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Dealing with Wasting in HIV Disease

Posted Aug 24 2008 1:49pm
ANNOUNCER: People with HIV and AIDS can experience a wide variety of changes in their bodies. Sometimes it's an unusual redistribution of fat in conditions known as lipodystrophy and lipoatrophy, which are linked to certain anti-HIV drugs. People with HIV also can lose fat, and even lean body mass, because they are unable to take in enough calories.

This can happen when the disease is well controlled. Or, it can be a consequence of opportunistic infections, when the disease has progressed.

DONALD KOTLER, MD: An example would be somebody whose immune function has deteriorated, and then develops a yeast infection in the mouth or the esophagus, so that people have pain when they swallow, and under those circumstances eat less. Or, someone develops a parasitic infection; they will not have a good immune response and clear the infection, so that intestinal damage may occur and there will be malabsorption.

ANNOUNCER: Doctors will treat the infection, and often prescribe protein-rich food, and exercise. Additionally, there may be some may benefit from medicines that improve the appetite.

DONALD KOTLER, MD: There are two types of appetite stimulants that are used, one that's related to the female sex hormone progesterone, which has a side effect of stimulating appetite. It's called Megace. The other major form of appetite stimulant is one that's related to marijuana. It's a cannabinoid. It's called Marinol.

ANNOUNCER: Sometimes a person who is ill primarily experiences the loss of lean body mass, a condition known as "wasting" or cachexia.

DONALD KOTLER, MD: It is a response to injury, not to lack of food. And a similar process occurs whether you have cancer, or bad trauma. Even a heart attack. Anything that has caused tissue damage in the body. The body's job under those circumstances is to clear the damage and repair it. In order to get the energy, in order to get the amino acids, the building blocks for this response. You get muscle wasting.

BRUCE POLSKY, MD: In many cases, the patients will have low amounts of testosterone, lower than they should have, which is a part of HIV disease as well. Those are patients that we will try to replace their testosterone to make them at normal levels.

ANNOUNCER: Testosterone, and anabolic steroids, which can have similar properties, can build up lost muscle.

DONALD KOTLER, MD: The use of testosterone or anabolic agents makes a lot of sense. And whether they are testosterone or its various compounds that are either injected, taken as pills or as a cream or as a patch, or the anabolic steroids, like nandrolone or oxandrolone. Or things like DHEA, which are the precursor chemicals that you could buy at a nutrition store. They all tend to lead to an increase in muscle mass.

ANNOUNCER: Testosterone in normal doses is generally well tolerated. But high doses of anabolic steroids, including testosterone, can bring about significant side effects.

DONALD KOTLER, MD: The major side effect of testosterone in its high dose is psychological. You've heard of steroid rage; it's sort of an over-aggressiveness.

ANNOUNCER: Another drug, growth hormone, can be helpful in patients whose testosterone is normal, whose cachexia continues with testosterone treatment, and for women. It can lead to significant weight gain and replenishes lean body mass.

BRUCE POLSKY, MD: What growth hormone does is alter the metabolism, and it causes the body to burn fat preferentially and at the same time retain nitrogen. Nitrogen is an important part of amino acids, which are the building blocks of protein, and therefore the building blocks of muscle and lean body mass.

ANNOUNCER: One human growth hormone produced by recombinant DNA technology, called Serostim®, is approved for the treatment of HIV wasting.

It may not be appropriate in patients who have diabetes or pre-diabetic conditions.

BRUCE POLSKY, MD: It's actually pretty well tolerated, but there are several side effects that are worth noting. The most prominent one is a recruitment of fluid, of water, into the subcutaneous tissues that can result in joint stiffness. It often will go away in time.

Growth hormone not only stimulates muscle mass and loss of fat, it also stimulates the cartilage, tendons, to grow. When you do that in an adult that is fully developed and has no more skeleton to develop, you may get these sorts of effects, which can be uncomfortable. They can be controlled by lowering the dose, or as I said, they often disappear on their own with time.

ANNOUNCER: There's some debate about how common serious weight loss and cachexia are among people with HIV, especially when the disease is under control. But when problems do occur, doctors say they can treat the cause effectively, and help speed recovery.

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