Nutrition and weight maintenance

November 2004     View PDF     En español

Hormone therapy

Recombinant human growth hormone (rHGH, Serostim) is FDA-approved for treating HIV-related wasting. Studies show that people with wasting who use rHGH have increases in muscle mass, energy level and decreases in body fat. People with wasting may not want to lose fat weight, however, so adding in strategies to maintain and increase body fat while taking rHGH makes sense. This might include using appetite stimulants, which usually results in fat gain.

Side effects from using rHGH include joint stiffness, edema, elevated lab markers of sugar and fat processing (glucose and triglycerides) and nausea. In studies these were usually mild and resolved with reduced doses. The drug is extremely expensive but is available through some federal access programs.

Anabolic steroids, like testosterone, may help treat or prevent wasting. (Anabolism refers to building proteins.) Few studies have examined using anabolic steroids in HIV, but doctors routinely correct testosterone deficiencies with testosterone replacement therapy. A broader and largely unanswered question is whether wider use of anabolic steroids helps prevent or treat wasting. There is little information available on how these steroids affect HIV production, but many people are experimenting to see if using steroids can help them maintain or increase their lean body mass.

A study evaluating the testosterone patch (Testoderm) for treating HIV-related weight loss showed that those using the placebo patch actually had better weight gain than those using the testosterone patch. While those on the testosterone patch experienced higher testosterone levels, these increases did not result in improved weight gain. This calls into question the use of testosterone therapy for managing unwanted weight loss and at the very least provides a caution to those considering this approach to set very clear therapy goals.

Women naturally produce testosterone. However, women with HIV-related wasting have lower than normal levels of it. Infrequent menstruation is one of many symptoms connected with AIDS wasting in women. Results from one study suggest that women who take a replacement dose of testosterone (a dose that brings the hormone to a normal level) experienced weight gain, return of menstruation and improved quality of life. Replacement therapy was generally well-tolerated. However, more studies are needed to measure its effects and safety in women living with HIV.

Another anabolic therapy, called oxandrolone (Oxandrin), is approved for treating unwanted weight loss when its cause cannot be identified. It is an oral drug and can be used by women as it is not as “virilizing” as other anabolics. When women use other anabolic steroids, it can cause them to grow facial hair and other male characteristics.

Anabolic steroids have side effects of varying degrees. They range from kidney toxicities, developing secondary male characteristics in women (like facial hair and enlarged clitoris), and shrinking of the testicles in men (testicular atrophy) to skin problems (including acne), among others. Testosterone therapy shuts down the body’s production of testosterone. This can create a dependency on the therapy. For these and other reasons, anabolic steroids are probably not the best first line of treatment for weight loss, but they may have some advantages before using therapies like rHGH.

DHEA is a product that is sold in health food stores and is believed to help the body produce testosterone. Studies looking at the effect of DHEA on various immune markers, like CD4+ cell counts, suggest that it appears to neither benefit nor harm the immune system. However, some people report that using DHEA has resulted in their improved quality of life. Simply because this product is available over-the-counter does not mean that it’s not without side effects or potential risks. Indeed, there have been reports that some people using DHEA are more likely to develop certain cancers.

None of these products should be used by pregnant women because of potential risks to their unborn child.