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HIV wasting disease: anabolic steroids raise heart attack risk and cause liver damage

A study that measured the effects of anabolic steroids on men with HIV wasting disease found that anabolic steroids cause decreased levels of HDL-cholesterol, increased levels of LDL-cholesterol, and serious liver toxicity within 12 weeks.

The results have implications for athletes who take anabolic steroids to enhance performance, says principal investigator Carl Grunfeld, at the San Francisco VA Medical Center.

The study is published in the Journal of Acquired Immune Deficiency Syndromes.

The researchers found that as expected, anabolic steroids lead to gains in both lean body mass and fat in men with HIV wasting.

he randomized, double-blind trial among 262 HIV-positive men was the largest study of its type on men with HIV-associated weight loss.

For the first 12 weeks of the trial, the men were randomly assigned to receive daily doses of either 20, 40, or 80 milligrams of the anabolic steroid Oxandrolone or a placebo.
They were allowed to receive open-label Oxandrolone for the second 12-week period.

Grunfeld says the adverse effects of the steroids predispose people to an increased risk of myocardial infarction. Furthermore, they found grade III and grade IV liver toxicity in some men, which means a very significant risk of serious liver damage." The men's testosterone levels were also depressed. These effects were not seen in men taking placebo, according to Grunfeld.

The researchers observed that in men with the most wasting, the 20 milligram dose was more effective than higher doses in promoting weight gain. Subjects who weighed more and were healthier – and were therefore more like athletes who use the drugs, observes Grunfeld – required higher doses to gain weight. This is significant, he says, because it demonstrates in healthy people, "you need a higher dose to get a benefit – and the higher the dose, the more the toxicity."

Based on observed changes in HDL and LDL, Grunfeld estimates that myocardial infarction risk would be increased 58 percent among men taking 20 milligrams of Oxandrolone per day, two-fold with a 40 milligram daily dose, and three-fold with 80 milligrams. "Add smoking or hypertension, and the risk becomes really serious," he says.

The ability to promote gains in both muscle and fat makes these drugs unique among the medications used for HIV wasting disease, notes Grunfeld. He says that among patients with serious wasting illnesses, the benefits of immediate weight gain could still potentially outweigh the risks of longer-term heart and liver damage. For these patients, he says, it is important to have a store of fat as well as muscle mass, because "opportunistic infections burn up muscle if there's no fat there. The more fat you have, the less muscle you burn."

Nonetheless, he notes, " We would still stop the drug among anyone who has grade III or grade IV liver toxicity."

Source: University of California - San Francisco, 2006