Take a Second Look at HIV-associated Wasting

Treating HIV-associated Wasting

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It’s important to set treatment goals for your patients with HIV-associated wasting. Possible treatment goals may include:

  • Resolve underlying issues that may be contributing to weight loss
  • Increase appetite
  • Increase body weight
  • Increase lean body mass
  • Improve patient-reported outcomes relating to symptoms of HIV-associated wasting

Along with treatment, appropriate nutrition and exercise can all play an important role in managing the health of your patients.

 

Nutrition

Nutrition-related complications for HIV positive individuals can include5-7:

  • HIV’s effect on metabolism, nutritional levels, and energy balance
  • Vitamin and mineral deficiencies
  • Weight gain and loss
  • Glucose metabolism disorders
  • Dyslipidemia
  • Hypertension
  • Renal disorders
  • Fatty liver disease
  • Bone disorders

Suggested guidelines for medical nutritional assessment from the American Dietetic Association5

  • Clinical symptoms
  • Body measurements
  • Lab data, including protein levels, micronutrient levels, and other nutrition-related measurements
  • Medical and nutritional patient history
  • Dietitian
  • Watch video
  • Introduction: 03:16
  • Nutrition-Related Complications: 07:53
  • Factors to Consider: 06:05
  • Nutrition, Exercise, and Lifestyle: 31:44
  • Medical Nutrition Therapy: 12:31
  • Total Time: 01:01:48

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Exercise

According to one source, regular physical activity can play an important role in improving a patient’s health.8

Physical activity is generally meant to include aerobic or anaerobic exercise, including8:

  • Jogging
  • Swimming
  • Weight lifting
  • Yoga
  • Pilates

Exercise assessment may include8:

  • Types of activity
  • Frequency
  • Duration
  • Intensity

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Pharmacologic Options

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.1

Information based on FDA-approved prescribing indications (not head-to-head studies). No conclusions regarding comparative safety or efficacy between products can be drawn from comparisons of this prescribing information.

Megace® (megestrol acetate) Prescribing Information. Par Pharmaceutical Companies, Inc., 2010. Megace® ES, an oral suspension steroid, is indicated for the treatment of anorexia, cachexia, or an unexplained significant weight loss in patients with a diagnosis of acquired immunodeficiency syndrome (AIDS).

Oxandrin® (oxandrolone) Prescribing Information. Savient Pharmaceuticals, 2005. Oxandrin®, an oral anabolic steroid, is indicated as an adjunctive therapy to promote weight gain after weight loss following extensive surgery, chronic infections, or severe trauma, and in some patients who without definite pathophysiologic reasons fail to gain or to maintain normal weight, to offset the protein catabolism associated with prolonged administration of corticosteroids, and for the relief of the bone pain frequently accompanying osteoporosis.

Marinol® (dronabinol) Prescribing Information. Unimed Pharmaceuticals, Inc., 2008. Marinol®, an oral cannabinoid in capsule form, is indicated for the treatment of anorexia associated with weight loss in patients with AIDS and nausea and vomiting associated with cancer chemotherapy in patients who have failed to respond adequately to conventional antiemetic treatments.

The most common adverse events with Serostim® treatment are myalgia, arthralgia, and peripheral edema. Click here to see additional Important Risk Information.

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Learn about Serostim

Access the full prescribing information.


References:

  1. Serostim® [somatropin (rDNA origin) for injection] Prescribing Information. Rockland, MA: EMD Serono, Inc.; 2007.
  2. Megace® ES (megestrol acetate) Prescribing Information. Spring Valley, NY: Par Pharmaceutical Companies, Inc.; 2008.
  3. Oxandrin® (oxandrolone tablets, USP) Prescribing Information. East Brunswick, NJ: Savient Pharmaceuticals, Inc.; 2005.
  4. Marinol® (dronabinol) Prescribing Information. Marietta, GA: Solvay Pharmaceuticals Inc.; 2008.
  5. American Dietetic Association. Position of the American Dietetic Association: nutrition intervention and human immunodeficiency virus infection. J Am Diet Assoc. 2010;110:1105-1115.
  6. 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;42:836-841.
  7. National Institutes of Health. Gastroparesis. NIH Pub #07-4348. July 2007:1-6. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/gastroparesis/Gastroparesis.pdf. Accessed June 29, 2010.
  8. Vining L. General nutrition issues for healthy living with HIV infection. In: Hendricks KM, Dong KR, Gerrior JL, eds. Nutrition Management of HIV and AIDS. American Dietetic Association. 2009:23-40.
Learn about contributors to HIV-associated wasting.
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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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