Hi Alanchiras,
I wasn't going to comment on this board again but I did get your email so I will respond. You have raised a LOT of issues and I am not sure how to cover them all in this limited amount of space as they are all far more complicated than I think most are aware of so there is nothing straightforward about what you are asking about. Even how to workout with resistance weights is the subject of books, of and by itself, and then when complicated with the issues of HIV disease, fatigue issues related to HIV, metabolic issues caused by HIV and the drugs used to treat HIV not to mention side effects, toxicities, and dosing/eating/sleeping schedules, nutritional issues specific to HIV, recovery rates from exercise based on individual factors, HIV induced factors, age and other, and then you add AAS to the mix-well you get the idea. So even this is hard for me to answer with a one size fits all fix since there isn't one. Partly, you have to get VERY tuned into your body and learn what works for you, remembering that most, but not all things will work to some degree for a little while and then you'll need to change your approach, just like with people that are HIV negative and how they need to vary their resistance training to continue to make progress. In this one fact, things are the same but from here they begin to diverge in approach. I think Nelson Vergel along with Michael Mooney have done a great service to the community by putting forth the whole AAS and wasting discussion and by publishing "built to survive" to give some very basic information. Most people, unfortunately, are ignorant of even the most basic of issues so to get them even to point A is really an accomplishment. Also, you can't very well talk about points C, D, and E when your audience has yet to even get to point A either. Realize too, that you can only put so much into print and it is unrealistic that the "whole" story can be put into print because of legalities and liabilies. But that is the world we live in unfortunately. Not all speech is "free." For example, I seriously doubt that I could publish a book on what I know about fina, testosterone, nandrolone decanoate, serostim, Oxandrin, KS, HIV, hormonal resistance, wasting, and how to "put it together" without serious investigation and ramifications from John Ashcroft and his lieutenants at the so called "Department of Justice." Of course there is also the fine line referred to as "practicing medicine without a medical license" as I am NOT a medical doctor. The upside is that the book is probably fairly good for most people with HIV, many of whom can barely muster the energy for a "basic" workout let alone a fairly "hardcore" bodybuilding workout--frankly, even a little bit is LIGHT YEARS beyond not working out at all with HIV disease. And you have to learn how much you are capable of doing in YOUR circumstances and deal with it accordingly as insufficient rest/recovery and overtraining have specific and very negative implications with HIV disease. This, however, does not mean that you should not workout very very hard but you have to take it in perspective. But in the end, you just need to jump in and just "do it" and figure it out as you go rather than sit around contemplating your navel and pondering the "right" answer to come along. In the end, the answers will mostly come with experience and comparing notes with others that have "succeeded" and then taking from it what you can use. It also depends on what your specific short term and longer term goals are as well.
Just to give you a little background on me, I have lifted weights for 29 years, competed in intercollegiate sports in college and after, including rowing, bicycle racing on the velodrome (banked bicycle track) and criteriums and also was trained by a pro fighter in kickboxing. I have served two times around in the military and have two honorable discharges. I was raised blue collar but managed to go to an "Ivy League" University back east during my undergraduate education and paid for my own college without help from family. I have lived with HIV for 19 years since 1984, survived Kaposi's Sarcoma (cancer), was diagnosed with full blown AIDS in 1993, have been told I would not survive more times than I care to count and have even survived high viral loads exceeding 3 million virons per cc of blood that left immunologists asking me, "why are you still alive?" I still work full time and work out a LOT and overall feel I have a pretty decent life and certainly have had an incredibly interesting and productive life inspite of all that has been thrown in my direction. I have also been one of those "very difficult and argumentative patients" that doctors usually dislike but statistically are the ones that seem more likely to survive long term HIV because I take very proactive action and interest in my health at all times. I have fired MANY HIV doctors and am very selective as to whom I will seek advice and scrips from. I have never been afraid to refuse treatment, based on likelihood of treatment actually succeeding vs quality of life issues, even when told that refusing treatment would result in my death. I always look for the logic behind the theory and to see if the pathways and mode of effect seem plausible and reasonable and if the outcome is worth the suffering to get there or if the treatment may actually poison your system or "do you in" even before the problem that you are supposedly trying to "fix" does. I don't take anything at face value but tend to pull it all apart and consider many additional options as well even when most people don't see that other options may even exist. But that is a whole book that could be written and in retrospect, my doctors felt that I ended up calling mostly all the right shots at the time when information was very limited and treatments were nonexistent to very new even though many of the decisions that I made flew in the face of medical thinking at THAT time.
I have followed this thing VERY closely for a VERY long time. It helps that I have a degree in science and I work in a very senior scientific capacity in a non medical field. However, there are many transferable skills from one branch of science to another that are very helpful. Also, I am somewhat of an "extremist" desiring to carry an extremely large amount of buffer lean mass because I am well aware of just how much lean mass I can loose when I get seriously "knocked down" by illness and how hard I have to work for every pound of it, trying to offset the extreme catabolic nature of HIV itself plus the additional problems caused by the HIV medications themselves. So this has always worked for me. Currently, I am 5'11.5" tall, lean and vascular--always in single digits in terms of body fat and around 250 lbs. I am constantly being asked what "show" I am getting ready for as I am so lean all the time. I also carry lots of extra lean mass for the obvious reason that many on this board are interested in as well. So that should give you some idea.
One thing to consider is that not everything that works for me will work for you and vice versa. This seems particularly true with hiv. There are so MANY variables, without a full assessment and background of your situation, it is really hard for me to comment so I will have to go on some basic "food for thought" stuff.
You are correct about lean body mass being "money in the bank" for a rainy day. This is not only one of the fundimental keys for living with this disease long term, but it is also key to having a decent quality of life with HIV. 97% of ALL HIV docs fail to grasp this single point alone. Just keeping viral load under control will NOT ensure your longevity or quality of life. In fact, this disease WILL bite you in the ass when you least expect it if you are so complacent to think that just because your viral load is non detect, you are "OK." You can COUNT on it. Oh, and by the way, a recent study by the American Medical Association (AMA) revealed that fully 25% of all so called HIV practitioners failed to meet even the most basic of published and accepted AMA Guidelines for treatment of HIV disease. Something to think about.
There are also MANY other issues, aside from lean body mass, not well understood. For example, very early on in HIV disease, the digestive tract becomes one of the early casualties. The ability to absorb fat diminishes and the ability to metabolize fat also seems to disappear--this is part of the reason that while certain hiv drugs may cause programmed cellular death of subcutaneous fat cells, the fat that was formerly contained within them still has to go somewhere and gets redistributed rather than metabolized, i.e. part of the lipodystrophy problem--although the actual mechanism for this is not quite this straight forward but will suffice for this discussion. Other ramifications are that for most people with HIV, they can eat a fair amount of fat and probably not absorb hardly ANY of it. This has implications for nutritional deficiencies regarding all of the fat soluble vitamins. Additionally, if you eat too much fat, you will invariably suffer serious gas/bloat and diarhea for the very reason that your system can not process it or absorb it very well or at all so thinking that you now have a fee ticket to eat all the Haagen Daaz that you can stand will leave you with belly cramps and bloat and lots and lots of gas. So you will still need to control fat intake depending on what your system will tolerate which is probably not a whole lot of it.
To be honest, most docs are myopic and only concern themselves with viral loads (mine have been undectectable now for more than seven years) and CD4 counts and a very few other parameters. Most miss the very essence of HIV which is WASTING and also miss the problems that arise relative to screwed up lipids profiles, most notably cholesterol (HDL tends to be very low and LOW total cholesterol is a HALLMARK of the disease) and tryglicerides (which tend to be very high and this also has some implications with lipodystrophy issues). Unfortunately, even if your total cholesterol is low as mine is being around 133 total most of the time, you may still need to be on Lipitor or some other cholesterol controlling medication as I do because my HDL has always sucked (long before I ever did any AAS either) and therefore I run 3 times the risk factor for heart disease without it being controlled strictly. Additionally, none of the lipid controlling medications will control your triglycerides well, but fortunately cold water fish oil seems to take care of this problem quite well and there is even medical literature that supports it (although I have seen enough lab results that I am fairly well convinced). Prescription Carnitor is also a good option to control lipids, and yes you can probably get your insurance to pay up to 3000 mg/day because it also controls cholesterol (although it seems to have even greater value in lipodystrophy issues as well but that isn't what they'll prescribe it for). Over the counter Carnitine has mostly been shown by lab tests to contain little to none of the advertised amount so I wouldn't waste my money or time with them. Go for the pharmaceutical stuff. The other glaring problem that physicians won't address seem to be testosterone replacement therapy. It has been my experience that while the number willing to consider it is improving, it is still probably only limited to the top 1-3% of HIV practitioners. That is aside from being willing to address the medibolic wasting issues that certain AAS seem to be able to address.
Even less is known about the hormonal resistence issues also common to many people with HIV but I along with some microbiologist friends of mine suspect that it has something to do with the "DNA" intereference activity of the NRTI's which make up the backbone of treatment for most all protocols for treating HIV disease. Remember, AZT for example is considered a "DNA Terminator" and it the very fact that it attaches to the end of your DNA strands that is the essence of its anti retro viral effect. This is a characteristic of the whole class, by the way and is not just limited to AZT. The impact of hormonal resistance is that you may find that "normal" testosterone doses may not actually work for you and that higher doses may be needed to get "normal" results, let alone supraphysiological effects (you'll be hard pressed to find ANY doctor that will prescribe supraphysiological doses however, let alone higher than normal even if you have evidence of hormonal resistance). As a ball park, testosterone replacement is given usually in dosages of 100-200 mg every one or two weeks. This is "industry standard" for the few that will even consider prescribing it. In reality, you may find that you do a lot better at 400 mg per week which would be considered on the high end of what is done but some people are, in fact, prescribed this amount. So that should give you some idea. Mostly it is done based on blood tests and clinical observations, i.e. if you show the symptoms of "low testosterone" even though your blood levels show you to be in the normal range, even at the nader, than the physician has the leeway to prescribe more based on his observations/professional medical opinion and that is only possible with VERY enlightened doctors. Most won't even consider it. They will look at blood test results for total and free testosterone ONLY if even that much.
Additionally, it was first denied by the medical and pharmaceutical communtiy but now it is known by them that some HIV drugs, crixivan in particular actually shut down testosterone production. The mechanism is still not known but this has been documented quite clearly in clinical and other settings. For a whole host of other reasons, sooner or later, most people with hiv disease find their testosterone production either shuts down completely or markedly. Once this happens, it normally does not resume no matter how well the virus and disease seem to be under control and at this point, replacement therapy is indicated. Unfortunately most HIV docs are NOT willing to even test for or discuss this issue as it is still somewhat taboo in the medical community and there is a large concern about giving people with HIV testosterone which can encourage them to go out and have sex. That is the weird paradox. However, without testosterone, a male with hiv WILL lose lean body mass and experience wasting even if they have a non dectable viral load over time. It is also a medical fact that once a person looses fifty percent of their "baseline" lean body mass, they will die without any other causes being present. Wasting is one of the top reasons for death with HIV even to this day. Also, it is entirely possible to experience wasting for years and not change body weight as you change body "compostion" based on losing muscle and organ tissue and replacement with fat. The fifty percent rule still applies as only LEAN metabolic body mass matters. The amount you can loose is also less than you may think because water constitutes 50-55% of your TOTAL body weight and lean mass is a percentage of that. Remember also that your skeleton is also "lean mass" but not metabolic mass and you also have to calculate your fat mass based on your body compostion to accurately track this.
You should also be aware that you mentioned that you are on Sustiva AND an anti-depressant. Sustiva is KNOWN to cause severe clinical depression in HIV patients and has resulted in numerous people committing suicide. I know of several cases specfically. Why is your doc maintaining you on this drug if you have symptoms of depression and from the sound of your medications and proposed changes, your depression remains unresolved by having you on an antidepressant? It would be far easier to change you to Viramune and acclimate you to it then keep you on Sustiva. The Viramune is in the same class and if acclimated properly, you should be able to avoid the sometimes fatal Stevens-Johnson symdrome that MAY appear with it (the whole body skin rash which marks the severe allergic reaction that some have to it). Some docs actually use prednisone for a month to suppress your tendency towards allergic reactions while increasing the dose from half dose for two weeks to full dose for two weeks and then withdrawal from prednisone. Just a thought. Other HIV drugs have also been shown to cause/contribute to depression as well. Been there done that too.
Now for the down and dirty. I don't know enough about your experience, length of time weight training, use of supplements, etc. However, I would break your workout up differently and do all back and biceps on the same day instead of having dumbbell row on the same day you do bench or push downs or dumbbell shoulder presses (chest/triceps/shoulders) since you obviously are doing a "split" along the lines of chest/shoulders/triceps on Monday, back/biceps/abs on Wednesday and legs on Friday. I also don't know how long you have been doing this specific routine.
As for question 1: All sets go to failure except warm up sets. Failure being defined as that point where you can no longer lift the weight "in good form"...in other words, you start cheating to finish the rep. Of course this is simplistic because there are many techniques to push failure on out to make it tougher.
As for question 2: All three options will work. None is better or worse than another just different. You should always be trying to make thing "different" to vary your workouts rather than do exactly the same rote thing each time you are in the gym.
As for question 3: Depends on how "you feel"... a half an hour is plenty for some not enough for others. It also depends on how you train and your goals so it MAY be enough but might not be.
As for your meds question: I don't see anything in there to treat lipid problems...have you had this thoroughly broken down, not just total cholesterol? Include a test for tryglycerides. It is hard to imagine that you do not have lipid problems with some of the drugs you are on. As for Sustiva, I discussed above already--try Viramune, may help alleviate your depression which is likely a result or contributed to by Sustiva. I also don't see blood pressure medication how is yours? I also don't see testosterone. Are you on nandrolone decanoate and NOT testosterone replacement? have your free and total testosterone levels been checked? 200 mg deca/week is ok but you may want to consider something more like 10-12 weeks on and 8 weeks off. Also all cycles should stack ON TOP OF testosterone and in case of HIV, it is likely that you should permanently be on replacement levels and cycle on/off above theraputic levels treating the replacement as your "normal" testosterone since most people with HIV produce little or none and I suspect yours would be low anyway because you are doing AAS. By the way, if your doctor THINKS that Androgel is acceptable for testosterone replacement, I have seen MANY lab tests that say otherwise. The amount absorbed through the skin is so small for most people as to be virtually worthless. Use parenteral only (injectible testosterone) for replacement. Has your doc checked the results of Androgel with you to see if it even makes your blood levels come into the normal range? And low normal does NOT cut it with HIV disease. Why doesn't your doc prescribe oxandrin at 20 mg/day instead of you having to buy dbol as I KNOW he doesn't prescribe THAT. Might save you some money and it would be legal as it is approved at that dosage for anti wasting therapy. You could then get a standing scrip and "cycle" eventually working up to 40 mg/day for eight or ten weeks on and eight or ten weeks off (by using it half the time but filling the scrip EVERY MONTH, you can save up during your off cycle to get enough for you cycle--a doc can not precribe it in a "cyclical way" as it then "appears" to the state medical licensing board to "NOT BE prescribed theraputically so he/she is better off writing a standing scrip for it just for your information.).
So hope that helps. It is a lot to digest.
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