EFFECTS OF TAPERING DOSES OF ORAL PREDNISONE ON VIRAL LOAD AMONG HIV-INFECTED PATIENTS WITH UNEXPLAINED WEIGHT-LOSS

In an exploratory study of virologic and immunomodulatory effects of c orticosteroid therapy for wasting syndrome, four HIV-infected adults w ith recent unexplained weight loss were given tapering doses of predni sone over a 2-month period, Serum neopterin and TNF receptor II levels decreased from baseline after 7 days, An antiretroviral effect was ob served initially, peaking on days 14-21 (mean change in HIV-1 branched chain DNA assay on day 21 of -0.52 log(10); mean change, from baselin e to nadir for each individual, of -0.63 log(10)); subsequent bDNA lev els returned toward baseline as prednisone was tapered, No patient los t weight and there was a mean weight gain of 3.5 kg, Anecdotal reports of corticosteroid benefits in the wasting syndrome may result in part from decreased T cell activation leading to decreased HIV replication , an effect that may be self-limited or that may occur only at higher prednisone doses, Studies involving more targeted immunomodulatory age nts for wasting syndrome are warranted.