• A variety of appetite stimulants may be used to improve appetite in patients who have inadequate caloric intake.1 While effective in helping patients gain fat, they produce only limited gains in lean body mass. As such, the clinician should not rely on these agents as the only intervention for patients with HIV-associated wasting.

• Dronabinol is effective at reducing nausea and increasing appetite.2,3 Its major drawback is its potential to induce central nervous system events, such as anxiety, confusion, emotional lability, and hallucinations.

• Megestrol acetate also improves appetite. It can produce significant increases in body weight, mostly in the form of fat.4,5

• Cyproheptadine hydrochloride also stimulates appetite. Only moderate increases in weight are achieved when it is used in these patients.6

References:

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

2. Beal JE, Olson R, Laubenstein L et al. Dronabinol as a treatment for anorexia associated with weight loss in patients with AIDS. J Pain Symptom Manage. 1995;10:89-97.

3. Timpone JG, Wright DJ, Li N et al. The safety and pharmacokinetics of single-agent and combination therapy with megestrol acetate and dronabinol for the treatment of HIV wasting syndrome. AIDS Res Hum Retroviruses. 1997;13:305-15.

4. Von Roenn JH, Murphy RL, Weber KM et al. Megestrol acetate for treatment of cachexia associated with human immunodeficiency virus (HIV) infection. Ann Intern Med. 1988;109:840-1.

5. Oster MH, Enders SR, Samuels SJ et al. Megesterol acetate in patients with AIDS and cachexia. Ann Intern Med. 1994;121:400-8.

6. Summerbell CD, Youle M et al. Megestrol acetate vs cyprohepatidine in the treatment of weight loss associated with HIV infection. Int J STD AIDS. 1992;3:278-80.