Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0019693 (HIV)
 170,526 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Although the HIV wasting syndrome has become a far less common manifestation of advanced disease since the introduction of highly active therapies, much has been learned about a number of potential therapeutic interventions. HIV wasting therapies are reviewed. The evaluation of some of these treatments for management of body habitus alterations associated with antiretroviral therapies may be appropriate.
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PMID:Potential interventions for HIV/AIDS wasting: an overview. 1112 31

The human growth hormone (HGH) expanded access program for people with AIDS wasting syndrome is now in its fourth month. Enrollment has been slow, largely due to cost. Since HGH falls under the Food and Drug Administration's (FDA) Treatment Investigational New Drug (TIND) regulations, patients are required to pay for the drug--at a cost of about $150 per day, or more than $1,000 per week. Few insurance companies will compensate for the cost of HGH, and no state Medicaid or AIDS Drug Assistance Programs have agreed to cover the compound. Serono Laboratories, the manufacturer, is operating an indigent program that provides free or discount HGH for individuals who cannot purchase the drug any other way. There are only 25 slots available in this program. Lack of available data on how and when to use the drug creates obstacles for physicians. Most of the public data available comes from a single, twelve-week, placebo-controlled study involving 178 participants. However, there are alternative treatments for wasting syndrome. A regimen of testosterone and synthetic anabolic steroids, given to men, has provided positive results on an anecdotal basis. Wasting syndrome comes from a metabolic change which occurs with chronic HIV infection. Rather than first using stores of fat, the body breaks down protein to meet its energy requirements.
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PMID:Slow launch for HGH. 1136 10

In October 1992, [name removed], an aluminum siding installer, applied for Supplemental Security Income Insurance Benefits and Disability Insurance Benefits because he was no longer able to perform construction jobs. His claims were denied. [Name removed] is a former alcohol, tobacco, and drug abuser who also contracted HIV and hepatitis C. [Name removed]'s physician diagnosed chronic obstructive pulmonary disease, emphysema, AIDS wasting syndrome, and alcoholism-induced peripheral neuropathy. U.S. District Judge Robert P. Patterson Jr. ruled that [name removed] was not incapacitated and should find a sedentary job. The judge did not take into account the wasting syndrome or the peripheral neuropathy. Rather than appealing the decision, Mr. [Name removed] will reapply based on new medical information that shows his condition has worsened since the original application.
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PMID:Disability claim rejected despite AIDS condition. 1136 70

Many individuals with AIDS will experience HIV wasting syndrome at some time in their disease progression. However, a number of new treatments, including anabolic steroids and a regular regimen of weight lifting, are providing benefits to those who experience this condition. Because wasting is difficult to stop once it has started, preventing or delaying the condition is imperative. Preventive measures include eating well, avoiding infections, and exercising. Treatments and interventions for wasting include nutritional supplements, appetite stimulants, anabolic steroids such as testosterone replacement, human growth hormone therapy, and weight lifting. However, the most effective human growth hormone therapy is probably expensive. Anabolic steroids can be valuable for the 20 percent of HIV-positive males who have below-normal levels of testosterone. Two appetite stimulants approved for use in AIDS patients with weight loss are megestrol acetate (Megace) and dronabinol (Marinol). Weight lifting is a natural way to gain lean body mass and muscle and has been shown to be effective in people who have advanced to a diagnosis of AIDS. Seven tips for fighting weight loss are included.
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PMID:Testosterone replacement, weight lifting help wasting. 1136 46

Wasting syndrome, one of the most common complications of HIV disease, is more often found in people of low socioeconomic status and women. The pathophysiology of wasting and its treatment are discussed. Perturbations of metabolism, malnutrition, androgen deficiency, treating underlying illnesses, nutritional considerations, and pharmacologic approaches are explored. The first step to treating HIV wasting syndrome is to provide appropriate antiretroviral therapy, including meticulous prophylaxis and treatment of opportunistic infections (OIs). Other treatments include using oral supplements or total parenteral feeding to maintain nutritional levels, approved appetite stimulants, such as Megestrol acetate and dronabinol, or the controversial use of anabolic steroids. Concerns about steroid use include potential for abuse, and the possibility of developing malignancies and severe gonadal dysfunction.
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PMID:The HIV wasting syndrome. 1136 90

Even with the introduction of highly active antiretroviral therapy (HAART), the expected eradication of HIV wasting syndrome has not materialized. Patients who gain weight on HAART seem to gain it as fat, with the body apparently unable to restore lean body mass, even with strenuous exercise programs. It may be that in addition to HAART, an anabolic or anti-inflammatory agent may be needed to reset body chemistry that was damaged by HIV. Serostim, Serono's brand of growth hormone, has been approved to treat wasting, and although it does seem to increase lean body mass and decrease fat in some patients, many patients were not compliant with taking the drug. Testosterone and anabolic steroids were also effective in causing weight gain. Thalidomide is being studied to attack the underlying cause of wasting, namely the overproduction of tumor necrosis factor alpha. In studying thalidomide, however, viral load went up slightly, and reduction of tumor necrosis factor levels was not documented; side effects included skin rash and sleepiness. Research is continuing in this area, with the need to use body composition measurements as a means to gain faster approval of therapies for wasting.
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PMID:No attrition in research on wasting therapies. 1136 78

Findings that were presented at the National Institute of Health (NIH) Conference on AIDS Wasting Syndrome are discussed. Discussions include an overview of wasting, wasting in pediatric AIDS, the influence of exercise and diet in wasting, the manipulation of protein synthesis and metabolism in treating wasting, and the effects of thalidomide therapy. How HIV infection affects resting energy expenditure, metabolism, and changes in energy balance, all cofactors in the development of wasting, are explained.
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PMID:NIH conference on AIDS wasting syndrome. National Institutes of Health. 1136 32

When the California Legislature reconvenes in January 1998 it will consider bills that were not resolved during the 1997 session. Senate Bill 705 makes it a felony for a person to intentionally infect another person with HIV through sexual activity. The current version of S.B. 705 only punishes those who intend to expose others to HIV through unprotected anal or vaginal intercourse. Senate Bill 885 would waive California's ban on nonprescription use of syringes and create a government-sanctioned needle exchange pilot program in Los Angeles, San Francisco, Long Beach, and San Jose through January 2000. It is unlikely that Governor Wilson will approve this bill. Senate Bill 1110 requires school districts to notify parents or guardians before pupils receive HIV prevention or human sexuality instruction. Senate Bill 535 establishes a $1 million State research program at the University of California to determine the efficacy of the medical use of marijuana for AIDS wasting syndrome, glaucoma, and cancer. Assembly Bill 1055 would require all contractors operating Medi-Cal managed care plans to provide all HIV medications that have been approved by the U.S. Food and Drug Administration.
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PMID:Thorny issues confront California lawmakers in 1998. 1136 83

Thalidomide is being investigated for its potential use in treating HIV wasting syndrome and other HIV-related conditions. Thalidomide is primarily broken down by hydrolysis; however, the metabolite responsible for its clinical effect is unknown. The optimum concentration of thalidomide or its metabolites to maximize benefits while minimizing toxicities is also unknown. Once daily administration is feasible because of thalidomide's 14- to 18-hour half-life. Because of thalidomide's known potential for causing birth defects, pregnant women are cautioned not to take the drug. One of the two thalidomide stereoisomers was presumed to be responsible for teratogenicity; trials using each isomer individually do not support this notion.
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PMID:Clinical pharmacology of thalidomide. 1136 75

Hormonal disturbances are common in patients with advanced HIV disease, and these imbalances may contribute to the loss of muscle and lean body mass. The most common endocrine manifestations related to HIV disease are reviewed and potential therapeutic strategies for combating AIDS wasting syndrome are discussed. Discussions include disturbances related to gonadal function and androgen levels, energy metabolism, growth hormone abnormalities, problems with adrenal and thyroid function, and disturbances in sodium and water balances. Disruptions in calcium, glucose, and lipid metabolism in AIDS patients are also examined. The anabolic agents nandrolone decanoate and oxandrolone are highlighted as therapies to AIDS wasting syndrome. While there are some benefits from these agents, both require further research to assess efficacy. Oral anabolic agents being studied include natural testosterone derivatives and growth hormone.
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PMID:Diagnosis and treatment of endocrine disorders in the HIV-infected patient. 1136 82


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