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Adjunctive
Treatments and Interventions
Progressive
Resistance Exercise (PRE)
A number of
studies have examined the benefits of progressive resistance exercise
(PRE) in patients with HIV infection.53-56
In these studies, patients participated in six or eight-week programs
consisting of progressive resistance training three-times-a-week.
Participants experienced increased muscle function and strength
in their arms and legs, as well as increased weight and lean body
mass. These studies suggest that supervised progressive resistance
exercise and fitness training have a positive influence by increasing
lean body mass and muscle strength.
Nutritional
Supplements
Regardless
of the treatment selected for HIV-associated wasting, all patients
should maintain appropriate caloric intake. High-calorie, nutrient-dense
foods in the form of supplements may assist with this purpose. Enteral
feedings should be reserved for patients with mechanical obstructions
who have intact gut function. Such feedings have been shown to increase
total body potassium, an index of body cell mass.57
Total parenteral nutrition (TPN) is rarely used today in patients
with HIV infection. Patients with evidence of malabsorption in the
form of intractable vomiting or diarrhea, however, may be candidates
for TPN. Those patients with malabsorption alone may respond more
favorably to TPN than those patients who have active secondary illness.58,59
Cytokine
Modulation
Cytokine modulators,
specifically thalidomide and pentoxifylline, have been studied for
the treatment of HIV-associated wasting. The role of inflammatory
cytokines in wasting is not completely known. It has been hypothesized
that the increased production of cytokines, such as tumor necrosis
factor (TNF), may result in increased energy expenditure and wasting.60
Three studies of thalidomide in patients with and without wasting
have shown increases in body cell mass and extracellular fluid,
and decreases in urinary nitrogen excretion.61,62
Half the weight gain was fat-free mass as measured by BIA. The most
recent study of thalidomide in patients with wasting demonstrated
significant weight gain with doses of 100 mg or 200 mg/day after
8 weeks.63 Neither thalidomide nor pentoxifylline
has been approved for the treatment of HIV-associated wasting.
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