why testosterone creams, applied once or twice daily, are currently my preferred testosterone delivery system. Testosterone Cream Natural testosterone can be mixed into a cream or gel so that it is absorbed shortly after rubbing it into the skin of the scrotum (in men) or the abdomen or thigh (in women). A compounding pharmacy with good quality standards is the best source for this type of application method. AndroGel, a testosterone gel made by the Unimed Pharmaceutical Company, cannot be applied directly to the scrotum and costs 5x as much as most compounded testosterone gels. In my practice I use Kronos Pharmacy (800-723-7455) and recommend concentrations from 1% to 20% to be applied 1-2x per day depending on the particular individuals needs. After 1-2 months of use, a repeat blood test is all thats necessary to fine- tune the dosage so you can stay in the optimal range for healing. Testosterone preparations always require a prescription. By administering testosterone in this fashion, you can most closely approximate the normal way your body releases testosterone into the bloodstream. Testosterone Patches There are two forms of testosterone patches currently available. The scrotal testosterone patch (Testaderm) is applied daily in the morning to a clean, dry scrotum which has been trimmed of hair. The Testaderm patch effectively increases the testosterone level into the normal range in most individuals yet it is often found uncomfortable to wear every day and sometimes falls off. A second type of testosterone patch can be applied to the upper body usually on the back or anterior abdomen. At the present time, testosterone body patches are made by two companies. Alza Pharmaceuticals makes Testaderm TTS, which stands for testosterone transdermal system, and Smith-Kline Pharmaceuticals makes Androderm. Both patches are similar in their effect but the Testaderm TTS patch is thinner, less bulky, and not as often associated with skin irritation. If skin irritation does occur, the application of triamcinalone 0.1% cream (available by prescription) underneath the patch can eliminate this side effect in most cases. In the next edition of my E-newsletter, I will cover Part 3 of Hormone Balancing for Immune System Support Using DHEA Properly plus many other interesting items with regard to your health. Please let your friends know about this E-newsletter so we can continue to grow as a healing community. Take care and, as always Keep Hope Alive! Jon D. Kaiser, M.D. |