Nutrition and weight maintenance

November 2004     View PDF     En español

Cytokine manipulation

Increases in certain chemical messengers (cytokines) produced by immune cells have been associated with increases in HIV production, disease progression, KS tumor progression and wasting syndrome. These cytokines, which include tumor necrosis factor (TNF) and interleukin 1 and 6 (IL-I and IL-6), are associated with inflammation.

A drug called thalidomide inhibits TNF. Several thalidomide studies have been completed and others are ongoing. One study examined its benefits in treating HIV-related sores in the mouth and esophagus. It showed that the drug is very effective in treating this condition. Another study evaluating its effect for treating HIV-related wasting shows that those taking thalidomide experience greater weight gain compared to those on placebo.

Celgene, the company making thalidomide for treating HIV-related weight loss, has a compassionate use program. The program will cover the full cost of the drug until the company gets approval from the FDA. For more information on this program, people can have their doctors contact the company at 1-800-801-8328.

Thalidomide causes serious birth defects when taken by pregnant women. For this reason, Celgene requires that women and men who access the drug through the program either agree to refrain from reproductive sex or use two methods of contraception (like one barrier and one hormonal). This would cover the period beginning four weeks before, through four weeks after, using thalidomide. The company recommends that men use condoms because researchers do not know if the drug is present in semen.

Thalidomide can cause serious birth defects if taken even once during the first trimester. If a woman taking thalidomide suspects for any reason that she has become pregnant, she should stop the drug and consult her healthcare provider immediately. It’s very important that both women and men, engaging in reproductive sex, use precautions to prevent pregnancy if either partner is taking thalidomide.

One side effect of thalidomide is peripheral neuropathy—pain and tingling in the hands and/or feet. The drug should be used cautiously when taking other therapies that cause neuropathy, like d4T, ddC and ddI. Other side effects include drowsiness, rashes, fever, irregular heart rhythm, low blood pressure and decreases in neutrophil counts (neutropenia), which are important cells that fight infection.