HIV Wasting Syndrome

Published in Micronutrient Supplementation for Patients with HIV, written by Dr. Michael Todd Greene, Ed.D., M.S.,  R.D.N., September 2009.

(Part of course “Severe Malnutrition” available on this website.)

Cachexia affects over 5 million people in the U.S. It is the major cause of excessive weight loss in the setting of ongoing disease. Symptoms include a disproportionate loss of muscle mass. Some advanced disease states include cardiac cachexia, chronic renal failure, chronic obstructive pulmonary disease, anorexia-cachexia syndrome in cancer, rheumatoid arthritis and cachexia, aging and weight loss, and AIDS-related cachexia (wasting syndrome) (Morley, Thomas and Wilson, 2006).

The major cause of cachexia is cytokine excess. Cytokines produce the following etiology of anrexia, weight loss, cognitive dysfunction, anemia and frailty. Cytokines are cell-associated protiens produced as an inflammatory immune response. To combat the effects on the body, there are three areas recommended, nutritional support, orexigenic agents (hormonal therapy) (Morley et al., 2006), and physical exercise (Wolfe, 2006).

Elaboration of pro-inflammatory cytokines may be the major factor responsible for AIDS wasting. Cachexia associated with AIDS is highly predictive of death. AIDS wasting includes anorexia, depression, medications, coexisting infections and a variety of gastrointestinal diseases (Morley et al, 2006).

The question arises, how does someone exercise when having fever, diarrhea and no appetite? Can an exercise pill help increase muscle without physical work?

The benefits of physical exercise on general health make the identification of an orally active agent that mimics the potential effects of exercise on metabolic diseases worth studying. Certain micronutrients like Resveratrol. have endurance-enhancing affects but the exact metabolic targets are still not know. Testing the effect of pathway specific drugs on endurance of mice in a treadmill test was documented in August 2008 (Narkar et al., 2008). This study found that AICAR (AICAR 5-aminoimidazole-4-carbonoxyamide ribonucleoside) is a drug found to help change the physical composition of muscle transforming tissue from sugar-burning fast twitch fibers to fat-burning slow-twitch ones. Essentially producing the benefits of aerobic activity without the work in mice. AICAR has been found to be safe (Zarembo, 2008).

Next must read blog: Proposed clinical trial: HIV Wasting Syndrome.

Morley, J., Thomas, D. & Wilson, M. (2006) Cachexia: pathophysiology and clinical relevance. The American Journal of Clinical Nutrition, 83(4), 735-743.

Narkar, V., Downes, M., Yu, R., Embler. E., Wang, Y. Banayo, E., et al. (2008). AMPK and PPARo Agonists Are Exercise Mimetics. Cell, 134(8), 405-415.

Wolfe, R. (2006). The underappreciated role of muscle in health and disease. The American Journal of Clinical Nutrition, 475-82.

Zarembo, A. (2008, August 1). AICAR: Scientists say they’ve put exercise in a pill. Los Angeles Times.


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