CHAPTER 103 • THE ATHLETE WITH HIV 605antiretroviral regimens to try and prevent the develop-
ment of resistance (Armstrong, Calabrese, and Taege,
2002).- Drug toxicities include myopathy, neuropathy, pan-
creatitis, cardiomyopathy, bone marrow suppression,
nephrotoxicity, lactic acidosis with hepatic steatosis
(potentially fatal), osteonecrosis, osteoporosis, hyper-
glycemia, hyperlipidemia, and lipodystrophy. All
these, even in their mildest forms, could have severe
effects on an athlete’s performance.
•A new class of medications—“fusion inhibitors”
(enfuvirtide is the first one on the market)—may
prove to be a tremendous advancement in HIV ther-
apy. They prevent HIV from entering immune cells
before it has a chance to replicate. They will be espe-
cially important for drug-resistant HIV. The current
drawbacks to this treatment include subcutaneous
administration and a very high cost, which may be
prohibitive (Jellin, 2003). - Immunonutrients and future therapy: Future therapy
for HIV will include the development of an HIV vac-
cine and possibly immune therapy. Another exciting
new area of HIV research is the role of immunonutri-
ents, such as glutamine, argenine, and cysteine. - Glutamine and argenine are amino acids that are
required for proper functioning of the immune
system. These amino acids are used during exercise
and it has been hypothesized that a deficiency in these
nutrients can have a detrimental effect on immune
function. Therefore, supplementation may be benefi-
cial for immune function. - Glutamine and argenine supplementation may
improve the cytokine profile and have an immunologic
benefit in HIV+ patients. One study showed improved
weight gain with argenine supplementation; however,
if any clinical benefit does exist at all, it requires large
doses (greater than 12 g/day). At this time there is
insufficient evidence to support supplementation in
healthy individuals, but supplementation in those suf-
fering from chronic or acute infections may have some
benefit (Field, Johnson, and Pratt, 2000). - Cysteine supplementation in HIV+ individuals may
slow disease progression or prevent muscle wasting.
But while some preliminary studies have shown
promise, further study is needed before recommenda-
tions can be made (Droge and Holm, 1997).
EFFECTS OF HIV ON SPORTS PARTICIPATION
RISK OFTRANSMISSION
•To caregivers: There are currently no reports of trans-
mission of HIV from an athlete to a health care
provider on the sidelines or in the training room.
- Determining theoretical risk to the athletic health care
provider is based on data on health care professionals
exposed to HIV by needlestick. The risk of serocon-
version has been reported as ranging from 0.2 to 0.4%
in various studies. - Additionally, there are seven reports of health care
workers who have contracted HIV from infected
blood splashed onto their mucous membranes or skin.
The risk from exposure to mucous membranes or
damaged skin is estimated at approximately 0.1%.
This is rare because it requires both a portal of entry
and prolonged exposure to large amounts of blood
(Gerberding, 1995).
•To other athletes: No transmission of HIV during
sports has ever been documented; however, two
reports of transmission of HIV during bloody fist-
fights have been verified by the CDC (Feller and
Flanigan, 1997). - In determining theoretical risk, the following should
be taken into account: the risk of injury and death
during sports is much higher than the risk of contract-
ing HIV; the conditions for a blood-born pathogen to
be transmitted during sports include (1) the presence
of an infected athlete, (2) a bleeding wound or exuda-
tive skin lesion in the infected athlete, ( 3 ) a skin lesion
or exposed mucous membrane on a susceptible ath-
lete, and (4) sustained contact between the portal of
entry on the susceptible athlete and the infective mate-
rial (Dorman, 2000; Mast et al, 1995). - The potential risk of HIV transmission during profes-
sional football has been estimated at less than 1 per
85 million game contacts (Brown et al, 1995).
•Off of the field situations: Athletes are more at risk of
contracting HIV off of the field than on the field.
•Off of the field situations in which athletes may more
commonly put themselves at risk for contracting HIV
include—sexual contact, use of injectible steroids or
other drugs with shared needles or paraphernalia, tat-
toos, and body piercings.
•One study showed there might be a higher proportion
of risky lifestyle behaviors among intercollegiate ath-
letes compared to nonathletes. This included number
of sexual partners and episodes of sexually transmit-
ted diseases (Nattiv and Puffer, 1991); however, this
may not be the case when female athletes are studied
separately from males. A study of the risk of HIV in
female intercollegiate athletes (based on sexual activ-
ity and intravenous(IV) drug use) showed high levels
of health risk behaviors; however, female athletes
showed fewer risky behaviors than their nonathlete
peers (controls were matched for age, education, and
ethnic status) (Kokotailo et al, 1998). - In the realm of the professional athlete, the rate of
risky behavior is unknown, but anecdotal evidence