Treatments for Wasting in Patients with the Acquired Immunodeficiency Syndrome

Corcoran, Colleen; Grinspoon, Steven

doi:10.1056/nejm199906033402207

Cited by 97 publications

(38 citation statements)

References 64 publications

(64 reference statements)

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“…6 In addition, antiretroviral therapy has been pointed out as a factor to bone metabolism unbalance, and may importantly contribute to bone mass loss. 7 Determining whether these changes are caused by an increased osteoclastic activity (reabsorption) or by the inhibited osteoblastic activity (formation) is essential for effective therapeutic strategies. Despite of that, most publications studying the activity of bone reabsorption and formation markers did not show enough statistical power to provide definitive conclusions.…”

Section: Introductionmentioning

confidence: 99%

Reabsorção no metabolismo ósseo de pacientes HIV-positivos

2009

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INTRODUÇÃO: Pacientes infectados pelo HIV apresentam osteoporose ou osteopenia densitométrica numa taxa de 28 a 50%. O objetivo deste estudo é verificar alterações na taxa de reabsorção/formação destes pacientes. MATERIAL E MÉTODOS: Realizou-se revisão sistemática com metanálise de estudos controlados que avaliaram a associação entre osteopenia e/ou alterações no metabolismo ósseo com a infecção pelo HIV. Todos os estudos que incluíam osteocalcina ou NTX com marcadores respectivos de formação e reabsorção ósseos foram incuidos. Cinco estudos foram classificados como evidência classe III e envolveram 456 indivíduos HIV positivos e 590 controles. O NTX teve aumento significante (p < 0.00014) no grupo HIV-positivo, enquanto osteocalcina não se mostrou alterada. CONCLUSÃO: O presente estudo permite concluir que, durante a infecção pelo HIV, o marcador NTX está significantemente elevado, refletido alta atividade reabsortiva no tecido ósseo. Isto aponta um papel importante na atividade osteoclástica na perda óssea de pacientes HIV-positivos.

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Section: Introductionmentioning

confidence: 99%

Reabsorção no metabolismo ósseo de pacientes HIV-positivos

2009

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“…It has also proven beneficial in a host of other dermatologic conditions [4]. Its in vitro suppression of tumor necrosis factor-␣ production is well documented, and it has been used to alleviate the cachexia of the HIV-associated wasting syndrome [5,6]. In the hematology community, it has been used to treat graft-versushost disease and most recently, severe plasma cell disorders [1,2,7].…”

Section: Introductionmentioning

confidence: 99%

Thalidomide‐associated hepatitis: A case report

Fowler

Imrie

2001

American J Hematol

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We report a case of hepatitis in a 58-year-old woman being treated with thalidomide for end-stage plasma cell leukemia. The patient had a medical history including chronic stable hepatitis C infection. At diagnosis there was a severe anemia, thrombocytopenia, hypercalcemia, IgG paraproteinemia, peripheral blood myeloma cells, and a marrow plasmacytosis with lytic bony lesion. The disease was refractory to standard chemotherapy, and she was treated with oral thalidomide. Within 1 week she became jaundiced and developed a marked transaminitis. This promptly resolved upon cessation of thalidomide alone. Thalidomide has recently enjoyed renewed interest as a treatment in many disorders, including plasma cell leukemia. To our knowledge, this is the first reported case of thalidomide-associated hepatotoxicity. Although the mechanism of its actions on the liver are uncertain, it is possible that thalidomide acts as a direct hepatotoxin or as an immuno-modulator, altering the activity of chronic viral hepatitis. We present this case to increase awareness of a new potential side effect of thalidomide as its clinical indications expand. Am. J. Hematol. 66:300-302, 2001.

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“…9 -11 The hope is that PI treatments may reverse some of the negative effects of HIV disease on growth in children by reducing viral load, improving immune function, and arresting some metabolic and endocrinologic changes, although the exact biological mechanism of their action is not known. 12 High viral load and low CD4 cell counts have been shown to be associated with growth retardation and growth failure in pediatric populations. 13,14 Failure to grow and gain weight are in turn risk factors for mortality in HIV-infected children.…”

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confidence: 99%

Impact of Protease Inhibitor-Containing Combination Antiretroviral Therapies on Height and Weight Growth in HIV-Infected Children

et al. 2001

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ABSTRACT. Objective. To examine beneficial or detrimental effects of protease inhibitor (PI)-containing antiretroviral regimens on height and weight growth in children with human immunodeficiency virus (HIV) infection.Methods. A prospective cohort study was conducted of 906 HIV-infected children, from pediatric research clinics in the United States, who were between 3 months and 18 years of age and who had height and weight assessed in 1995 (before introduction of PIs in this population) and at least once more through 1999. Changes in age-and gender-adjusted height and weight growth associated with PI use were assessed.Results. Compared with a healthy reference population, children were more affected in height (mean z score: ؊0.90 [18th percentile]) than in weight (mean z score: ؊0.42 [34th percentile]) at baseline (1995). Two thirds of children received at least 1 PI during 1996 to 1999. In the multivariate mixed effects regression models adjusted for baseline log 10 CD4 cell count, baseline age, gender, and race/ethnicity, the use of PIs was associated with per-year gains of 0.13 z scores in height and 0.05 z scores in weight relative to the expected growth with non-PIcontaining regimens (eg, after 1 year of PI use, a representative 6-year-old boy in our study would be approximately 0.7 cm taller and 0.1 kg heavier than if he had not received PIs). No significant differential effects of PIs on height or weight growth according to specific agents or children's sociodemographic or clinical characteristics were found.Conclusions. Although the use of PI-containing regimens was not associated with growth retardation, it was associated with only small annual increments in height and weight growth in HIV-infected children. Pediatrics 2001;108(4). URL: http://www.pediatrics.org/cgi/content/ full/108/4/e72; HIV-1, protease inhibitor, growth, children.ABBREVIATIONS. PI, protease inhibitor; HIV, human immunodeficiency virus; PACTG, Pediatric AIDS Clinical Trials Group; HAZ, height-for-age-and-gender z score; WAZ, weight-for-ageand-gender z score. P rotease inhibitors (PIs) have been used increasingly in the treatment of human immunodeficiency virus (HIV)-infected children since the mid-1990s. However, little is known about the longterm effects of PI-containing combination antiretroviral therapies on height and weight growth in pediatric populations. HIV-infected children fall behind HIV-uninfected children who are born to HIVinfected mothers in age-and gender-appropriate height and weight in the first few years of life. [1][2][3] Studies that examined the effect of zidovudine on height and weight gain in HIV-infected children were limited by sample size and produced mixed results. 2,4 Some small clinical studies [5][6][7][8] suggested that PI treatments may have beneficial effects on weight and/or height growth in HIV-infected children, but other studies found no improvements in growth associated with the use of PI-containing regimens. 9 -11 The hope is that PI treatments may reverse some of the negative effects of HIV ...

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Treatments for Wasting in Patients with the Acquired Immunodeficiency Syndrome

Cited by 97 publications

References 64 publications

Reabsorção no metabolismo ósseo de pacientes HIV-positivos

Reabsorção no metabolismo ósseo de pacientes HIV-positivos

Thalidomide‐associated hepatitis: A case report

Impact of Protease Inhibitor-Containing Combination Antiretroviral Therapies on Height and Weight Growth in HIV-Infected Children

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