Bulletin of Experimental Treatments for AIDS, July, 1998
Harvey S. Bartnof, MD
While information regarding testosterone levels in HIV positive men has been forthcoming, information about levels in HIV positive and HIV negative women has been sparse. Women are known to have very low levels of total testosterone originating from the ovaries and adrenal glands. This hormone plays a role in maintaining cell and muscle mass in both men and women. Given the common problem of wasting in HIV/AIDS, filling in the gaps in this information is important. One problem has been the lack of an accurate, sensitive test to measure the low levels of free (unbound) testosterone in women.
Now, researchers from Drew University of Medicine have devised a sensitive and accurate test to measure free testosterone levels in women. The test is able to measure levels in the picomolar per liter range. A total of 34 HIV negative and 37 HIV positive women were enrolled in the study.
Both total and free testosterone blood levels in the HIV positive women were less than half of those in the HIV negative women, a significant difference. Among HIV positive women, no significant differences were found between those with or without weight loss or between those who were or were not menstruating. The researchers also found an inverse correlation between HIV viral load and blood testosterone levels: the higher the viral load, the lower the testosterone levels, and vice versa.
Throughout the menstrual cycle, levels of free and total testosterone were relatively stable. The exception was in the 3 days before ovulation. According to the principles of classic Darwinian selection, such a testosterone surge would increase libido, thereby increasing the chance of a sexual encounter(s), pregnancy and species propagation. Studies that measure the effects of testosterone supplementation in HIV-positive women with wasting are in progress.
Sinha-Hikim I and others. The use of a sensitive equilibrium dialysis method for the measurement of free testosterone levels in healthy, cycling women and in human immunodeficiency virus-infected women. Journal of Clinical Endocrinology and Metabolism 83(4):1312-1318, 1998.
In a letter to the editor of The Lancet, researchers from Hannover Medical School in Germany reported that a triple anti-HIV regimen caused systemic lupus erythematosus (lupus), an autoimmune disease, to be unleashed. Autoimmune diseases arise when the immune system attacks part of the body, causing illness.
The patient was a 36-year-old woman who had been HIV-positive for over 10 years. She had noticed some mild morning swelling in her finger knuckles for some time; knuckle swelling is a type of arthritis which can be a sign of lupus. Her symptoms worsened during the 3 months after starting HAART. Her regimen included AZT plus 3TC plus indinavir. Blood tests then revealed autoimmune antibodies diagnostic of lupus. Stored blood samples from the prior 5 years were weakly positive for lupus antibodies. Past reports of patients with lupus indicated that many had improved symptoms after becoming infected with HIV, due to immune suppression. The letter's authors suggested that their patient is exhibiting the opposite effect: HAART-induced immune system recovery leading to increased autoimmune symptoms associated with inflammation.
Behrens G and others. Highly active antiretroviral therapy. The Lancet 351:1057-1058. April 4, 1998.
Researchers from the Naval Medical Center in San Diego reported the successful treatment of recurrent, refractory, azole-resistant vulvovaginal candidiasis in a woman with AIDS. Azole-resistant candidiasis can grow even in the presence of an antifungal drugs such as ketoconazole (Nizoral), fluconazole (Diflucan) and itraconazole (Sporanox). Topical nystatin did not relieve her genital symptoms. Topical gentian violet was disliked by the patient because it stained her clothes and bathtub.
A 10-day, twice-daily course of 600 mg vaginal suppositories containing boric acid and a 5% boric acid topical lanolin ointment achieved a successful outcome. Symptoms were relieved within 24 hours. The patient tolerated the therapy well and no boric acid was detected in her blood. Subsequent relapses were successfully treated with 2-3 day courses of boric acid. The mechanism by which boric acid can control fungal infection is not known. The weak acid may penetrate the fungal cell wall and disrupt the cellular membrane.
While the incidence of candidiasis among people with AIDS has plummeted for those who are successfully treated with HAART, some HIV positive women may have refractory vaginal candidiasis and may benefit from the therapy.
Shinohara Y Todd and others. Successful use of boric acid to control azole-refractory Candida vaginitis in a woman with AIDS. Journal of Acquired Immunodeficiency Syndromes and Human Retrovirology 16(3):219-220, 1997.
Swate TE and others. Boric acid treatment of vulvovaginal candidiasis. Obstetrics Gynecology 43:893-895, 1974.
Clinical researchers at Brown University in Rhode Island reported a case of possible HIV transmission to a 35-year-old gay man by body piercing. Sexual transmission is considered an unlikely possibility because the man denied having had anal intercourse or receptive oral intercourse (receiving ejaculate) with any of the 3 male partners he had had within a year prior to becoming HIV positive.
The man had 7 negative HIV antibody tests between 1990 and July 1994. He later became HIV positive with an indeterminate Western blot antibody test in November 1994 and received a positive confirmatory test in December 1994. He reported no symptoms of HIV seroconversion illness.
During the second half of 1994, the man had 5 separate body piercings: 1 each in Amsterdam and New York City and 3 in Boston. The man had a total of 8 body piercings including his penis, scrotum, nipples, navel, tongue, chin, eyebrows and nasal septum (the cartilage separating the 2 nostrils). His only stated history of injection drug use was cocaine once in 1987. He denied any history of blood transfusions or receiving any blood products. He had no history of occupational risk as a healthcare worker or emergency services provider.
The authors stated that this case represented the first case of HIV transmission possibly due to body piercing. They commented that the practice is increasingly popular but largely unregulated. The medical literature has documented cases of HIV transmission from acupuncture and tattooing. Consumers of such services should be aware of the potential risk of HIV transmission, in addition to transmission of hepatitis B, C and D. Sterilized equipment would minimize such risk. Effective disinfectants include rubbing alcohol, diluted bleach (1:100 with water) and povidone iodine. Heating piercing implements in an autoclave is also effective.
Pugatch D and others. Possible transmission of human immunodeficiency virus type 1 from body piercing. Clinical Infectious Diseases 26:766-767. March 1998.
Tweeten S and others. Infectious complications of body piercing. Clinical Infectious Diseases 26:735-740. March 1998.
Researchers at the University of Washington measured rectal HIV using anal swabs in 55% of 374 HIV positive gay/bisexual men in Seattle. The mean CD4 cell count was 523 cells/mm3. Blood plasma HIV RNA levels were not stated. Only 10% were taking antiretroviral therapy at the time of the sampling.
The presence of HIV DNA in anal/rectal swab samples was statistically associated with each of the following: inflammation on any anal Pap test, current anal warts, the presence of human papilloma virus (HPV) DNA, and a past history of rectal douching or enema. Non-white racial or ethnic background (17% of the total) was associated with a 60% decreased risk of rectal HIV DNA.
The presence of HIV RNA in anal/rectal swab samples was statistically associated with each of the following: inflammation found by anal Pap test, anal/rectal HIV DNA and blood plasma HIV RNA. Blood CD4 cell counts were not statistically related to either anal/rectal HIV DNA or RNA.
In 2 of 8 men who had undetectable blood plasma HIV RNA, HIV was detected on anal swabs. The presence of inflammation on the anal Pap smears was associated with the presence of other infections, including herpes simplex virus, CMV and HPV. The authors suggested that anal/rectal shedding of HIV DNA or RNA may reflect local HIV production from pelvic lymphoid follicles, and that anogenital HIV growth may represent a separate compartment from blood plasma HIV. The findings also have implications for HIV transmission to the insertive partner during anal intercourse, as well as to those performing oral-anal sex.
Kiviat NB and others. Determinants of human immunodeficiency virus DNA and RNA shedding in the anal-rectal canal of homosexual men. The Journal of Infectious Diseases 177:581-578. March 1998.
Harvey Bartnof, MD, is a member of the San Francisco AIDS Foundation's Scientific Advisory Committee.
980701
BE980715
Copyright © 1998 - Bulletin of Experimental Treatments for AIDS (BETA). Reproduced with permission. BETA is published four times a year by the San Francisco AIDS Foundation. All rights reserved. Noncommercial reproduction is encouraged. Subscription lists are kept confidential. Call 415.487.8060; FAX: 415.487.8069. Mailing Address: P.O. Box 426182, San Francisco, CA 94142-6182. beta@sfaf.org http://www.sfaf.org/beta.html
This information is designed to support, not replace, the relationship that exists between you and your doctor.