Use of growth hormone and other anabolic agents in AIDS wasting

JPEN J Parenter Enteral Nutr. 1999 Nov-Dec;23(6 Suppl):S202-9.

Use of growth hormone and other anabolic agents in AIDS wasting.

Mulligan K, Tai VW, Schambelan M.

Division of Endocrinology, San Francisco General Hospital, CA 94110, USA.

Body wasting and loss of lean body mass (LBM) have been associated with increased
mortality and disease progression, and reduced quality of life, in patients with
human immunodeficiency virus (HIV) infection. The failure of nutritional
therapies and, more recently, of effective viral suppression, to consistently
restore LBM has prompted investigation of the pharmacologic use of a number of
specific protein anabolic agents, including recombinant human growth hormone
(rhGH), insulin-like growth factor I (rhIGF-I), and synthetic testosterone
derivatives, such as nandrolone decanoate, oxandrolone, and oxymetholone. In a
placebo-controlled trial, treatment with rhGH resulted in a significant and
sustained increase in weight that was accompanied by an even greater increase in
LBM and a decrease in fat, and improvement in treadmill work output. Preliminary
data suggest that short-term rhGH treatment may be effective in mitigating weight
loss in patients with secondary infections. Open-label studies of nandrolone
decanoate suggest that this injectable agent also can increase weight and LBM.
Two oral agents, oxandrolone and oxymetholone, can increase weight, but their
effects on LBM in placebo-controlled trials have not been reported. Taken
together, these studies demonstrate that HIV-infected individuals can regain
weight and LBM under the 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 determined.