Anorexia/cachexia in patients with HIV: lessons for the oncologist.
Early intervention and attention to nutritional status are essential in patients with cachexia. Identification of reversible causes of decreased energy intake and/or weight loss is the first step in treatment. When such factors cannot be identified, pharmacologic interventions should be considered. To date, megestrol acetate is the most effective appetite stimulant. Appetite and weight gain occur to a greater and more rapid degree as megestrol dose increases. Unfortunately, the weight gain is due predominantly to an increase in fat mass. Whether this is due to a lack of exercise in the face of increased caloric intake and/or to the hypogonadal effects of megestrol acetate is being tested in ongoing clinical trials. Anabolic agents, particularly growth hormone, are exciting potential therapies. No data are yet available on alternate doses and schedules of growth hormone or on its effect in patients with decreased oral intake. Current studies addressing combination therapy with anabolic agents and appetite stimulants should clarify their respective therapeutic roles.
Von Roenn
J H
JH
Northwestern University Chicago, Illinois, USA.
Knopf
K
K
D000273:Adipose Tissue / Q000187:drug effects; D045930:Anabolic Agents / Q000627:therapeutic use; D000855:Anorexia / Q000209:etiology*; D001066:Appetite / Q000187:drug effects; D019167:Appetite Stimulants / Q000008:administration & dosage / Q000627:therapeutic use; D002100:Cachexia / Q000209:etiology*; D004338:Drug Combinations; D002149:Energy Intake; D015444:Exercise; D015658:HIV Infections / Q000150:complications*; D019382:Human Growth Hormone / Q000627:therapeutic use; D006801:Humans; D008495:Medical Oncology; D019290:Megestrol Acetate / Q000008:administration & dosage / Q000627:therapeutic use; D009369:Neoplasms / Q000150:complications*; D009752:Nutritional Status; D015430:Weight Gain / Q000187:drug effects; D015431:Weight Loss
D045930:Anabolic Agents; D019167:Appetite Stimulants; D004338:Drug Combinations; D019382:Human Growth Hormone; D019290:Megestrol Acetate