By Harold Oster, MD

Question-I was diagnosed six months ago with HIV. I am healthy. I am also on Paxil for depression. I work out with a trainer three times a week. I am in better shape than ever. Does exercising effect my viral load? When you have HIV, when is exercising not good to do?

Answer-One good rule of thumb is that exercise has rarely been shown to adversely affect any condition. Several studies address the issue of exercise in HIV infection. Few, if any, studies have shown that exercise has a negative impact, and some have shown a positive one.

Perhaps the greatest value of exercise in HIV infection is to prevent or treat weight loss. In AIDS wasting syndrome, a patient loses more than 10 percent of his or her body weight. Resistance exercises can help restore body weight. Aerobic exercise has been shown to be beneficial as well.

Exercise also has a positive effect on mood and outlook. Some medical research indicates that enhanced mental well-being is associated with an improved course in many illnesses, including HIV. While some experts believe that these studies are not conclusive, most agree that enhancing mental well-being is good in and of itself.

Exercise can also activate the immune system, and for HIV patients, this has been the cause of some concern. Because HIV replicates in immune cells, activating the immune system could result in an increase in viral replication and a temporary elevation of the viral load. (This is the reason the flu vaccine can cause brief increases in the viral load.) However, a recent study that looked at patients' viral load after exercise found no significant elevations.

In summary, I would encourage you to continue your exercise routine. I would not count on exercise to prevent HIV from progressing, however, and I would also encourage you to follow the advice of your physician regarding both exercise and the use of antiviral therapy. You should be careful not to overexert yourself, especially while on certain antiviral drugs. Some of these medications can cause problems if your muscles become stressed and if you become dehydrated

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