Dealing with Wasting in HIV D... Video Transcript

Participants

Donald P. Kotler MD, Graeme Moyle MBBS, MD, Bruce Polsky MD

Summary

People with HIV can experience many changes in their bodies. Listen to experts explain why people with HIV lose body weight and muscle mass and what they can do to gain it back.

Webcast Transcript

ANNOUNCER: People with HIV and AIDS can experience a wide variety of changes in their bodies. Sometimes it's an unusual redistribution of fat in conditions known as lipodystrophy and lipoatrophy, which are linked to certain anti-HIV drugs. People with HIV also can lose fat, and even lean body mass, because they are unable to take in enough calories.

This can happen when the disease is well controlled. Or, it can be a consequence of opportunistic infections, when the disease has progressed.

DONALD KOTLER, MD: An example would be somebody whose immune function has deteriorated, and then develops a yeast infection in the mouth or the esophagus, so that people have pain when they swallow, and under those circumstances eat less. Or, someone develops a parasitic infection; they will not have a good immune response and clear the infection, so that intestinal damage may occur and there will be malabsorption.

ANNOUNCER: Doctors will treat the infection, and often prescribe protein-rich food, and exercise. Additionally, there may be some may benefit from medicines that improve the appetite.

DONALD KOTLER, MD: There are two types of appetite stimulants that are used, one that's related to the female sex hormone progesterone, which has a side effect of stimulating appetite. It's called Megace. The other major form of appetite stimulant is one that's related to marijuana. It's a cannabinoid. It's called Marinol.

ANNOUNCER: Sometimes a person who is ill primarily experiences the loss of lean body mass, a condition known as "wasting" or cachexia.

DONALD KOTLER, MD: It is a response to injury, not to lack of food. And a similar process occurs whether you have cancer, or bad trauma. Even a heart attack. Anything that has caused tissue damage in the body. The body's job under those circumstances is to clear the damage and repair it. In order to get the energy, in order to get the amino acids, the building blocks for this response. You get muscle wasting.

BRUCE POLSKY, MD: In many cases, the patients will have low amounts of testosterone, lower than they should have, which is a part of HIV disease as well. Those are patients that we will try to replace their testosterone to make them at normal levels.

ANNOUNCER: Testosterone, and anabolic steroids, which can have similar properties, can build up lost muscle.

DONALD KOTLER, MD: The use of testosterone or anabolic agents makes a lot of sense. And whether they are testosterone or its various compounds that are either injected, taken as pills or as a cream or as a patch, or the anabolic steroids, like nandrolone or oxandrolone. Or things like DHEA, which are the precursor chemicals that you could buy at a nutrition store. They all tend to lead to an increase in muscle mass.

ANNOUNCER: Testosterone in normal doses is generally well tolerated. But high doses of anabolic steroids, including testosterone, can bring about significant side effects.

DONALD KOTLER, MD: The major side effect of testosterone in its high dose is psychological. You've heard of steroid rage; it's sort of an over-aggressiveness.

ANNOUNCER: Another drug, growth hormone, can be helpful in patients whose testosterone is normal, whose cachexia continues with testosterone treatment, and for women. It can lead to significant weight gain and replenishes lean body mass.

BRUCE POLSKY, MD: What growth hormone does is alter the metabolism, and it causes the body to burn fat preferentially and at the same time retain nitrogen.