Use of Pentoxifylline Therapy for Patients with AIDS-Related Wasting: Pilot Study

Abstract

Severe weight loss is a common manifestation of advanced infection with the human immunodeficiency virus. The level of tumor necrosis factor alpha (TNF-alpha), an inducer of cachexia in laboratory animals, is elevated in the serum of some patients with AIDS. In a pilot study, five patients with unexplained AIDS-related wasting were treated with pentoxifylline, a known suppressor of TNF-alpha production. Three of the five patients had elevated baseline serum levels of TNF-alpha, and these three patients did not have significant weight gain after 4-8 weeks of pentoxifylline therapy despite the reduction of serum TNF-alpha levels. The remaining two patients, who did not have elevated serum levels of TNF-alpha, continued to lose weight and developed extensive bacterial pneumonia within 3 weeks of starting pentoxifylline therapy. Thus, therapy with pentoxifylline did not clearly benefit the patients with AIDS-related wasting in this uncontrolled pilot study; indeed, it might have been harmful for a subgroup of these patients.

Weight Loss and Wasting in Patients Infected with Human Immunodeficiency Virus

“…Until the mechanism by which thalidomide causes weight gain and the clinical significance of the increases in virus load and TNFa are understood, it is difficult to define a specific role for thalidomide in the treatment of HIV-associated wasting. A variety of other weak cytokine suppressors, including pentoxifylline [97], N-3 fatty acids [98], and ketotifen [76,99] have been studied in subjects with HIV-associated weight loss, but their use for this indication is not supported by current data.…”

Human immunodeficiency virus endocrinopathy

“…A number of agents like anabolic steroids (oxandrolone, nandrolone), megesrtol acetate, thalidomide, human chorionic gonadotropin, pentoxyfiline, amino acid mixtures and omega 3 fatty acids have been tried in this setting with variable efficacy but potential side effects. [86–90] Only testosterone administration has proved useful to increase lean body mass, especially in conjunction with progressive resistance training. Supraphysiologic dose GH administration is currently reserved for severe wasting refractory to other treatments.…”

The Cytokine Basis of Cachexia and its Treatment: Are They Ready for Prime Time?

“…In a small pilot study in HIV-infected patients, pentoxifylline provided no evidence of weight gain after 6 weeks of treatment. 250 Another group of investigators found that in decreasing TNF-␣ secretion, pentoxifylline increased the mycobacterial load in macrophages from AIDS patients resulting in disseminated Mycobacterium avium-intracellulare complex infection. 251…”