HIV+ and Overweight- Suggestions?

[Paul]

Hi everyone,

My name is Paul. I am a 48 year old male, 120kg (264 pounds) HIV+ since 2003. HIV is fine and undetectable. My endocrine system is another thing altogether.

My current regimen is as follows:

2ml depo testosterone weekly
1 x 25mg Aromasin every 6 days. (used to be every 3 days but due to cost changed to every 6 days)

I have started this month to also take Acetyl L Carniine, Zinc + Copper, Vitamin E, Vitamin D & Co-Q10 as suggested on this site and Magnesium. I also take 150mg Aspirin daily to keep my blood thin. I have been on this TRT for the last 2 years. Got my blood tests back and will give you the results which concern me.

Test	Result	Reference	Units
Haemoglobin	21.3	14.3 - 18.3	g/dl
Red Cell Count	6.47	4.89 - 6.11	10[SUP]12[/SUP]/l
Haematocrit	59.8	43.0 - 55.0	%
MCH	32.9	27.0 - 32.0	pg
Immature Granulocytes	0.70
Urate	0.46	0.21 - 0.43	mmol/l
Homocysteine	27	< 15	umoll
TSH (Roche)	3.58	0.27 - 4.20	mIU/l
Prolactin	7	4 - 15	ug/l
DHEAS	6.2	1.9 - 13.4	umol/l
Total Testosterone	29.1	8.0 - 27.1	nmol/l
SHBG (Roche)	28.6	11.4 - 52.3	nmol/l
Free Testosterone Calculated	728	180 - 536	pmol/l
Oestradiol	103	< 208	pmol/l
FSH	0.6	1.2 - 15.8	IU/l
LH	< 0.1	1.3 - 9.6	IU/l
PSA	1.66	0.0 - 4.0	ng/ml

My GP said I need to have blood removed at a hospital because of my high Haematocrit which I understand. Can't donate because of my HIV.

He also says I have gout because if my high Urate.

Homocysteine is also a concern and very high.

Prolactin is high.

My Total T and Free T is also high.

I'm not sure about my Oestradial if that is too high.

I will need to reduce my weekly T dosage. maybe to 1.5ml every 10 days instead of 2ml every 7 days ?

FSH & LH suppressed because of my TRT ?

PSA seems OK.

Any advice from the experts here would be much appreciated. I will be going to an endocrinologist with these result soon as well.

Many thanks,

Paul.

 

[Nelson Vergel]

Paul

Yes, you have to give blood. Since HIV+ people cannot donate, your doctor has to write an order for a therapeutic phlebotomy. You may need to give 1 unit 1 month apart and then every 3-4 months (have him measure your ferritin blood levels to make sure they do not extract too much blood. Low ferritin can make you tired).http://www.thebodypro.com/content/64756/testosterone-replacement-therapy-and-polycythemia.html

When you say 2 mls of testosterone per week, do you mean 200 mg or 400 mg (It depends on the strength and country)?

Do not waste your time or money measuring LH and FSH since you are on testosterone and your HPT axis is shut down.

Aromasin can increase liver enzymes and decrease HDL. What are these values?

Your estradiol is 29 pg/mL. Not high at all. Do you know if it was tested using ultrasensitive assay?

You say your weight is 264 Lbs. How tall are you? Are you overweight or a bodybuilder? What is your blood pressure like at that T dose?

 

[Paul]

Hi Nelson,

Thank you for your quick reply. To answer your questions :

Depo-Testosterone is 100mg/ml. I get a 10ml vial an get 5 injections out of it so I take 200mg per week. I tried 100mg per week (1ml) but I found it was not enough.

Last time I had my LDL tested was in the beginning of November last year. Results were:

Cholesterol Total 5.3 2.8 - 4.9 mmol/l
Triglycerides 1.3 0.5 - 1.6 mmol/l
HDL 1.3 1.0 - 1.6 mmol/l
LDL 3.8 1.6 - 2.9 mmol/l

We only had 1 estradiol test available. I asked my GP to indicate it to be ultrasensitive but I am not sure if the lab actually did it or not.

I am overweight. I am 6 feet (1.82m).

My blood pressure is too high for my liking as well. Last time I checked it was around 130/97

There was one other test I did last November which concerns me as well. It was a fasting glucose test.

Glucose Fasting 4.5 3.9 - 6.0 mmol/l
Insulin Fasting 19.4 0.2 - 9.4 mIU/l
Homa Index 3.88 0.8 - 2.0

I'm very concerned about my Insulin.

Many thanks,

Paul.

 

[Vettester Chris]

Paul, welcome to EM. Thanks for joining.

If possible, we need to look a lot deeper on the thyroid. It's impossible to really make any comments with the TSH-Only lab, but even that lab at 3.58 mIU has me suspicious on your thyroid productivity. See about getting Free T4, Free T3, Reverse T3 & Antibodies (TPO, TgAb).

 

[Paul]

Hi Chris,

Thanks for the reply. I will pop in to my GP on Thursday to have them done. When I ordered the thyroid test last week I thought that they would do all that automatically but it seems that you have to specify it. I will let you know as soon as I have the results.

Kind regards,

Paul.

 

[Gene Devine]

Hi Chris,

Thanks for the reply. I will pop in to my GP on Thursday to have them done. When I ordered the thyroid test last week I thought that they would do all that automatically but it seems that you have to specify it. I will let you know as soon as I have the results.

Kind regards,

Paul.

Most GP's are not trained well in how to evaluate Thyroid health and will go simply by reference ranges...which we all know here is not right.

High TSH like yours is suspect like Chris noted.

The labs he listed are spot on to give you a good assessment as to what is going on.

Make sure to insist on these labs as you may get some push back when the GP says "but your TSH is in range"...and that isn't right.

 

[Paul]

Hi Gene,

Thanks for the advice. I have my GP "well trained" He is used to me coming in with research and medical information. He said to me a while back I probably know more about HIV than he does and now he wants to know if I'm studying endocrinology.

I'm only going to him to get the tests done but will be visiting an endocrinologist with my results. I have discovered over the years that I need to take control of my own health and that's why I bought both of Nelson's books and subscribe to sites that are up to date with the latest research.

My last endocrinologist did all the tests, called himself Dr. Testosterone, eventually diagnosed me with leaky gut syndrome and wanted me to do a quick IV cure that would instantly cure all my issues. When he mentioned that my testosterone was high, which it wasn't according to Nelson's books, and he was just rushing me and charging me an arm and a leg, I never went back.

I am now going to a new endocrinologist who was educated in France (I live in Johannesburg, South Africa) and will see what he has to say.

I'll post my T3, T4 etc. results as soon as I get them.

 

[Nelson Vergel]

Paul

Wow..I want that IV cure!

By the way, you definitely have insulin resistance. You have high fasting insulin and high HOMA score. This problem is more common in HIV+ people than HIV-. Insulin resistance can cause (and/or be the cause) of obesity. Ways to decrease insulin resistance is exercising 30 min a day or 1 hour 3-4 times a week, increasing fiber intake, decreasing simple carbs, switching HIV medication regimens away from protease inhibitors (many docs are switching people to integrase inhibitor-based regimens), losing weight, and taking medications like Metformin (glucophage).

I talk about ways to improve insulin resistance in this article: http://www.positivelyaware.com/2012/12_01/hiv_wellness_series.shtml

I assume you have undetectable HIV and a good CD4 cell level. Correct me if I am wrong.

Metformin has shown promise in decreasing fat and lipids in people with HIV, so discuss with your doctor. http://jama.jamanetwork.com/article.aspx?articleid=192922

Some anti-aging physicians think Metformin is a true anti-aging medication: http://www.huddlebuy.co.uk/articles/Neil-Palmer-SEO-Webinar-IM3

The good thing is that your lipids are not bad. I assume you do not take statins.

Please let us know more pieces of the puzzle!

 

[Paul]

Hi Nelson,

My HIV regimen is Viramune and Truvada (Tencitab is the generic form from Aspen who also make Truvada). Take it in the morning. My last blood test were fine. CD4 611, CD4% 30 and undetectable <40 copies according to their undetectable levels. Same for my wife.

The new endocrinologist I am seeing wants me to start monitoring my glucose level with a glucometer. When I 1st spoke to him a few weeks back he was also surprised that no-one had put me on Metformin yet so that is a positive sign from his side.

I have changed my diet. Less bread and more cruciferous vegetables. Has done wonders for my bowel movements. Using coconut oil now to cook as well. trying to cut out as much as possible sugary foods as well as artificial sweeteners. Trying to stick to slightly flavoured water.

No I don't take statins.

I'll post my Thyroid result next week when I get them.

many thanks for the links.

 

[Nelson Vergel]

Paul

Good to know about your immune system and no statins. Your medication regimen is actually one of the most metabolic friendly ones out there, so good for you. I think with hormone balance, Metformin, a good diet and exercise you will be in shape soon as those pounds start shedding off (which will also normalize your glucose, blood pressure and insulin resistance).

 

[Nelson Vergel]

More good news on Metformin:

Metformin aids in the stabilization of metastatic prostate cancer
Higher dose metformin associated with improved survival among colorectal cancer patients

 

[Paul]

Thank you Nelson,

I popped into my GP this morning and got blood drawn for every single Thyroid option. Also had a phlebotomy done. Will go back in a months time to do the 2nd one. Must say I feel a bit better after getting rid of the blood.

 

[Paul]

Hi Nelson,

Finally got a moment to login and post my latest test results. I also went for a therapeutic phlebotomy and will be going again next month. Thereafter I will go every 3 months as per your advise. My thyroid results are as follows:

TSH..........3.17, Range 0.27-4.20, mIU/l
Free T4.....19, Range 12-22, pmol/l
Free T3.....5.4, Range 3.1-6.8, pmoll

Antithyroidglobulin..........<10, Range <116, IU/ml
Antithyroid Peroxidase.....9, Range <35, IUml
TSH Receptor Antibody....<0.9, Range <1.75 IU/ml

These are the only Thyroid tests available for me. I hope it is enough. I also did a Insulin Fasting test as well and it came out at 16.0, Range 0.2-9.4, mIU/l. My GP has subsequently put me on Clucophage 500mg one tablet at night with meals.

My questions are as follows:
Looking at all my test result above, should I keep on with my regimen as is or should I lower it a bit. I have decided to do the following and please let me know if it is OK:

I have dropped down from 2ml per week to 1.5ml. The reason is that when I did the 1st set of tests above they were done 10 days after my last T injection. I think that perhaps 2ml per week may be a bit too high ?

I have gone back to taking 25mg Aromasin every 3 days instead of every 6 days. I feel it has improved my libido as it was almost non existent. Even though my estradiol was in an acceptable range, I feel that it was perhaps still too high for me.

What are your views on Homocysteine as my level is quite high ?

I was also told to take 100mg of 7-Keto DHEA. Should I start on that as well ?

The plus point is I have lost some weight as I can tighten my belt up a notch again.

My biggest worry is my fatigue and high body temperature. Especially in the mornings after my shower. I remember my mother complaining about hot flushes when she went through menopause and I now fully understand her as it gets very irritating at times when my body temperature flares up and I get all sweaty. I am frequently feeling hot even in winter.

Many thanks for all your help.

 

[Nelson Vergel]

Glad you got the Glucophage. Retest your fasting insulin and see if you have to increase dose.

I would not change your T dose.

Your thyroid is pretty good.

Your homocysteine can be lowered with B vitamins and a baby aspirin a day. Get a B-100 complex and take it twice per day since Glucophage depletes B vitamins.

DHEA may help with fatigue but may increase your temperature issues.

 

[Paul]

Hi Nelson,

Just a report back on how I'm doing. I have decided to go on a low carb high fat diet and have done so since Juy 2014. To date I have lost around 35 pounds (16kgs). Have managed to get my pre-type 2 diabetes under control. Long story short, my HBa1C is at 5.5. I feel so much better and a lot of my niggling issues have gone away.

I tried some Nettle Root Extract instead of the Aromasin (because of pricing) and it improved my libido very much. However The supplement company selling it (http://www.solal.co.za) is not providing it anymore. They referred me to a compounding pharmacy (http://www.compounding.co.za) here in Johannesburg, South Africa. I have been trying to find one so that I can get perhaps all my meds at a cheaper price and custom made up.

However, they don't provide depo-testosterone that I am currently using but instead "bioidentical hormones".

Could I have your expert advise on what you think about bioidentical hormones? Are they as effective as the old school stuff? I also want to see if I can get HCG from them as well as is advised by ExcelMale.

Many thanks.

 

[Nelson Vergel]

Paul

I am so happy to hear about your great progress.

Bioidentical testosterone is the same as the "Old school stuff". They are made from the same raw material. The term bioidentical is just a marketing term used by the compounding industry to differentiate themselves from big pharma.

Ask the compounding pharmacy to make you a low dose (5-10 mg) Cialis pill to take every day. It is better than Nettle Root, a supplement found to have counterfit viagra anyway.

The compounding pharmacy should be able to make HCG. Have you asked them?

 

[Paul]

Hi Nelson,

I'm shocked that they would put fake viagra in Nettle Root extract. That was not the reason I wanted to use it. I was looking for an alternative to Aromasin and because apparently NRE helps against Benign Prostatic Hyperplasia, Aromatase Inhibition and prevention of the binding of SHBG. Aromasin is very expensive and I needed an alternative.

Yes it did improve my libido as well and I hope it was not because of the fake viagra. According to the label on the bottle it contained Nettle Root 20:1 Extract at 250mg and the inactive ingredients were mostly cellulose and different magnesiums.

Would a daily Cialis have the same effect as what I mentioned above and is it save for long term use ? I thought Cialis was similar to Viagra ? I'm trying to inhibit aromatization of the testosterone into eostrogen.

I wil let you know what the compounding pharmacy says.

Many thanks.

 

[Nelson Vergel]

Cialis can help with ED and BPH.

What is your latest estradiol test ?

 

[Nelson Vergel]

Interesting new data on Metformin and immune function in HIV+ men with normal glucose and undetectable viral load at baseline. They may include Metformin in combination with cure-related therapies as we get more data.

AIDS Research and Human Retroviruses- Ahead of PrintFull Access
Effects of Brief Adjunctive Metformin Therapy in Virologically Suppressed HIV-Infected Adults on Polyfunctional HIV-Specific CD8 T Cell Responses to PD-L1 Blockade
Glen M. Chew,
Ana Joy P. Padua,
Dominic C. Chow,
Scott A. Souza,
Danielle M. Clements,
Michael J. Corley,
Alina P.S. Pang,
Marissa M. Alejandria,
Mariana Gerschenson,
Cecilia M. Shikuma, and
Lishomwa C. Ndhlovu
Published Online:5 Nov 2020my.access — University of Toronto Libraries Portal



Abstract
Targeting inhibitory immune checkpoint receptor pathways has shown remarkable success in improving anticancer T cell responses for the elimination of tumors. Such immunotherapeutic strategies are being pursued for HIV remission. Metformin has shown favorable clinical outcomes in enhancing the efficacy of programmed cell death-1 (PD-1) blockade and restoring antitumor T cell immunity. Furthermore, monocytes are known to be a strong predictor of progression-free survival in response to anti-PD-1 immunotherapy. In a single-arm clinical trial, we evaluated the immunological effects over an 8-week course of metformin therapy in seven euglycemic, virally suppressed HIV-infected participants on combination antiretroviral therapy (cART). We assessed changes in peripheral HIV-Gag-specific T cell responses to immune checkpoint blockade (ICB) with anti-PD-L1 and anti-T cell immunoreceptor with immunoglobulin and ITIM domain (TIGIT) monoclonal antibodies (mAbs) and changes in CD8 T cell and monocyte subsets using flow cytometry. Study participants were all male, 71% (5/7) Caucasian, with a median age of 61 years, CD4 count of 739 cells/μL, and plasma HIV RNA of <50 copies/mL on stable cART for >1 year. Ex vivo polyfunctional HIV-Gag-specific CD8 T cell responses to anti-PD-L1 mAb significantly improved (p < .05) over the 8-week course of metformin therapy. Moreover, frequencies of both intermediate (CD14+CD16+; r = 0.89, p = .01) and nonclassical (CD14lowCD16+; r = 0.92, p = .01) monocytes at entry were predictive of the magnitude of the anti-HIV CD8 T cell responses to PD-L1 blockade. Collectively, these findings highlight that 8-week course of metformin increases the polyfunctionality of CD8 T cells and that baseline monocyte subset frequencies may be a potential determinant of PD-L1 blockade efficacy. These data provide valuable information for HIV remission trials that utilize ICB strategies to enhance anti-HIV CD8 T cell immunity.

More on Metformin and HIV:

Repurposing Metformin in Nondiabetic People With HIV: Influence on Weight and Gut Microbiota
Repurposing Metformin in Nondiabetic People With HIV: Influence on Weight and Gut Microbiota