Wasting Syndrome
Treatment Advocacy Issues
  • Wasting is defined as an involuntary loss of >10% of normal body weight.

  • Wasting is the second largest killer of people with AIDS (PWA's) in the US (source: CDC 1995).

  • Wasting is among the top three main killers of PWA's in the world (source: WHO).

  • No effective prophylaxis treatment has been approved for this opportunistic illness.

  • Dr. Donald Kotler has found that once Lean Body Mass (LBM) decreases to 54% of normal, death occurs no matter what the opportunistic infection may be.

  • Sometimes total body weight does not change even when people are already wasting. Body composition, however, changes dramatically (fat and water content increases while LBM decreases).

  • The only two drugs approved in the US for wasting are Megace and Marinol. Megace is a progesterone (female hormone) based compound that does stimulate appetite, but causes severe metabolic disturbances, including increased fat weight, impotence in males, and excessive menstrual bleeding in females. Marinol is a pure version of the most well-known active ingredient in marijuana that is also an appetite stimulant. While Marinol is effective and is a relatively safe compared to many other drugs, it does not increase LBM by itself.
    A lot of anecdotal information from HIV+ bodybuilders and progressive HIV physicians point to the fact that anabolic steroids, an alternative and economical but stigmatized treatment, are highly effective to prevent and reverse wasting and improve quality of life of HIV+ patients. No controlled studies have been performed due to the lack of interest from the pharmaceutical companies (patents have expired in the 1960's for most of these compounds). Only community based trials are the potential source for the data needed to make this treatment approach a standard of care for HIV+'s across the entire country (not only major metropolitan areas).

  • Women and children are especially ignored when it comes to wasting. Some anabolics, like oral Oxandrin (oxandrolone), which was brought back to the US market on November 1, 1995 by Bio Technology General (BTG), are safe enough when it comes to androgenicity (masculinizing effects) and liver toxicity. Serostim human growth hormone is a relatively safe, but not economical therapy for those two underserved HIV communities, when dosing is correct. The growth hormone dose typically recommended can cause side-effects like severe joint aches, so dosing is a major consideration. It is probably better for most people to underdose rather than use the dose Serono gives in the instructions that come with Serostim. PoWeR also advocates investigation into the use of other mild, relatively safe anabolic steroids like Primobolan for women and children, however Primobolan is not available in the United States. Primobolan is available in Mexico and Europe, though.

  • Specific anabolic steroids, unlike anti-inflammatory corticoid steroids which are immuno-suppressive, can be immuno-potentiating. There are studies performed on cervical cancer, alcoholic hepatitis, and auto-immune diseases like rheumatoid arthritis, lupus and colitis that show improved cell mediated response, weight gain, decrease in mortality and improvements in quality of life in those patients. Studies with PWA's are generally lacking but a least three will start in 1996 in this country. These studies will be community based trials sponsored by PoWeR. These studies will look at not only LBM but also immune markers, while exposing patients to proper nutrition, anabolics, and supervised resistance weight training. Studies including women are also being designed.

  • Anabolic steroids, even though they are extremely economical and effective, have not been included in any county, city or state Drug Assistance Programs available to the indigent or those with limited income. Testosterone Cypionate and Deca-Durabolin, the two most common injectable anabolics, cost under $100/month! However, only patients with insurance and with progressive doctors are getting access to this treatment. Some other HIV+ patients are risking getting potentially dangerous counterfeit anabolics from dealers (with no medical supervision).

  • Anabolic steroids are available at a low cost and over the counter in most Third World countries. This treatment option is one of the few which does not have to be "imported" from the industrialized world.

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