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Being Alive

Study on Loss of Appetite


Being Alive 1995 May 5: 7

The CDC has stated that weight loss of greater than 10% of body weight is the index diagnosis for almost one-fifth of AIDS cases. Realizing the importance of weight management as it relates to successful recovery from opportunistic infections, medical providers are increasingly including nutritional supplements, hormone replacement, and/or appetite stimulants as part of treatment. There has been increasing literature on loss of appetite, and the dramatic effects it has on life expectancy.

Study of Marinol's Effects In a recent issue of the Journal of Pain and Symptom Management, the effects of dronabinal (Marinol), were evaluated in 139 patients with AIDS related anorexia. Marinol is referred to by many as pill-form marijuana. The main active ingredient in marijuana is THC, which is what causes the "munchies" associated with smoking it. Legal ramifications aside, marijuana can be dangerous to the lungs, and many AIDS related infections are of the lungs and lung tissues.

Marinol is THC, synthesized and put into pill form. It was first approved by the FDA as a treatment for nausea associated with chemotherapy. Additional studies led to a second indication for treatment of AIDS-related anorexia.

Causes of Appetite Loss Many factors play a role in appetite and weight loss. Zinc deficiencies can alter a person's perception of taste and smell. Diarrhea, nausea and vomiting caused by gastrointestinal disorders play a part in the ability a person has to absorb nutrients. Depression, anxiety and medication side effects can also add to this problem. Hypogonadism (low levels of testosterone) has also become an increasingly important factor in the weight maintenance equation.

What the Study Tells Us "This study is important because it demonstrates that the anorexia of AIDS can be controlled with Marinol," said Jeffrey Beal, MD of St. John Medical Center, one of the chief investigators from this study. The patients studied had already lost weight and had T-cell counts less than 50. Additionally, these patients were in advanced stages and had experienced HIV-related symptoms for an average of 31 months.

Patients treated with dronabinol experienced improvements in appetite and mood, and decreased nausea in the six weeks they were evaluated. Those who received dronabinol showed a .1 kg mean weight gain vs. the placebo group who had a .4 kg mean loss. Patients who continued on dronabinol in the open-label study that followed, showed continued weight gain. A study to determine the long-term effects of this drug is now underway. These early findings of improved appetite and mood, decreased nausea, and weight maintenance, demonstrate that dronabinol may positively affect the quality of life for people with AIDS.

Appetite Stimulants Currently there are two products available: The dronabinol mentioned above and Megestoral acetate (Megace). Studies done on Megace have shown weight gain; however, the studies have also shown that this weight is virtually all fat. Another important consideration with Megace therapy is that because it is a female sex hormone, it further lowers testosterone levels, sometimes by as much as 66%. It can also cause impotence in men.

While Marinol has side effects as well, most are proven to be dose-related. Euphoria, the most commonly reported side effect, is usually caused by too high a dose or a result of morning administration. It should be taken twice daily, before lunch and dinner. Both medications are approved by Medi-Cal and available through ADAP.

Medication alone is not the cure-all for wasting. Exercise is also important to the maintenance of lean body mass, although later stages of the illness may prevent this option. A nutritionist's evaluation of your diet may show that there are simply too few calories being consumed. "What keeps people with AIDS well longer, and living longer, is eating, and eating right", says Ed Lor, pharmacist at San Francisco General Hospital. The results of this study show that Marinol may play an important part in improving the desire to eat and should be discussed with your doctor if you are experiencing wasting, anorexia, and/or loss of appetite.

(The main sources of information for this article are the study mentioned, and the January 1995 issue of the Journal of the Physicians Association for AIDS Care.)


Information in this article was accurate in May 5, 1995. The state of the art may have changed since the publication date. This material is designed to support, not replace, the relationship that exists between you and your doctor. Always discuss treatment options with a doctor who specializes in treating HIV.