AEGiS-GMHC: Nutritional and Wasting Reports at the Tenth International Conference

Important note: Information in this article was accurate in 1994. The state of the art may have changed since the publication date.

Nutritional and Wasting Reports at the Tenth International Conference

Gay Men's Health Crisis "Treatment Issues", Vol. 8, No. 7 - September 1994
David Gilden

Although the Tenth International Conference on AIDS in Yokohama last month was particularly poor in information about the nutritional aspects of AIDS, researchers did present several significant reports on treating AIDS wasting syndrome. Morris Schambelan, M.D., of the University of California San Francisco described very positive results from a trial utilizing recombinant human growth hormone (rHGH) produced by Serono Laboratories.[1] Although rumors about this trial had circulated before, Dr. Schambelan's account was the first official disclosure of the data, which covered an initial twelve weeks of placebo-controlled observation and up to two years of further follow-up in which all trial participants received rHGH.

In the trial's first phase, the 90 trial participants receiving human growth hormone (at a rate of 0.1 mg per kilogram of body weight) gained an average of 1.5 kilograms. Their lean body mass went up three kilograms, and they lost 1.5 kilograms of fat. These people's treadmill performance also increased ten percent. A full quality of life assessment has yet to be done. In comparison, the 88 people originally on placebo at first gained a pound in weight on average, but by the end of the twelve weeks, their weight was back to baseline.

These figures suggest that rHGH works as expected, by reorienting the body's metabolism to building protein stores and breaking down fat rather than just adding weight. During the extended follow-up period, trial participants continued to regain weight, with some increasing by more than twenty pounds to reach their pre-illness mass. Since human growth hormone is very expensive to produce, the question now is whether the extra weight and lean tissue can be maintained if therapy is stopped.

Dr. Schambelan further noted that levels of insulin-like growth factor (IGF) rose substantially during the first twelve weeks of rHGH therapy. Much of growth hormone's effect may be due to IGF. But in another presentation at the conference, researchers from Genentech, Inc. reported negative results from a trial using small amounts of its version of rHGH plus IGF.[2] The effects on 52 trial participants appeared to be minimal after six weeks, and Genentech says it has no plans for further trials concerning wasting syndrome.

A cheaper alternative to human growth factor and insulin-like growth factor may be thalidomide. Thalidomide interferes with the production of tumor necrosis factor (TNF), excessive amounts of which are suspected of accelerating weight loss as well as HIV replication. In a small study conducted in Mexico City,[4] an average weight gain of eight percent was recorded after twelve weeks on thalidomide, compared to an average loss of eight percent in the trial's placebo arm. A similar study conducted in Thailand[3] found that trial participants increased their weight by 4.5 percent after 21 days. Nearly half the people in the Thai trial also had tuberculosis, which like HIV is known to cause very high TNF production. Neither trial could measure any effect on HIV levels or CD4 counts. The trials also did not collect detailed body composition data.

(A trial of thalidomide for HIV wasting is just getting under way at Rockefeller University in New York and several other sites around the country. Note that because of thalidomide's notorious history of causing birth defects, women "of child-bearing potential" have been excluded from thalidomide trials. This is an issue that raised considerable controversy during one of the Conference sessions.) The necessity of analyzing body composition and not just weight gain was underscored by two posters at the conference concerning the appetite stimulant Megace.[5,6] Both studies found that although Megace triggered significant weight gains in men with HIV-related wasting, most or all of that gain was composed of fat. The lack of increase in lean tissue may be at least partly explained by the reduction in serum testosterone associated with Megace that the first study detected.

Another nutritional strategy that received some limited support at the Tenth International Conference on AIDS was vitamin supplementation. An eight-year observation of 280 gay or bisexual HIV-positive men forming part of the United States' Multicenter AIDS Cohort Study (MACS)[7] tracked survival rates according to intake of specific vitamins. High intakes of vitamins B1, B2, B6, C and niacin were associated with decreased mortality rates. In particular, those who at the beginning of the study were taking vitamin B6 supplements equal to at least two times the RDA had a 40 percent lower death rate during the eight-year period. Zinc supplementation, on the other hand, was associated with an increased death rate.

1 Schambelan M et al. Tenth International Conference on AIDS Abstract Book. Aug 7-12 1994; II:35, oral presentation 432B.

2 Bukar JG et al. II:223, poster PB0903.

3 Reyes-Terçn G et al. II:65, oral presentation 536B.

4 Klausner JD et al. I:221, poster PB0312.

5 Engelson ES et al. II:222, poster PB0900.

6 Stute A et al. II:223, poster PB0907.

7 Tang A et al. II:220, poster PB0894.

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