Pharmacologic agents used for nutritional disorders of HIV/AIDS

Weight loss in the HIV patient appears to result from the interplay of poor nutritional intake, altered metabolism, and malabsorption. Rapid weight loss, defined as greater than 4 kg in four months or less, is associated with non-gastrointestinal secondary infection; and slower weight loss is typically associated with diarrheal disorders, malabsorption and villous atrophy. Non-infectious causes of HIV-associated diarrhea may include hyperosmolar tubal feedings, antibiotics, magnesium-containing antacids and supplements, Vitamin C, or sorbitol-containing liquid medications. Antidiarrheal agents fall into three categories: antimotility agents, agents acting directly in the intestinal lumen, and hormonal agents such as octreotide. In one study, 41 percent of the subjects experienced a reduction in diarrhea when treated with octreotide. Nutritional deficits may be associated with painful symptoms of opportunistic infections, side effects of medications, lifestyle issues or psychological issues related to drug treatment. Such deficits can be treated with nutritional supplements, megestrol acetate (Megace), dronabinol (Marinol) and testosterone therapy. One study compared Advera, a recently-released peptide-based nutritional supplement, with a standard formulation, Ensure. It was found to result in better maintenance of body weight with significantly fewer hospitalizations. Recombinant human erythropoietin has been shown to reduce the number of transfusions required in patients receiving zidovudine with low endogenous erythropoietin levels (<500 IU/L). Where it fails to increase the serum hematocrit, iron deficiency is often present. Supplemental iron, given orally as a tablet or liquid, or intravenously as iron dextran, can help resolve this problem.