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Query: UMLS:C0019693 (HIV)
 170,526 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

AIDS Wasting Syndrome (AWS), a devastating consequence of HIV disease, is defined as involuntary loss of body mass and a disproportionate loss of muscle mass. Its exact mechanisms are unknown, but some of the side effects of drugs or opportunistic infections can increase the likelihood of developing AWS. Low testosterone levels are associated with AWS in both men and women, and testosterone replacement therapy is indicated. Other anabolic therapies are available, including serostim (growth hormone), but the cost is prohibitive. Nandrolone, Oxandrolone, and Megestrol Acetate are other medications that have some effectiveness in combating AWS. Thalidomide has shown promise in treating wasting and contact information is provided for a compassionate use program. The need for proper nutrition and exercise is also emphasized.
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PMID:Approaches to the AIDS Wasting Syndrome. 1136 49

Clinical trials being conducted at the Harvard/Boston City Medical Center, AIDS Clinical Trials Unit (ACTU) are described. Criteria for inclusion in the study are included, as well as the status of the trial and contact information to enroll. Also included is a list of other Boston clinical trials. Current HIV trials include ACTG 388, which is comparing four-drug regimens to three-drug regimens; ACTG 384, which is studying when protease inhibitor therapy should be initiated; and ACTG 359, which is studying viral loads in patients who have received at least six months of treatment. Treatment studies are also underway for immune-based therapies, Kaposi's sarcoma, and AIDS wasting syndrome.
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PMID:Harvard/Boston City Medical Center AIDS Clinical Trials Unit. 1136 52

Oxandrin and Anadrol-50 are both oral anabolic steroids approved by the Food and Drug Administration (FDA), and they are competing for market share in the world of HIV treatments. Both are described as "open label" drugs and as such, are prescribed to reverse wasting and metabolic complications associated with HIV. Anadrol-50 is among the most potent steroids ever developed for building muscle, and study participants gained an average of 14.5 pounds for each 100 pounds of weight. Early studies indicate minimal side effects with liver toxicity, but that is not a certainty since oral anabolics are known for liver toxicity. Many studies have documented Oxandrin's safety and effectiveness in treating HIV wasting. It is metabolized in the kidney and acts without the masculinizing side effects associated with other steroids, such as Anadrol-50. One study showed an average weight gain of 24 pounds following 8 months of treatment. Oxandrin is the best choice for those at the earliest stages of AIDS wasting syndrome. However, when a more aggressive treatment is necessary, Anadrol-50 is stronger, less expensive, and more effective, but liver function must be monitored closely.
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PMID:Comparing Oxandrin and Anadrol-50. 1136 32

AIDS wasting syndrome (AWS) is a complication of advanced HIV disease characterized by loss of lean body mass. The loss of endogenous anabolic hormones, such as testosterone, is thought to contribute to muscle loss. Studies have shown that more than half of male AIDS patients have low testosterone levels, and increased AIDS severity is correlated with increases in the presence of hypogonadism. Hypogonadism among HIV-infected patients is marked by decreased muscle mass and functional capacity, fatigue, and reduced quality of life. Recently, a 6-month randomized, placebo-controlled trial was conducted on the effects of administering testosterone intramuscularly to hypogonadal HIV-infected men. Patients receiving testosterone experienced significant increases in muscle and lean body mass as well as improved quality of life, appearance, and well being. A 6-month open label extension confirmed a sustained anabolic effect. As an alternative to intramuscular injection, transdermal patches are now available, offering similar benefits and more stable testosterone levels. Transdermal testosterone studies have been initiated in women as well, with promising results. Synthetic testosterone analogues, such as Oxandrolone and nandrolone decanoate, also have been studied in AWS patients. Trials of both resulted in significant weight gain at certain doses, but also demonstrated a significant risk of liver damage. Other anabolic agents are also under investigation.
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PMID:The use of testosterone in the AIDS wasting syndrome. 1136 8

A comparison of the four most common types of 17 alpha-alkylated anabolic-androgenic steroids (alpha-AAS) indicates that all are effective, all have some risk of liver toxicity, and each needs to be administered properly. Higher doses of 17alpha-AAS, together with other lifestyle and chemical factors, may produce a greater chance for liver toxicity, but overall the risk of adverse hepatic function is lower than believed. The use of alpha-AAS for treating AIDS Wasting Syndrome may be a viable option if appropriate dosing is used. Patients should be monitored and tested regularly.
HIV Hotline 1998 Dec
PMID:Does the choice of alpha-AAS really make a difference? 1136 79

HIV-infected patients from moderate regions who travel in tropical countries may experience clinical disease progression due to exposure to bacteria (including mycobacteria), fungi and parasites. In the Swiss HIV Cohort Study we examined the hypothesis that travelling increases the risk of tuberculosis, wasting syndrome, cryptosporidiosis, isosporiasis, cryptococcosis, coccidiomycosis, histoplasmosis and Salmonella septicaemia. A total of 4549 participants were included (in 1988-98) of whom 596 (13.1%) travelled at least once. During 16,800 person-years of follow-up 231 patients developed at least 1 of the diseases of interest. Wasting syndrome was the only diagnosis significantly associated with travelling (hazard ratio 2.16, 95% confidence interval 1.09 to 4.30). The risk of wasting syndrome ('slim disease') should be taken into account when counselling HIV-infected patients intending to travel in tropical regions.
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PMID:Increased risk of wasting syndrome in HIV-infected travellers: prospective multicentre study. 1170 54

Infection with the human immunodeficiency virus (HIV) is often associated with the acquired immunodeficiency syndrome (AIDS), and wasting is one of the defining clinical features of AIDS. Muscular weakness due to myopathy may develop at any stage of HIV infection. We report two illustrative cases of HIV-associated myopathies. One was due to inflammatory myosits most likely directly related to the HIV infection, and the other was most likely the result of mitochondrial damage due to zidovudine, a nucleoside analogue commonly used in treating HIV infection. Biopsies from both patients showed alterations of myofiber structures, of varying severity, culminating in necrosis, lipid droplets, and lymphoplasmocytic inflammatory response. The zidovudine-treated patient also showed distinctive mitochondrial changes, predominantly enlargement, variation in shape and size, and disorganization of the cristae. These two types of HIV-associated inflammatory myopathies are reviewed, along with other HIV-associated myopathies, including HIV wasting syndrome, nemaline rod myopathy, pyomyositis, rhabdomyolysis, cardiomyopathy, and other miscellaneous myopathies associated with HIV infection.
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PMID:AIDS-related myopathy. 1181 Apr 29

Involuntary weight loss with lean tissue depletion is a serious and AIDS-defining complication of HIV infection. This article explores definitions of AIDS wasting syndrome (AWS), its etiology, methods of assessing body composition, and pharmacological treatments. Recent research literature on the role of exercise in the prevention and treatment of AWS is reviewed. Included are studies of the safety of exercise, the effects of exercise on the immune system, and the effects of exercise on weight gain and body composition as well as studies of exercise in combination with medications and other interventions. Implications for clinical practice are discussed.
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PMID:The role of exercise in the prevention and treatment of wasting in acquired immune deficiency syndrome. 1182 58

An update on clinical aspects of HIV in africa highlights new proposed clinical definitions of adult AIDS and of tuberculosis in HIV+ adults, and staging of adult HIV infection. The 1986 WHO clinical definition of AIDS has been widely used in Africa, but now research suggests that this definition has several limitations: the definition will pick up several unrelated diseases such as diabetes mellitus and renal failure. It does not ascertain cases of AIDS marked by nonopportunistic infections. Most persons with pulmonary tuberculosis may be wrongly diagnosed with AIDS by this definition. The study showed that the WHO clinical definition has good specificity and positive predictive value for HIV+ people, but its positive predictive value fell to 30% in identifying people with AIDS in Africa. New definitions should take into account any serious morbidity, tuberculosis, neurological disease, both endemic localized Kaposi's, and aggressive typical Kaposi's sarcoma, and HIV serological testing. Tuberculosis is a problem because few HIV+ people suspected of having pulmonary TB (sputum-negative TB) actually have it based on bronchoscopy, while HIV+ persons with TB experience high mortality, often from pyogenic bacteremia. HIV+ persons with TB suffer high rates of relapse, possibly related to insufficient drug treatment or reinfection. 1 study showed that 6 months of isoniazid significantly improved incidence of TB over 30 months of follow-up. Staging of AIDS in Africa based on degree of immunosuppression was proposed as: 1) clinically inapparent HIV infection marked by pulmonary TB, soft tissue infections, and community acquired pneumonia; 2) lymphadenopathy, oral thrush, widespread pruritic maculopapular rash, herpes zoster, enteric illness, dysentery, and Kaposi's sarcoma; and 3) HIV wasting syndrome, chronic pulmonary disease, meningitis, and fever of unknown origin.
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PMID:Some clinical aspects of HIV infection in Africa. 1231 68

Many HIV patients develop weight loss, which increases morbidity and mortality. We aimed to assess the effects of testosterone therapy on lean body mass, total body weight, over-all exercise functional capacity, and perceived quality of life in patients with HIV wasting syndrome and its adverse effects. We systematically reviewed randomised, placebo-controlled trials that compared the effects of testosterone therapy with placebo in HIV patients with wasting. Eight trials met the inclusion criteria and 417 randomised patients were included. Only six trials used lean-body mass, fat-free mass, or body-cell mass as outcome measures. The meta-analysis of the six trials showed a difference in the lean body mass between the testosterone group and placebo group of 1.22 kg (95% CI 0.23-2.22) for the random effect model and 0.51 kg (0.09-0.93) for fixed effect. However, the difference was much greater in the three trials that used the intramuscular route-3.34 kg in the post-hoc analysis. All eight trials included total body weight as an outcome measure, the meta-analysis of which showed a difference of 1.04 kg (-0.01-2.10) between testosterone group and placebo group by random effect and 0.63 kg (-0.01-1.28) for fixed effect models. Over-all, the incidence of adverse effects is similar in both groups. Testosterone therapy has been shown in this review to increase lean body mass more than placebo. The increase is even greater if the therapy is given intramuscularly. There is also a small positive effect in total body weight. The study is, however, limited by the small numbers and heterogeneity of the population, which potentially introduced bias into the methods and results. Testosterone therapy may be considered in patients with HIV wasting syndrome to reverse muscle loss, but there is a concern about the adverse metabolic effects of long-term testosterone administration and long-term follow-up for these patients is needed.
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PMID:Testosterone therapy in HIV wasting syndrome: systematic review and meta-analysis. 1267 58


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