Identifying and evaluating your patients for HIV-associated Wasting

White female in a yellow sweater, not actual Serostim® patient

Identifying HIV‑associated Wasting

Evaluating your HIV‑positive patients for HIV‑associated wasting

HIV‑associated wasting may affect anyone living with HIV, even when they are well controlled with ART.

Are your patients experiencing symptoms of HIV‑associated wasting?

Patients living with HIV may experience episodes of unintentional weight loss, loss of LBM, and decreased physical endurance. Looking beyond unintentional weight loss and identifying other symptoms can be an important factor in determining if they are experiencing HIV‑associated wasting. This is why it’s important to talk about any symptoms they may be experiencing at every appointment.

A holistic approach to determine if your patients are experiencing symptoms of HIV‑associated wasting includes initiating open-ended discussions about LBM, body weight, and physical endurance.

The following steps can help you decide if further intervention and treatment may be right for your patient.

Initiate a conversation at every appointment

Proactively speak to patients about potential HIV‑associated wasting symptoms.

Consider asking your patients:

Have you had unintentional weight loss?
Have you recently lost weight without trying?
Does your unintentional weight loss affect your health?
Do your clothes fit more loosely due to unintentional weight loss?
Have friends, family, or coworkers noticed any changes in your weight?
Do you have a loss of energy, along with unintentional weight loss?
Do you frequently feel tired?
Are you exercising less?
Do you need to rest more often?
Is it more difficult to complete some of your activities?

Asking these questions at every appointment may aid with early identification of HIV‑associated wasting.

Examine the patient and review medical history

Measuring weight, reviewing your patient’s weight history (including a premorbid or prediagnosis weight, as well as changes in weight over time), calculating body mass index (BMI), and evaluating LBM can help you uncover physical changes that may suggest HIV‑associated wasting.

Clinically manage your patients

Clinically managing patients to assess for HIV‑related comorbidities, such as HIV‑associated wasting, can add a layer of complexity for healthcare providers (HCPs), especially during telemedicine visits.

Some methods you may consider when screening patients for changes in weight, in person or virtually, include:

Weighing them during in-office visits, or asking them to keep a record of their weight and self-report it during visits by:
- Keeping a scale at home
- Weighing themselves at their local pharmacy, at an AIDS service organization, during their routine lab visits, or wherever a scale is available
Inquiring about whether their clothing fits differently
Looking for changes in physical appearance and asking about involuntary changes in body habits and decreasing physical endurance

HIV‑associated Wasting Conversation Starter

Use this helpful resource to support conversations with your HIV‑positive patients about their symptoms and HIV‑associated wasting

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See how Serostim^® provides statistically significant improvements in the 3 key symptoms of HIV‑associated wasting

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Recommended dosage and administration for treatment with Serostim^®

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References:

Serostim^® (somatropin) for injection [prescribing information]. Rockland, MA: EMD Serono, Inc.
Dudgeon WD, Phillips KD, Carson JA, Brewer RB, Durstine JL, Hand GA. Counteracting muscle wasting in HIV‑infected individuals. HIV Med. 2006;7(5):299-310.

Important Safety Information and Indication

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CONTRAINDICATIONS

Acute Critical Illness: Serostim^® (somatropin) should not be initiated in patients with acute critical illness due to complications following open heart or abdominal surgery, multiple accidental trauma or acute respiratory failure.

Active Malignancy: Somatropin is contraindicated in the presence of active malignancy. Any preexisting malignancy should be inactive and its treatment complete prior to instituting therapy with somatropin. Discontinue somatropin if there is evidence of recurrent activity.

Hypersensitivity: Serostim^® is contraindicated in patients with a known hypersensitivity to somatropin or any of its excipients. Systemic hypersensitivity reactions have been reported.

Diabetic Retinopathy: Somatropin is contraindicated in patients with active proliferative or severe non-proliferative diabetic retinopathy.

WARNINGS AND PRECAUTIONS

Acute Critical Illness: Increased mortality (42% vs 19% in somatropin compared to placebo treated) in patients with acute critical illness due to complications following open heart surgery, abdominal surgery or multiple accidental trauma, or those with acute respiratory failure has been reported after treatment with pharmacologic amounts of somatropin.

Concomitant Antiretroviral Therapy: Somatropin has been shown to potentiate HIV replication in vitro, and there was no increase in virus production when antiretroviral agents were added to the culture medium. No significant somatropin-associated increase in viral burden was observed. All patients received antiretroviral therapy for the duration of treatment during Serostim^® clinical trials.

Neoplasms: Patients with preexisting tumors should be monitored for progression or reoccurrence. Monitor patients on somatropin therapy carefully for preexisting nevi.

Impaired Glucose Tolerance/Diabetes: Patients with other risk factors for glucose intolerance should be monitored closely during Serostim^® therapy. Cases of new onset impaired glucose tolerance, new onset type 2 diabetes, and exacerbation of preexisting diabetes have been reported in patients receiving Serostim^®. Some patients developed diabetic ketoacidosis and diabetic coma and, in some, improved when Serostim^® was discontinued and in others persisted. Some of these patients required initiation or adjustment of antidiabetic treatment.

Intracranial Hypertension: Intracranial hypertension (IH) with papilledema, visual changes, headache, nausea, and/or vomiting has been reported usually within the first 8 weeks of somatropin therapy and rapidly resolved after stopping or reducing the somatropin dose. Funduscopic examination should be performed prior to initiating treatment with somatropin and periodically during treatment. If papilledema is observed, treatment should be stopped and restarted at a lower dose after IH-associated symptoms have resolved.

Severe Hypersensitivity: Serious systemic hypersensitivity reactions including anaphylactic reactions and angioedema have been reported with postmarketing use of somatropin products. Patients and caregivers should be informed that such reactions are possible and that prompt medical attention should be sought if an allergic reaction occurs.

Fluid Retention/Carpal Tunnel Syndrome: Increased tissue turgor (swelling, particularly in the hands and feet) and musculoskeletal discomfort (pain, swelling and/or stiffness) may occur during treatment with Serostim^®, but may resolve spontaneously, with analgesic therapy, or after reducing the frequency of dosing. Carpal tunnel syndrome may occur and if the symptoms of carpal tunnel do not resolve by decreasing the weekly number of doses, it is recommended that Serostim^® treatment be discontinued.

Skin Atrophy: Rotate the injection site to avoid tissue atrophy.

Pancreatitis: Cases of pancreatitis have been reported rarely. Consider pancreatitis in patients who develop persistent severe abdominal pain.

ADVERSE REACTIONS

In clinical trials in HIV‑associated wasting or cachexia the most common adverse reactions (incidence >5%) were arthralgia, myalgia, peripheral edema, arthrosis, nausea, paresthesia, generalized edema, gynecomastia, hypoesthesia and fatigue.

SPECIAL POPULATIONS:

Somatropin should be used during pregnancy only if clearly needed and with caution in nursing mothers because it is not known whether somatropin is excreted in human milk. The safety and effectiveness of somatropin in pediatric patients with HIV have not been established. Clinical studies did not include sufficient numbers of subjects > 65 to determine a response different from that of younger patients. Studies have not been conducted in patients with hepatic or renal impairment. Gender-based analysis is not available.

INDICATIONS AND USAGE

Serostim^® (somatropin) 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.

Please click here for full Prescribing Information.