Restauration de la masse maigre par l'administration de facteurs de croissance lors de la dénutrition sévère associée au VIH

Body wasting, particularly loss of lean body mass (LBM), is a frequent complication of human immunodeficiency virus (HIV) infection and has been associated with impaired quality of life, accelerated disease progression, and reduced survival. The failure of nutritional or appetite-stimulating therapies to consistently restore LBM has prompted investigation of specific protein anabolic hormones as potential therapies for HIV-associated wasting. Treatment with pharmacologic doses of recombinant human growth hormone (rhGH) resulted in weight gain and nitrogen retention in a short-term metabolic ward study. Furthermore, rhGH induced sustained increases in weight and LBM, accompanied by decreases in fat, during a 12-week placebo-controlled multicenter trial. Recombinant human insulin-like growth factor-I, which is believed to mediate the protein-anabolic effects of rhGH, improved nitrogen balance only transiently during a metabolic ward study. In placebo-controlle multicenter trial, a combination of rhIGF-I with low doses of rhGH produced an increase in LBM that was less than half of that achieved with pharmacologic doses of rhGH alone during a comparable study period. Preliminary studies of testosterone and its derivatives have demonstrated increases in weight and LBM in patients with HIV infection. At this time, in double-blind, placebo-controlled trials, only pharmacologic doses of rhGH have produced sustained increases in LBM. Future studies of the use of growth factors in patients with HIV-associated wasting should be designed not just to evaluate the best ways to use these agents, but also to determine whether clinically relevant functional benefits accompany increases in weight and/or LBM.