What treatment options are available for your patients?
With multiple factors involved in the cause of HIV-associated wasting, multiple treatment options have been proposed and studied
The precise causes of HIV-associated wasting are not well known and vary among individuals. However, a growing body of evidence suggests that many factors may contribute to HIV-associated wasting. Because the causes and presentations of HIV-associated wasting are multifactorial, different treatment options may be indicated for different symptoms. The decision to prescribe a pharmacological treatment must be made in full consideration of the potential risks and benefits to each individual patient.1-5
- Nutritional deficiencies may arise in HIV-infected patients1,6
- Nutritional supplements may play a role in boosting caloric intake, but must be taken regularly in order to maintain results4
- HIV-infected patients may have reduced caloric intake1,6
- Appetite stimulants may stimulate a patient's appetite, but do not always address nutritional deficiencies as patients may not choose to consume nutrition-rich foods
- Some stimulants may have a greater effect on fat than on muscle4,5
- Some testosterone therapies have been shown to increase lean body mass in patients with HIV-associated wasting, but not all formulations of therapy are equally effective4,7,8
- It is recommended that patients receiving testosterone therapy undergo annual prostate examinations along with additional monitoring depending on formulation4,8
- FDA-approved anabolic steroids may help increase weight2,4
- Anabolic steroids should be used with caution in HIV-infected patients and appropriate monitoring should be conducted.4,7
- FDA-approved growth hormone has been shown to increase both weight and physical endurance while decreasing fat in patients with HIV-associated wasting4,9
- Treatment administration requires daily subcutaneous injection by patients or caregivers and appropriate monitoring should be conducted6
- Progressive resistance training exercises can help develop lean body mass1,4
- Not all patients have access to proper equipment or training
Proper nutrition and exercise are essential for treating HIV-associated wasting. Encourage your patients to speak with you about creating an effective exercise routine and diet program.
- Resistance training exercises have been shown to increase LBM and muscular strength, but patients need proper equipment and training1
- Light to moderate exercise is safe for people living with HIV1
- Exercises that may benefit your patients include
- Aerobic: swimming, cycling, walking
- Strength training
- Flexibility training
- Nutritional counseling has been shown to increase caloric intake in patients1
- Giving patients supplemental high-calorie drinks, working with them to create a plan for balancing their diet, and targeting specific dietary deficiencies may help patients gain weight10
Learn more about a specific treatment option for HIV-associated wastingLearn More
- Dudgeon WD, Phillips KD, Carson JA, Brewer JA, Durstine JL, Hand GA. Counteracting muscle wasting in HIV-infected individuals. HIV Med. 2006;7(5):299-310.
- Mangili A, Murman DH, Zampini AM, Wanke CA. Nutrition and HIV infection: review of weight loss and wasting in the era of highly active antiretroviral therapy from the nutrition in healthy living cohort. Clin Infec Dis. 2006;42(6):836-842.
- Gelato M, McNurlan M, Freedland E. Role of recombinant human growth hormone and HIV-associated wasting and cachexia: pathophysiology and rationale for treatment. Clin Ther. 2007;29(11):2269-2288.
- Grinspoon S, Mulligan K; for the Department of Health and Human Services Working Group on the Prevention and Treatment of Wasting and Weight Loss. Weight loss and wasting in patients infected with human immunodeficiency virus. Clin Infec Dis. 2003;36(Suppl 2):S69-S78.
- Badowski ME, Perez SE. Clinical utility of dronabinol in the treatment of weight loss associated with HIV and AIDS. HIV AIDS (Auckl). 2016;8:37-45.
- Wasserman P, Segal-Maurer S, Wehbeh W, Rubin DS. Wasting disease, chronic immune activation, and inflammation in the HIV-infected patient. Top Clin Nutr. 2011;26(1):14-28.
- Ashby J, Goldmeier D, Sadeghi-Nejad H. Hypogonadism in human immunodeficiency virus-positive men. Korean J Urol. 2014;55:9-16.
- Bhasin S, Brito JP, Cunningham GR, et al. Testosterone therapy in men with hypogonadism: an Endocrine Society* clinical practice guideline. J Clin Endocrinol Metab. 2018;103(5):1715-1744.
- Moyle GJ, Daar ES, Gertner JM, et al. Growth hormone improves lean body mass, physical performance, and quality of life in subjects with HIV-associated weight loss or wasting on highly active antiretroviral therapy. J Acquir Immune Defic Syndr. 2004;35(4):367-375.
- de Pee S, Semba RD. Role of nutrition in HIV infection: review of evidence for more effective programming in resource-limited settings. Food Nutr Bull. 2010;31(4):S313-S344.