Conclusions

Studies using a variety of statistical approaches have demonstrated that losses of weight and LBM are associated with impaired quality of life, accelerated disease progression, and reduced survival in patients with HIV infection. Collectively, these results suggest that reversal or mitigation of wasting could improve survival and the overall clinical course in such patients and, thus provide a strong rationale for investigating the effectiveness of anabolic therapies such as GH. Studies evaluating the safety and efficacy of this pharmacologic intervention against wasting have produced promising results, but several important issues surrounding the use of anabolic agents such as GH in this setting remain.

First, the appropriate dosing and maintenance regimens must be identified. These questions are important not only for the purpose of limiting side effects, but also because the costs of GH are considerable and may ultimately limit its accessibility. In evaluating the pharmacoeconomic implications of the use of GH in this population, consideration must be given to potential savings from any potential increase in the patient's ability to live independently or reduction in HIV-associated complications or reliance on TPN that might result from this therapy. Other important issues such as quality of life cannot be assigned a monetary value but must be considered. Certainly, the ultimate question is whether amelioration of wasting can improve survival, but placebo-controlled studies probably cannot be ethically conducted for periods sufficient to detect such an effect, should it exist. Overall, future studies should be designed not just to evaluate the best regimens and the best ways to use anabolic therapies in patients with HIV-associated wasting, but also to determine whether clinically relevant functional benefits accompany increases in weight and/or LBM.

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