Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0024523 (malabsorption)
 7,319 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Involuntary weight loss or wasting indicative of severe protein energy malnutrition is a frequent complication of acquired immune deficiency syndrome (AIDS). Malnutrition, with its associated adverse effects on immunocompetence, may contribute to the progression of AIDS itself. Since death from wasting is ultimately related to the magnitude of tissue depletion, restoration of body cell mass may enhance survival. The mechanism of weight loss in AIDS has not been clearly elucidated. The etiology is likely to be multifactorial, the result of interactions between decreased caloric intake, malabsorption, and alterations in energy expenditure secondary to hormonal and/or metabolic abnormalities. Although weight loss is occasionally reversible with treatment of underlying infections and/or easily identifiable and reversible causes, the majority of patients are not this fortunate. Enteral and parenteral nutrition, which are expensive, cumbersome, and potentially morbid, have been suggested by some as therapeutic options. Megestrol acetate, a synthetic, orally active progestational agent, has been reported to stimulate appetite and weight gain. Data regarding the use of megestrol acetate for the treatment of cachexia related to human immunodeficiency virus (HIV) infection demonstrate convincingly its effectiveness in treating many patients with HIV-related anorexia and cachexia.
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PMID:HIV-related cachexia: potential mechanisms and treatment. 146 29

Two appetite stimulants, megestrol acetate and cyproheptadine were administered in a randomized trial to 14 patients who had no evidence of opportunistic infection or malabsorption but were wasted (had lost more than 5 kg body weight) as a result of human immunodeficiency virus (HIV) infection. Energy intakes were calculated from a 7 day weighed dietary record. Mean energy intakes per kilogramme body weight were similar in both treatment groups (greater than 34 kcal/kg) and were higher than that in well British males. Energy intakes increased by just over 500 kcal during both treatments, but fell to pretreatment levels after therapy. Patients in both treatment groups gained a moderate amount of weight. Megestrol acetate was associated with impotence in 4 patients. Insufficient calorie intake alone is not a common cause of wasting associated with HIV and the role of appetite stimulants is likely to be limited.
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PMID:Megestrol acetate vs cyproheptadine in the treatment of weight loss associated with HIV infection. 150 60

Weight loss and wasting are significant contributors to morbidity in patients infected with the human immunodeficiency virus (HIV). The approach to the patient with HIV and weight loss needs to be proactive and comprehensive, as early intervention may be beneficial and the weight loss may be multifactorial. Evaluation for weight loss needs to be directed at any apparent contributing cause and can include dietary evaluation, treatment of intercurrent complicating infections or malignancies, and maximization of HIV therapy. Some patients will also benefit from an evaluation of the gastrointestinal tract to document malabsorption and/or opportunistic enteric infections. It is also prudent to evaluate testosterone levels in male patients. Interventions in the patient who is not able to take in sufficient calories should include dietary advice and/or nutritional supplements, as well as the use of appetite stimulants. Megace (Bristol-Myers Squibb, Princeton, NJ) has been shown to effectively increase appetite, oral intake, and body weight. For the patient with malabsorption and/or diarrhea, treatment of enteric infections should be attempted. These patients may benefit from the replacement of some dietary fat with medium-chain triglycerides, either in a nutritional product or to replace cooking oils. Other patients may benefit from the use of anabolic agents such as growth hormone, nandrolone, testosterone, or oxandrolone, which are all effective at increasing lean body mass. For select patients, agents such as thalidomide might be of benefit, although its mechanism of action is not clear. There are few data from prospective, controlled trials of combinations of these agents, but these studies are underway. It is likely that the optimal interventions for patients will be combinations of agents to improve oral intake and add lean body mass, which will permit a reduction in morbidity from weight loss and an improvement in quality of life for the HIV-infected patient.
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PMID:Single-agent/combination therapy of human immunodeficiency virus-related wasting. 962 91