AIDS-associated anorexia.

Abstract

The pathogenesis of AIDS-associated anorexia involves any one or a combination of several factors, including malnutrition and nutrient abnormalities, gastrointestinal dysfunction, metabolic dysfunctions, neuropsychiatric disturbances, economic and sociocultural factors, and anorexigenic medications. Appropriate management of anorexia is multidisciplinary, involving pharmacologic assessment, neuropsychiatric evaluation, and appetite stimulants. Two pharmacologic agents, the cannabinoid dronabinol (Marinol) and the synthetic progesterone megestrol acetate (Megace), are approved by the FDA for use as appetite stimulants. Corticosteroid replacement is approved to reverse anorexia and weight loss associated with adrenal insufficiency. The use of androgen replacement or growth hormone in the treatment of anorexia and weight loss is currently investigational but shows promise. Dronabinol has been studied in a double-blind appetite stimulation study run in 18 centers. The six-week study focused on appetite stimulation and weight gain as end points in patients with AIDS-related weight loss. Results are summarized, and considerations that must be addressed by the administering clinician are presented.