Therapeutic options for HIV-associated bodyweight loss. A risk-benefit analysis

Involuntary bodyweight loss, a common complication of infection with HIV, is an indicator of poor prognosis and decreased survival. Because of the multifactorial pathogenesis of HIV-related wasting, emerging therapies are directed at the multiple proposed mechanisms of involuntary bodyweight loss. The initial evaluation and treatment of HIV-related bodyweight loss is focused on the identification and treatment of reversible causes of bodyweight loss, such as secondary opportunistic infections or endocrine dysfunction. Nutritional intervention should begin in the early stages of HIV infection and continue throughout the life of the patient. Of the appetite stimulants, megestrol most consistently promotes bodyweight gain, but with a predominance of fat, not lean, body mass. Anabolic therapies such as testosterone derivatives and recombinant human growth hormone (somatropin) stimulate the addition of lean body mass and are being actively researched for the treatment of HIV-associated wasting. Finally, thalidomide, a potent inhibitor of tumour necrosis factor-α, is a potentially useful therapy that is still under investigation. New research into the treatment of HIV-related bodyweight loss is focusing on combination therapies.