Potential Interventions for HIV/AIDS Wasting: Overview
Donald I. Abrams, M.D.
Prior to the current era of highly active antiretroviral therapies (HAART), the wasting syndrome was a frequent late-stage manifestation of advanced HIV infection. The etiology of wasting was felt to be multifactorial. Attempts to reverse the syndrome with nutritional or single pharmacologic interventions were generally unsatisfactory. Just as potential progress in the treatment of weight loss from the use of combined modalities of therapy was about to become realized, the AIDS wasting syndrome all but disappeared with the advent of HAART. Now, after 3 years of widespread use of protease-inhibitor-containing regimens, another constellation of alterations in body composition is presenting patients and providers with a new set of therapeutic challenges. Again, a multipronged approach to therapy will likely be required.
Numerous approaches to HIV-associated weight loss have been attempted. Prevention is always a desirable goal. A recent CPCRA trial demonstrated no effect of dietary supplements in forestalling weight loss in at-risk patients. Appetite stimulants (megestrol acetate and dronabinol) have been approved for treatment of HIV-associated anorexia and weight loss, but both are associated with some untoward side effects. Smoked marijuana has become a popular alternative in some regions. Anabolic agents such as testosterone, anabolic steroids, and recombinant human growth hormone may improve weight loss alone or in combination with appetite stimulants or resistance exercise. Inhibitors of tumor necrosis factor alpha, such as thalidomide, are also being investigated and show some promise as therapy, with combination regimens currently under evaluation.
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