Von Roenn J H, Roth E L, Craig R
Department of Medicine, Northwestern University Medical School, Chicago, Ill.
Oncology. 1992;49 Suppl 2:50-4. doi: 10.1159/000227129.
Involuntary weight loss or wasting indicative of severe protein energy malnutrition is a frequent complication of acquired immune deficiency syndrome (AIDS). Malnutrition, with its associated adverse effects on immunocompetence, may contribute to the progression of AIDS itself. Since death from wasting is ultimately related to the magnitude of tissue depletion, restoration of body cell mass may enhance survival. The mechanism of weight loss in AIDS has not been clearly elucidated. The etiology is likely to be multifactorial, the result of interactions between decreased caloric intake, malabsorption, and alterations in energy expenditure secondary to hormonal and/or metabolic abnormalities. Although weight loss is occasionally reversible with treatment of underlying infections and/or easily identifiable and reversible causes, the majority of patients are not this fortunate. Enteral and parenteral nutrition, which are expensive, cumbersome, and potentially morbid, have been suggested by some as therapeutic options. Megestrol acetate, a synthetic, orally active progestational agent, has been reported to stimulate appetite and weight gain. Data regarding the use of megestrol acetate for the treatment of cachexia related to human immunodeficiency virus (HIV) infection demonstrate convincingly its effectiveness in treating many patients with HIV-related anorexia and cachexia.
非自愿性体重减轻或消瘦是获得性免疫缺陷综合征（AIDS）常见的并发症，提示严重的蛋白质能量营养不良。营养不良及其对免疫功能的相关不良影响，可能会促使艾滋病病情进展。由于消瘦导致的死亡最终与组织消耗程度相关，恢复体细胞量可能会提高生存率。艾滋病患者体重减轻的机制尚未完全阐明。病因可能是多因素的，是热量摄入减少、吸收不良以及激素和/或代谢异常继发的能量消耗改变之间相互作用的结果。虽然通过治疗潜在感染和/或易于识别和可逆的病因，体重减轻偶尔是可逆的，但大多数患者没有这么幸运。肠内和肠外营养费用昂贵、操作繁琐且有潜在风险，一些人建议将其作为治疗选择。醋酸甲地孕酮是一种合成的口服活性孕激素，据报道可刺激食欲并增加体重。关于使用醋酸甲地孕酮治疗与人类免疫缺陷病毒（HIV）感染相关恶病质的数据令人信服地证明了其对许多HIV相关厌食和恶病质患者的有效性。
