• A variety of adjunctive treatments and interventions have been used to improve weight gain and increase lean body mass in patients with HIV-infection.1-11

• Several studies have investigated the use of progressive resistance exercise.1-5 In these studies, patients participated in 6-or 8-week programs consisting of progressive resistance training 3-times-a-week. Increased muscle function and strength in arms and legs, as well as increases in weight and lean body mass were noted.

• Nutritional supplements may be used to improve nutritional intake.6-8 These include protein bars, drinks, enteral nutrition, and total parenteral nutrition. Enteral feedings should only be reserved for patients with mechanical obstructions who have intact gut function.6 Total parenteral nutrition (TPN) is rarely used today in these patients. However, patients with evidence of malabsorption, such as intractable vomiting or diarrhea, may benefit from TPN.7,8

• Cytokine modulators, such as thalidomide and pentoxifylline, have also been studied as treatments for HIV-associated wasting.9-11 Increased production of cytokines, such as tumor necrosis factor, may result in increased energy expenditure and wasting.9 Two studies of thalidomide in patients with and without wasting have shown increases in body cell mass and extracellular fluid, as well as decreases in urinary nitrogen excretion.10,11 Cytokine modulators are not approved therapies for HIV-associated wasting, and remain experimental.

References:

1. Bhasin S, Storer TW, Javanbakht M et al. Testosterone replacement and resistance exercise in HIV-infected men with weight loss and low testosterone levels. JAMA. 2000;283:763-70.

2. Spence DW, Galantino ML, Mossberg KA et al. Progressive resistance exercise effect on muscle function and anthropometry of a select AIDS population. Arch Phys Med Rehabil. 1990;71:644-8.

3. Roubenoff R, McDermott A, Wood M et al. Feasibility of increasing lean body mass in HIV-infected adults using progressive resistance training. Program and abstracts of the 12th World AIDS Conference, Geneva, Switzerland; June 28-July 3, 1998. Abstract 42357.

4. Rigsby LW, Dishman RK, Jackson AW et al. Effects of exercise training on men seropositive for human immunodeficiency virus-1. Med Sci Sports Exerc. 1992;24:6-12.

5. Grinspoon S, Corcoran C, Parlman K et al. Effects of testosterone and progressive resistance training in eugonadal men with AIDS wasting. A randomized, controlled trial. Ann Intern Med. 2000;133:348-55.

6. Kotler DP, Tierney AR, Ferrarao R et al. Enteral alimentation and repletion of body cell mass in malnourished patients with acquired immunodeficiency syndrome. Am J Clin Nutr. 1991;53;149-54.

7. Melchlor J, Chasstang C, Gelas P. Efficacy of 2-month total parenteral nutrition in AIDS patients: a controlled randomized prospective trial. AIDS. 1996;10:379-84.

8. Kotler DP, Tierney AR, Culpepper-Morgan JA et al. Effects of home total parenteral nutrition on body composition in patients with acquired immunodeficiency syndrome. JPEN J Parenter Enteral Nutr. 1990;14:454-8.

9. Grunfeld C, Feingold KR. Metabolic disturbances and wasting in the acquired immunodeficiency syndrome. N Engl J Med. 1992;327:329-37.

10. Haslett P, Hempstead M, Seidman C et al. The metabolic and immunologic effects of short-term thalidomide treatment of patients infected with the human immunodeficiency virus. AIDS Res Hum Retroviruses. 1997;13:1047-54.

11. Reyes-Teran G, Sierra-Madero JG, Martinez del Cerro V et al. Effects of thalidomide on HIV-associated wasting syndrome: a randomized, double-blind, placebo-controlled clinical trial. AIDS. 1996;10:1501-7