Nutrition, infection and immunity

Effect of dronabinol on nutritional status in HIV infection

OBJECTIVE

To examine the effect of dronabinol (delta-9-tetrahydrocannabinol) on appetite and nutritional status in patients with symptomatic HIV infection and weight loss.

DESIGN

Double-blind, randomized, placebo-controlled, crossover trial with two five-week treatment periods separated by a two-week washout period. Patients received dronabinol 5 mg twice daily before meals or placebo.

SETTING

A university-based HIV/AIDS clinic and a large infectious disease private practice largely devoted to care of patients with HIV.

PARTICIPANTS

Twelve HIV-infected patients who had had at least a 2.25-kg weight loss participated in the study. Five patients completed the protocol, and seven withdrew (two because of drug intolerance, two because of disease progression, two because of noncompliance, and one because of experimental antiretroviral therapy).

MAIN OUTCOME MEASURES

Main outcome measures included caloric intake, weight, percent body fat, serum prealbumin, and symptom distress.

RESULTS

During dronabinol treatment, subjects experienced increased percent body fat (one percent, p = 0.04); decreased symptom distress (p = 0.04); and trends toward weight gain (0.5 kg, p = 0.13), increased prealbumin (29.0 mg/L, p = 0.11), and improved appetite score (p = 0.14).

CONCLUSIONS

In a selected group of HIV-infected patients with weight loss, short-term treatment with dronabinol may result in improvement in nutritional status and symptom distress.

Nutritional support of patients with AIDS

Investigators are now predicting that nearly 100% of the estimated 12 million HIV-positive persons in the world will develop AIDS. Most persons with AIDS will experience progressive weight loss and malnutrition prior to death. Because nutritional therapy clearly has a beneficial effect on the clinical course and immunologic status of the critically ill general population, one must not disregard its potential for benefits in the treatment of persons with AIDS. As a result of the escalating cost of medical therapy and the inevitable AIDS epidemic, the nutritional management of persons with AIDS must be simple to administer and cost effective. The author has developed nutritional screening criteria to identify those patients who would most benefit from nutritional therapy. Because these patients differ in their nutritional requirements, diet tolerance, and degree of gut dysfunction, there is no single nutritional therapy that can be used routinely to treat all malnourished persons with AIDS.