Tuesday, April 22, 2014

Effect of Human Growth Hormone on Exercise Capacity in Patients With HIV

Over 700 patients with HIV-associated wasting while receiving HAART were randomly assigned to double-unsighted treatment for 12 weeks with recombinant human growth hormone (rhGH) daily or on alternate days, or to placebo. Maximum exercise intensity increased by a median of 2.35 kJ in the alternate-days group and 2.60 kJ in the daily group but decreased by 0.25 kJ in the placebo group. The median difference between the daily and placebo groups was 2.85 kJ (P < .0001). These improvements suggest that rhGH treatment may enable patients with wasting to perform activities of daily living that would be exhausting without rhGH treatment.

Wasting, characterized by loss of body weight and lean tissue, including skeletal muscle, was a common display of HIV infection before the introduction of HAART. Studies in the 1980s showed that wasting was an independent danger element for mortality in patients with AIDS and that there was a manage relationship between the degree of wasting and the danger of death. Despite the success of HAART in improving survival of patients with HIV infection in the developed earth, weight loss remains an independent predictor of mortality in the HAART interval.

Therefore, HIV-related wasting represents an significant clinical difficulty in the management of HIV infection. A low functional capacity, characterized by low maximal aerobic capacity compared with that of duration-matched healthy persons, is an significant manifestation of HIV infection. This may be attributable to the adverse effects on muscular function from mitochondrial damage that is caused by nucleotide reverse transcription inhibitor (NRTI) antiretroviral medication use, as well as to the loss of muscle tissue, which constitutes part of the wasting syndrome.

Treatment options for patients with HIV-related wasting include nutritional advice and exercise; testosterone replacement treatment is also indicated in men with gonadal dysfunction. In adding, the use of recombinant human growth hormone (rhGH) has attracted increasing attention as a potential treatment, after initial reports that this agent promotes nitrogen retention and protein synthesis in patients with HIV infection.

In an original randomized placebo-controlled trial conducted before the introduction of HAART, treatment with rhGH, 6 mg daily (DD) for 12 weeks, in patients with HIV-related wasting produced signifi -cant improvements compared with placebo in corpse weight, lean cadaver mass (LBM), and practise capacity on a treadmill. Subsequently, a great double-blind placebo-controlled study was designed to investigate the effects of rhGH remedy on exercise capacity, cadaver weight, and body composition in HIV-infected patients with wasting who were receiving HAART. The prime efficacy end point of the study was change in greatest train intensity from baseline to 12 weeks. The initial results of the study have been reported elsewhere. Here we present-day a more detailed examination of the exercise content data from this study and consider the implications of the patient's ability to effect daily tasks without excessive fatigue.

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