Use of growth hormone and other anabolic agents in AIDS wasting

Body wasting and loss of lean body mass (LBM) have been associated with inc reased mortality and disease progression, and reduced quality of life, in p atients with human immunodeficiency virus (HIV) infection. The failure of n utritional therapies and, more recently, of effective viral suppression, to consistently restore LBM has prompted investigation of the pharmacologic u se of a number of specific protein anabolic agents, including recombinant h uman growth hormone (rhGH), insulinlike growth factor I (rhIGF-I), and synt hetic testosterone derivatives, such as nandrolone decanoate, oxandrolone, and oxymetholone. In a placebo-controlled trial, treatment with rhGH result ed in a significant and sustained increase in weight that was accompanied b y an even greater increase in LBM and a decrease in fat, and improvement in treadmill work output. Preliminary data suggest that short-term rhGH treat ment may be effective in mitigating weight loss in patients with secondary infections. Open-label studies of nandrolone decanoate suggest that this in jectable agent also can increase weight and LBM. Two oral agents, oxandrolo ne and oxymetholone, can increase weight, but their effects on LBM in place bo-controlled trials have not been reported. Taken together, these studies demonstrate that HIV-infected individuals can regain weight and LBM under t he proper therapeutic circumstances. The effects of reversal of wasting on survival and disease progression, long-term safety, and the potential value of these therapies in the treatment of fat redistribution remain to be det ermined.