New supplement treats AIDS wasting successfully
Pilot shows weight gains in muscle
Wasting syndrome long has caused serious problems for about one in four AIDS patients, causing them to gain more fat mass while their overall body weight declines significantly. The syndrome robs them of lean body mass and sometimes leads to muscle weakness and organ failure.
Clinicians most commonly have treated AIDS wasting with testosterone injections or injections of a human growth hormone, such as Serostim, manufactured by Serono Laboratories in Norwell, MA. (See story on AIDS wasting in AIDS Guide for Health Care Workers, inserted in this issue.)
However, patients sometimes discontinue these treatments because of side effects. And the injections require prescriptions and careful medical oversight.
Now a new study presented at the 6th Confer ence on Retroviruses and Opportunistic Infections in Chicago suggests there might be an easier treatment that has no known side effects and does not need to be prescribed or injected. The treatment is a mixture of ß-hydroxy ß-methylbutyrate (HMB), arginine, and glutamine that patients take in the form of an orange-flavored drink mix. The mixture, called Juven, is made by MTI Biotech in Ames, IA, and is sold over the counter as a dietary supplement. (See description of Juven, next.)
A double-blind, placebo-controlled study targeting 68 AIDS patients who had lost more than 10% of their body weight had remarkable outcomes, says Robert H. Clark, MD, director of HIV clinical services for Nassau County Medical Center in East Meadow, NY. The clinic treats more than 900 AIDS patients, 600 of which are regular patients.
"It was a pilot study and it showed unbelievable results," Clark says. "We had a control group and we had a group we gave the Juven to, and after eight weeks the Juven group gained more muscle than they would in just about any treatment regimen out there."
The Juven study group gained an average of 6.5 pounds over eight weeks, including a 5.5-pound gain of muscle weight. The placebo group continued to lose muscle at an average of 1.5 pounds during the eight-week period.
Clark’s team saw no significant side effects with the supplement, and some patients reported that their diarrhea and bowel problems were reduced.
The study also found that the participants taking Juven had an increase in T-cells and their HIV viral loads decreased. The control group’s viral load increased. (See chart detailing results, below.)
| Improvement in Immune Status in Wasting AIDS Patient by Providing Muscle and Immune Tissue-Specific Nutrition | |||
| Parameter |
Eight week change |
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| Lymphocytes, 1000/mm3 |
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| CD3/mm3 |
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|
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| CD4/mm3 |
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|
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| CD8/mm3 |
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|
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| VL, log copies/ml |
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|
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| VL>400 (n=28), log copies/ml |
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Source: PCP, wasting/protozoa, and other organ system complications (poster session #86). 6th Conference on Retroviruses and Opportunistic Infections. Chicago; Feb. 1-5, 1999. _________________________________________________________________ |
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"The other exciting news was about lipodystrophy, where patients start to get fat in all the wrong places and start to look funny and complain horribly about it," Clark says. "With Juven, they tended to redistribute their fat back to a more normal distribution pattern."
Researchers found that change by measuring the patients’ total body fat using a volume displacement machine and then measuring their arms and legs with circumference measurements and calipers, he explains. They also did a CT-scan of the patients’ thighs.
"Here all they had was nutrients, and their fat seemed to distribute to a more normalized pattern, and they gained five pounds of muscle in eight weeks," Clark says.
Clark says clinicians should use Juven as a preventive measure and have AIDS patients take the supplement before they lose body weight from wasting. "You don’t want to start after wasting begins; instead, just head them off at the pass."
The supplement, consisting of two amino acids and HMB, was developed at Iowa State University in Ames, where scientists were interested in the growth of muscle and preventing muscle breakdown. Clark says they isolated HMB and discovered its importance to muscle development. "It’s been used by body builders to build more muscle, and it’s been used in a lot of studies of animals that have shown how to increase muscle mass in chicken breasts, for example."
The supplement comes in little packets and costs less than $180 per month. Clark recommends patients take one package mixed into eight ounces of water twice a day. It has a pleasant orange taste, and the company is developing other flavors.
Clark and other researchers soon will conduct more studies with Juven, looking at whether AIDS patients taking the supplement have fewer emergency room admissions, fewer bouts with pneumonia, less diarrhea, and other problems.
"We’ll follow patients over a longer period of time to see whether they sustain the weight gain and to see if they get a better response to decreasing infections," Clark says. "It seems pretty pro mising that I might get a decreased utilization of health care resources from these patients."
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