Wasting Syndrome

Wasting, also known as cachexia, is an unintended loss of more than 10 percent of body weight. It involves loss of lean body tissue, including muscle, as well as the loss of weight. The symptoms cannot be explained by a non-HIV-related condition.1-3

Before the development of antiretroviral therapy (ART) for HIV treatment, wasting syndrome was taken as conclusive evidence of an AIDS diagnosis in nearly 33 percent of people with HIV. Because of the development of HIV treatment, fewer people who are living with HIV progress to an AIDS diagnosis. However, wasting syndrome remains a problem, even in people on antiretrovirals.3-5

What causes wasting syndrome?

For people living with HIV/AIDS, wasting syndrome is a complex process that results from abnormal metabolism, the process by which the body converts food and drinks into energy. In wasting syndrome, the body becomes less able to process carbohydrates, proteins, and fats to produce energy and build tissue.6

Scientists believe that the following factors may contribute to wasting syndrome:6-8

  • Chronic inflammation, even while taking antiretrovirals
  • Damage to the lining of the gut
  • Low levels of hormones, such as testosterone, or resistance to growth hormones
  • An increase in the number of calories burned while at rest. The average resting energy use in people who are HIV positive is 8 to 11 percent more than people who are HIV negative.
  • Infections, cancers, or other coexisting health conditions
  • Reduced food intake due to appetite loss, nausea, fatigue, depression, social isolation, or inability to afford adequate food.
  • Difficulty eating or swallowing, sometimes because of sores or an infection in the mouth or throat
  • Diarrhea caused by infection or medicines

Symptoms and diagnosis

Early detection of wasting syndrome usually depends on weight loss or a change in physical appearance. Diagnosis requires a medical history, physical examination, and charting of body weight at each doctor’s visit.9

Symptoms of wasting syndrome may include:6

  • Fatigue
  • Reduced physical endurance
  • Reduced quality of life

A loss of fat tissue alone is not a sign of wasting syndrome. It may be a symptom of lipoatrophy, a loss of fat without malnutrition. This is sometimes caused by antiretroviral therapy. In lipoatrophy, fat loss is mostly in the face, trunk, or arms and legs. In wasting, the loss of fat and lean body mass usually is spread evenly throughout the body.6,10 Bioelectrical impedance analysis, which shows body fat in relation to lean body mass, can confirm the diagnosis of wasting.11

How is wasting syndrome treated?

If you are HIV positive, you should keep track of your weight and contact your doctor if you begin to have unexplained weight loss. If you wait until wasting is severe, reversing it can be difficult. Catching it early allows for a variety of treatments:6

  • Taking ART as directed can control HIV, related immune suppression, and opportunistic infections. If 1 medicine causes nausea or diarrhea, talk to your doctor about switching to a different drug.

Working with a dietitian or therapist

  • A registered dietitian can help you create a healthy meal plan with increased calories, fat, and protein to meet your needs
  • Medicines can treat digestive problems and other conditions that can reduce appetite, cause difficulty eating, or decrease absorption of nutrients
  • A mental health therapist may help you manage depression, anxiety, and other conditions that affect appetite

Nutrition and exercise

  • If you have a hard time meeting your nutritional needs with regular food, high-calorie liquid supplements like Ensure can fill the gap
  • You can build muscles with exercise, especially strength training while making sure you eat enough calories through a healthy meal plan

Other treatment options

  • For men with low testosterone levels, testosterone replacement therapy can help increase weight and lean body mass. Side effects may include acne, changes in cholesterol level, and increased risk of cardiovascular disease.
  • Serostim (somatropin), a synthetic growth hormone, increases weight and muscle mass while reducing fat. Side effects may include muscle or bone pain and swelling.
  • Medical marijuana and Marinol (dronabinol), a synthetic form of marijuana, stimulate the appetite but may cause a gain of more fat than muscle. Well-known side effects may include mood changes, dizziness, anxiety, drowsiness, and lack of concentration and memory.

Treatment of wasting can improve your enjoyment of food, absorption of nutrients, and quality of life.

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