Take a Second Look at HIV-associated Wasting

About HIV-associated Wasting

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HIV-associated wasting, or cachexia, is a condition of abnormal metabolism resulting in1,2:

  • Involuntary weight loss
  • Inappropriate loss of lean body mass (LBM)
  • Decreased physical endurance

HIV-associated wasting is characterized by abnormalities in the way the body uses carbohydrates, fats, and proteins to meet energy and tissue-building needs, which result in involuntary weight loss, loss of LBM, and decreased physical endurance.1,2-6

The exact pathophysiology of HIV-associated wasting is not definitively understood. Possible causes include 2-4,7-9,18:

  • Proinflammatory cytokines
  • Disruptions in the growth hormone (GH)/insulin-like growth factor-1 (IGF-1) axis
  • Low hormone levels (ie, testosterone)
  • Elevated resting energy expenditure (REE)
 

Prevalence

HIV-associated wasting—which involves involuntary weight loss or loss of lean body mass (LBM)—can affect anyone with HIV.10-12

analyses document the diagnosis or evidence of HIV-associated wasting or cachexia

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Impact of HIV-associated Wasting on Patients

HIV-associated wasting is more than weight loss. When HIV-associated wasting develops, the impact on patients can be serious.

  • Individuals with HIV-associated wasting lose weight without trying1-3
  • HIV-associated wasting depletes the body of lean body mass, including muscle1-3
  • Patients with HIV-associated wasting may have less physical endurance1-3
  • HIV-associated wasting can be a serious medical problem1-3

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Abnormal Metabolism

HIV-associated wasting is a condition of abnormal metabolism. The way the body uses carbohydrates, fats, and proteins to meet energy and tissue-building needs is altered. This results in1,3-6:

  • Involuntary weight loss
  • Loss of lean body mass
  • Decreased physical endurance

Elements of the body that play a role1

  • Skeletal muscle
  • Organ tissue
  • Blood and blood constituents
  • Intracellular and extracellular water

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Elements of the body that play a role

 

Contributors

The etiology of HIV-associated wasting is not definitely understood. It is known that HIV disrupts the anabolic/catabolic process, but the exact pathophysiology of HIV-associated wasting is unknown.5,15,16 The mechanisms of HIV-associated wasting are multifactorial.2,4,7

  • HIV-associated wasting may be linked to growth hormone (GH) resistance, known as acquired GH resistance or acquired insulin-like growth factor (IGF)-1 resistance9,17,18
  • It is thought that HIV-associated wasting may be linked to the signaling of several related circulating molecules, including tumor necrosis factor (TNF)-α, GH, IGF-1, and testosterone2,5,7,9,17,18
  • HIV-associated wasting can occur even in patients with higher CD4 counts and lower viral loads11

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Some factors associated with metabolism and/or reduced caloric intake may be potentially important individually, or collectively, in triggering weight loss/HIV-associated wasting4,19-21

Elements of the body that play a role

  • HIV-Associated Wasting Pathophysiology:
    A Video Presentation for Physicians
  • Watch video
  • Total Time: 17:34
 

Learn about treating HIV-associated wasting

Access the full prescribing information.


References:

  1. Serostim® [somatropin (rDNA origin) for injection] Prescribing Information. Rockland, MA: EMD Serono, Inc.; 2007.
  2. Dudgeon WD, Phillips KD, Carson JA, et al. Counteracting muscle wasting in HIV-infected individuals. HIV Med. 2006;7:299-310.
  3. Castaneda C. Muscle wasting and protein metabolism. J Anim Sci. 2002;80(suppl):E98-E105.
  4. Roubenoff R, Grinspoon S, Skolnik PR, et al. Role of cytokines and testosterone in regulating lean body mass and resting energy expenditure in HIV-infected men. Am J Physiol Endocrinol Metab. 2002;283:E138-E145.
  5. Lutz NW, Yahi N, Fantini J, et al. Perturbations of glucose metabolism associated with HIV infection in human intestinal epithelial cells: a multinuclear magnetic resonance spectroscopy study. AIDS. 1997;11:147-155.
  6. Frost RA, Lang CH, Gelato MC. Transient exposure of human myoblasts to tumor necrosis factor-α inhibits serum and insulin-like growth factor-I stimulated protein synthesis. Endocrinology. 1997;138:4153-4159.
  7. Grinspoon S, Corcoran C, Stanley T, et al. Effects of androgen administration on the growth hormone-insulin-like growth factor I axis in men with acquired immunodeficiency syndrome wasting. J Clin Endocrinol Metab.1998;83:4251-4256.
  8. Morley JE, Thomas DR, Wilson MG. Cachexia: pathophysiology and clinical relevance. Am J Clin Nutr. 2006;83:735-743.
  9. Jain S, Golde DW, Bailey R, et al. Insulin like growth factor-I resistance. Endocr Rev.1998;19:625-646.
  10. Gelato M, McNurlan M, Freedland E. Role of recombinant human growth hormone in HIV-associated wasting and cachexia: pathophysiology and rationale for treatment. Clin Ther. 2007;29:2269-2288.
  11. Tang AM, Jacobson DL, Spiegelman D, et al. Increasing risk of 5% or greater unintentional weight loss in a cohort of HIV-infected patients, 1995 to 2003. J Acquir Immun Defic Syndr. 2005;40:70-76.
  12. Wanke CA, Silva M, Knox TA, et al. Weight loss and wasting remain common complications in individuals infected with human immunodeficiency virus in the era of highly active antiretroviral therapy. Clin Infect Dis. 2000;31:803-805.
  13. Siddiqui J, Phillips AL, Freedland ES, et al. Prevalence and cost of HIV-associated weight loss in a managed care population. Curr Med Res Opin. 2009;25:1307-1317.
  14. Boulanger L, Miller JD, MacEachern L, et al. Prevalence of cachexia (wasting syndrome) diagnosis and treatment among patients with HIV/AIDS: a medical claims database analysis. Poster presented at: 12th International Society for Pharmacoeconomics and Outcomes Research; May 19-23, 2007; Arlington VA.
  15. Maagaard A, Kvale D. Mitochondrial toxicity in HIV-infected patients both off and on antiretroviral treatment: a continuum or distinct underlying mechanisms? J Antimicrob Chemother. 2009;64:901-909.
  16. Casula M, Bosboom-Dobbelaer I, Smolders K, et al. Infection with HIV-1 induces a decrease in mtDNA. J Infect Dis. 2005;191:1468-1471.
  17. Lieberman SA, Butterfield GE, Harrison D, et al. Anabolic effects of recombinant insulin-like growth factor-I in cachectic patients with the acquired immunodeficiency syndrome. J Clin Endocrinol Metab. 1994;78:404-410.
  18. Frost RA, Lang CH. Alteration of somatotropic function by proinflammatory cytokines. J Anim Sci. 2004;82:E100-E109.
  19. 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 for Healthy Living Cohort. Clin Infect Dis. 2006;42:836-842.
  20. Kulstad R, Schoeller DA. The energetics of wasting diseases. Curr Opin Clin Nutr Metab Care. 2007;10:488-493.
  21. Macallan DC, Noble C, Baldwin C, et al. Energy expenditure and wasting in human immunodeficiency virus infection. N Engl J Med. 1995;333:83-88.
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Important Risk Information and Indication Toggle Button

Important Risk Information

Serostim® [somatropin (rDNA origin) for injection] should not be used in patients with active malignancy, diabetic retinopathy, known hypersensitivity to somatropin or diluent, or hospitalized for acute critical illness.1

Impaired glucose tolerance, new and exacerbation of diabetes mellitus and rare cases of pancreatitis have been reported. Glucose intolerance requiring initiation or adjustment of antidiabetic treatment has persisted following treatment discontinuation. Patients with risk factors for glucose intolerance should be monitored closely during Serostim® therapy.1

The most common adverse reactions associated with Serostim® use were musculoskeletal discomfort (pain, swelling and/or stiffness) and increased tissue turgor (swelling, particularly in the hands and feet). Symptoms were dose-related and generally mild-to-moderate in severity, and often subsided with continued treatment, analgesic therapy, or dose reduction. If persistent tissue turgor occurs, treatment discontinuation is recommended.1

Alternate-day treatment is associated with fewer side effects and resulted in a similar improvement in work output and should be considered in patients at increased risk of adverse events.2

Hyperglycemia may occur in HIV-infected individuals for a variety of reasons and has also been reported in Serostim® clinical trials. Patients with a history of hyperglycemia or other risk factors for glucose intolerance should be monitored closely during Serostim® use. Glucose complications include exacerbation of pre-existing diabetes mellitus, new-onset impaired glucose tolerance, and type 2 diabetes mellitus.1

  1. Serostim® [somatropin (rDNA origin) for injection] Prescribing Information. Rockland, MA: EMD Serono; 2007.
  2. 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;35:367-375.

Indication

Serostim® [somatropin (rDNA origin) for injection] is indicated for the treatment of HIV patients with wasting or cachexia to increase lean body mass and body weight, and improve physical endurance. Concomitant antiretroviral therapy is necessary.

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