Management of HIV-related bodyweight loss

Use of Dronabinol Improves Appetite and Reverses Weight Loss in HIV/AIDS-Infected Patients

Objective: To determine whether dronabinol affects appetite and weight status in patients living with HIV/AIDS. Methods: A retrospective chart review was conducted to analyze weight and appetite changes and nausea status in patients with HIV/AIDS who received dronabinol for 3 to 12 months from January 11, 1993, to March 17, 2003. Results: Of the 117 patients who lost weight before baseline, 63% maintained or gained weight. In patients receiving dronabinol for 1 year, the mean weight gain (± SD) was 3.7 ± 10.6 lb. The percentage of patients experiencing loss of appetite decreased significantly from 71% at baseline to 26% at 1 month (P < .001) and continued to decline throughout the trial. The percentage of patients experiencing nausea at baseline (38%) decreased consistently from week 2 on; this change from baseline was significant at month 6 (P = .031). Conclusion: When taken for 3 months to 1 year, dronabinol significantly improves appetite and reverses weight loss in patients living with HIV/AIDS.

Effect of exercise and strength training on cardiovascular status in HIV-infected patients receiving highly active antiretroviral therapy

A routine evaluation of lipid metabolism and body fat distribution along with a careful cardiovascular risk stratification according to international guidelines are required for HIV-infected patients receiving highly active antiretroviral therapy. Intervention includes evaluation of patients for both epidemiological and clinical factors, and for anthropometric and biochemical parameters. Diet counseling, prescription of antihyperlipidemic drugs and exercise training are the cornerstones of programs devoted to protecting patients from side effects of therapies that compromise quality of life and the functions of organs like the pancreas and heart that are involved in lipid disorders.

Endotoxin-induced changes in food consumption in healthy volunteers are associated with TNF-alpha and IL-6 secretion

This study examined the effects of endotoxin administration on food and water consumption in humans, and the associations between these changes and endotoxin-induced secretion of cytokines, cortisol, and fever. Twenty healthy male volunteers received an i.v. injection of Salmonella abortus equi endotoxin (0.8 ng/kg) or saline in two experimental sessions. Blood samples were collected hourly, and rectal temperature was monitored continuously. Food consumption was significantly reduced at 0-4 h and significantly elevated at 4-5 h after the endotoxin injection. Endotoxin administration had no significant effect on water consumption. Endotoxin-induced secretion of TNF-alpha and IL-6 was positively associated with the decrease in food consumption (r=0.61 and 0.68), and negatively associated with the rebound increase in food consumption (r=-0.53 and -0.45). Neither the febrile response, nor the secretion of cortisol was associated with the changes in food consumption. These results suggest that TNF-alpha and IL-6 are involved in endotoxin-induced anorexia in humans.

Weight gain associated with protease inhibitor therapy in HIV-infected patients

Weight loss and wasting are significant complications of HIV disease. HIV protease inhibitor therapy promotes clinical, immunologic and virologic improvement in HIV-infected patients. In this study, we sought to determine the specific effect of HIV protease inhibitors on patient weight. Ten consecutive HIV patients were treated with protease inhibitor-containing regimens over six months. CD4 T-cell counts, plasma viral load levels and bariatric changes were monitored during the study. Patients experienced a mean weight gain of 19 Pounds (P = 0.006). There was a significant increase in mean CD4 T-cell count (P = 0.008) and a significant decrease in mean viral load level (P = 0.004). The increase in CD4 T cells did not correlate with weight gain, whereas the decrease in viral load did show a significant correlation with the weight increase (P = 0.003). The mechanism of protease inhibitor-induced weight gain is discussed. The medications may also be useful for wasting diseases unrelated to HIV.