• Patients suffering from HIV wasting can be treated with a variety of interventions and therapies.1 The goals are to improve nutritional intake and to address changes in body composition.

• All patients should receive in-depth assessment and counseling by a registered dietitian or nutritionist. If anorexia is present, appetite can be stimulated by prescribing either dronabinol or megestrol acetate. Identifiable infections of the GI tract, such as cytomegalovirus, should be treated immediately in order to reduce malabsorption.

• Changes in body composition can be addressed by treating HIV infection, as well as any opportunistic infections, fever, or malignancies. Replacement testosterone therapy is helpful in men with HIV wasting and androgen deficiency. Anabolic steroids, such as nandrolone, may be useful in men with HIV wasting who do not have hypogonadism. Recombinant human growth hormone is useful for reducing nitrogen loss and building lean body mass in some patients.

• Exercise, consisting of progressive resistance and fitness training, may also be helpful if it is properly supervised. Insufficient data exist, however, to recommend it routinely.

• Finally, cytokine regulation has been attempted with the use of thalidomide and other agents, although such approaches should be considered experimental.

Reference:

1. Nemechek PM, Polsky B, Gottlieb MS. Treatment guidelines for HIV-associated wasting. Mayo Clin Proc. 2000;75:386-94.