HIV Wasting:
Management and Treatment Algorithm

General Patient Management /Assessment:
Adjust ART regimen
Treat OIs and malignancies
Address psychosocial problems
Obtain nutritional counseling
Treat anorexia with appetite
stimulants
If patient is testosterone normal:
Begin 12-week course of GH therapy
Document response to therapy by:
- Obtaining serial body weights
- Calculating BCM
If patient is testosterone deficient:
Begin natural testosterone replacement therapy
After 4-weeks:
- Reassess patient for increases in BCM
- Obtain serum total and free testosterone
If BCM normalizes:
Stop GH therapy
Observe patient for 8-week period
Monitor BW, BCM, and for symptoms of wasting
If wasting reappears after 8 weeks: Restart GH therapy
If BCM continues to decline: Begin GH therapy
If BCM stabilizes: Monitor BW, BCM, and for symptoms of wasting


• This is a management and treatment algorithm for HIV-associated wasting.1

• As discussed earlier, initial concurrent management begins with the application of five general principles designed to correct any underlying conditions.

• If wasting still exists, testosterone replacement therapy is recommended in those patients who are deficient. Should body cell mass continue to decline after 4 weeks of therapy, treatment with growth hormone is indicated.

• Patients with wasting who have normal testosterone levels can begin growth hormone therapy for a period of 12 weeks. Once body cell mass normalizes, therapy can be stopped and the patient observed for 8 weeks. If wasting reappears, growth hormone therapy can then be re-initiated.

Reference:

1. Treatment Guidelines for HIV-Associated Wasting, Consensus Development Panel Meeting, July 26, 2000, New York, NY.